Transforming Junior Doctor On-Call Roster Design with a 98% Improvement in Fairness and Availability


Tallaght University Hospital (TUH) is one of Ireland’s major academic teaching hospitals. With 562 beds, 16 theatres and 20 critical care beds – the 3,000 staff treat over 410,000 patients per year.


Unfair medical rostering

TUH’s medical workforce team was responsible for creating medical on-call rosters for almost 90 junior doctors. The manual process of generating these quarterly rosters was complex and time-consuming, requiring at least 12 person weeks per year. There were also complex requirements and rules to consider which made ensuring roster fairness difficult and resulting in complaints from doctors. Three rosters were needed for 30 registrar (senior grade), 30 SHO (middle grade) and 26 interns (foundation grade) doctors, four times per year. Requirements included:

  • Roster Fairness objectives to be met including even distribution of day, night, and weekend call shifts.
  • Over 20 constraints included: avoiding consecutive weekends, ensuring required rest day gaps between call to meet European Working Time Directive (EWTD) regulations, doctors from the same specialty not on call on the same day or near same day, plus other specialty and consultant specific restrictions.


roster optimisation logic for fairer rosters

TUH replaced complex and time-consuming manual spreadsheet processes with MedModus’ automated Roster Optimisation application to produce much fairer rosters in less than 5 minutes. Our rostering application uses an advanced mathematical optimisation model to achieve all rostering objectives while ensuring all constraints are adhered to. Rosters for all grades of doctors are produced simultaneously to avoid specialty clashes and improve doctor availability. The tool also considers annual leave and previous roster allocations. Thousands of roster permutations are tested in minutes to produce an optimal result.


MedModus dramatically improved fairness for TUH junior doctors with instances of rest day rule breaches e.g., doctors working more than 1 bank holiday, falling to zero. The solution also improved doctor availability for stretched medical teams ensuring instances of unavailability due to specialty clashes fell by 98%. As a result, more doctors were on hand within their specialties to provide care. Other benefits of the solution included:

Time to produce each roster reduced from weeks to minutes.


More accurate and fairer rosters.


Improved EWTD compliance.


Productivity of 12 person weeks per year.


Fast turnaround of last-minute roster changes.


Wider application to other disciplines (expanded to surgery and 160 doctors in total).


MedModus responsive managed service to help TUH during busy roster ‘seasons’.


Producing these rosters was a real headache for our department. The number of factors to consider made it time- consuming and prone to error. The automation of this process has resulted in fairer rosters with less errors and saved valuable HR time.

Tallaght University Hospital, Head of HR Medical Division

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