Rostering in healthcare is never simple. In emergency departments, however, it carries a different weight altogether.
Emergency departments operate in high-pressure, time-critical environments where patient acuity is unpredictable, demand can escalate rapidly, and clinical decisions are made under sustained pressure. In this setting, workforce planning is not merely an administrative task – it’s part of the operational infrastructure that supports safe, effective and timely patient care.
Unlike many other clinical settings, emergency departments must maintain constant readiness. They cannot defer demand, slow activity or pause services when pressure rises. As a result, the impact of rostering decisions is amplified. Getting rostering right supports clinician wellbeing, fairness and sustainability – and enables multidisciplinary teams to perform at their best in urgent care settings.
Understanding the unique challenges of emergency department rostering is a critical first step in designing approaches that genuinely support emergency medicine in public hospitals.
While all hospital departments face workforce challenges, emergency departments face a distinct set of factors that significantly increase rostering complexity.
Emergency departments rely on a mix of day, evening and night shifts, with strict sequencing requirements to manage fatigue and support safe clinical decision-making. Certain shifts cannot follow others, and consecutive working days must be carefully balanced with adequate recovery time.
As departments scale, the number of valid shift combinations increases rapidly, making rostering increasingly complex across large teams and multiple roles.
Emergency departments bring together a diverse workforce, including senior clinicians, junior doctors, trainees and interns. Each group has distinct supervision requirements and skill profiles that must be accurately reflected in the roster.
Many roles are interchangeable across rosters, adding flexibility but also increasing complexity. Rostering must ensure that the appropriate mix of experience is available at all times, while supporting training pathways and supervision.
Emergency departments often manage large numbers of rosters and roles simultaneously. Ensuring fairness – particularly around weekend and night work and the distribution of different shift types – is an ongoing challenge.
At the same time, rosters must remain flexible. Leave, staff movement, and evolving service requirements are a constant reality. Approaches that allow ongoing refinement, rather than wholesale redesign each roster cycle, are essential to maintaining trust and workforce wellbeing.
The combination of urgency, scale and complexity in emergency care means that rostering approaches designed for other settings don’t always translate effectively.
In emergency departments, even small changes can have system-wide implications. As complexity grows, manual effort often increases, placing additional administrative burden on clinical leaders and operational teams, and detracting from clinical leadership and workforce planning.
Effective emergency department rostering approaches must manage multiple constraints simultaneously, adapt to change without destabilising the roster, support fairness and transparency over time, and reduce unnecessary administrative workload – all while supporting people working in one of the most demanding clinical environments in the hospital.
Advances in AI-supported rostering have enabled new ways of managing complexity in emergency departments. Rather than traditional manual rostering that relies on rigid patterns, AI-supported rostering transforms the process through a foundational rule-based approach, enabling rosters to be built around clinical intent – such as workload balance, fairness, skills matching, and correct shift allocations – while remaining adaptable as conditions change.
When implemented thoughtfully, AI-supported rostering can balance multiple requirements simultaneously, support consistency and equity across large teams, enable iterative improvement, and reduce time spent on manual adjustments.
As Dr Chris Jones, practising anaesthetist and founder of HosPortal, notes:
“Clinicians understand how quickly small roster decisions can have a big impact in high-pressure environments. Rostering systems need to reflect clinical reality – not force teams to work around rigid structures.”
Crucially, these approaches are designed to support clinical judgement, not replace it.
A busy public hospital emergency service, such as Maitland Hospital Emergency Department, illustrates how these considerations come together in practice.
Maitland Hospital is a major public hospital with about 340 beds, located in Metford, New South Wales, serving the growing communities of Maitland and the broader Upper and Lower Hunter regions. The hospital operates a 24/7 emergency department and is a regional healthcare provider for a large, diverse, and rapidly growing population.
The emergency department’s rostering team was managing a high level of complexity, driven by a diverse mix of staff roles, numerous rosters, and the range of shift patterns required to support their busy emergency service. They went in search of an AI-driven rostering solution that could better manage this level of detail and complexity, while making scheduling more manageable and maintaining fairness, flexibility, and operational efficiency for their high-pressure clinical environment.
The emergency department partnered with HosPortal to implement an AI-supported, rules-based rostering approach designed to manage their complex constraints such as their patterns, rules, workforce mix, shift distributions and fairness. Rather than treating rostering as a static task, they focused on using AI to support a structure that could evolve over time, adapt to future change, and reduce unnecessary administrative burden.
As a result, they transitioned to a rostering process that was more manageable and scalable over time. Manual adjustments were reduced with each build, fairness and consistency across shift allocations improved, and the team gained greater visibility and confidence in how rosters were constructed. Importantly, the approach enabled ongoing refinement, meaning each new roster build improved on the last rather than requiring the process to start from scratch.
This experience reflects a broader reality – and possibility – across hospital emergency departments: when rostering complexity is supported by intelligent, adaptive systems, teams are better able to balance competing demands while maintaining a focus on clinician wellbeing and patient care.
In emergency departments, the margin for error is smaller. Time is critical, pressure is constant, and the consequences of workforce strain are felt immediately. Rostering may sit behind the scenes, but its impact is tangible — shaping clinician experience, team performance and the conditions under which patient care is delivered.
By recognising the unique challenges of emergency department rostering and adopting approaches that reflect those realities, public hospitals can better support the people who deliver emergency care every day.
HosPortal is an Australian, clinician-led workforce planning and rostering platform developed over more than 15 years by practising clinicians and software experts. Founded and led by Dr Chris Jones, a practising anaesthetist, HosPortal was built in response to firsthand experience of the clinical, operational and human complexity of healthcare rostering.
HosPortal supports rostering, leave and workforce planning across more than 100 hospital departments and thousands of healthcare professionals throughout Australia and New Zealand, helping healthcare teams manage complexity while supporting fairness, wellbeing and sustainable service delivery.