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Do ward housekeepers free up time for care?

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A small-scale evaluation found that a housekeeping service gave more time for essential care and therapeutic activities, and improved staff morale


Introducing a ward housekeeping service may give nursing staff more time to
focus on essential care. This small-scale evaluation found the role freed up healthcare assistant time and improved staff morale.

Citation: Tye L et al (2012) Do ward housekeepers free up time for care? Nursing Times [online]; 108: 9, 19.

Authors: Laura Tye is nurse practitioner; Stephanie Urmson is nursing assistant; both at the Brooker Centre, Halton General Hospital, Runcorn; Lindsey Maloney is modern matron, 5 Boroughs Partnership Foundation Trust.


The NHS Plan recommended that hospitals should introduce ward housekeeping services (Department of Health, 2000). Recent figures show that more than 53% of hospitals have done so (DH, 2010).
Ward housekeepers have “a ward-based non-clinical role centred on cleaning, food services and maintenance to ensure the basics of care are right for the patient” (May and Smith, 2003).
Their introduction could give nursing staff more time to focus on providing essential patient care, an issue that has been highlighted recently (Parliamentary and Health Service Ombudsman, 2011).
Since there is little published evidence on the benefits of a ward housekeeping service, staff working on Grange Ward conducted a small-scale service evaluation comparing activities on the ward before and after the housekeeper service had been introduced.

Evaluation method

The evaluation was based loosely on that of Hurst (2010), who conducted a large-scale study to investigate the activities of nursing staff and housekeepers in 34 general hospital wards. The results suggested that housekeepers make a difference by reducing the hours nursing staff spend “working inappropriately” (Hurst, 2010).
We aimed to examine activities in an organic mental health inpatient setting, where the client group generally consists of patients with advanced dementia. Four major areas were measured using three forms of data collection:

  • A 20-activity code sheet was given to two healthcare assistants (HCAs) who were on duty for the morning shift for eight days; this allowed them to document their actions accurately throughout the study period;
  • A staff questionnaire was given to four HCAs. The questionnaire was devised to explore stress levels, job satisfaction and staff morale before and after the housekeeping service was introduced.
  • Information on sickness/absence levels and patient falls were obtained from performance data and completed incident report forms.

These variables were measured before the housekeeper was introduced and after she had become established in her role.


Code sheet: Introducing the housekeeper clearly increased the time HCAs had to provide essential care. For example, the percentage spent on one-to-one contact with patients rose from 5% to 27%; for planned therapeutic activities this increased from no time to 16%.
Staff questionnaire: Job satisfaction and morale also increased. For example, work-related stress levels fell by 19%.
High demands and work overload contribute significantly to occupational stress and job dissatisfaction in nursing staff (McVicar, 2003). Stress is a major contributor to occupational ill health; this can result in high sickness absence levels, high staff turnover and poor organisational performance.
Performance data: The number of patient falls during two four-week periods halved from 16 before the housekeeper started work to eight afterwards. Staff absence also reduced significantly.


The housekeeping service has given HCAs more time to provide essential care, which has, in turn, resulted in increased morale and job satisfaction. Some results, however, may have an element of coincidence (for example, staff sickness levels).
This work shows that the study should be repeated on a larger scale to explore benefits and cost-effectiveness further; the trust has agreed to fund this.

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