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Shift pattern standardisation


The NHS is renowned the world over for its caring service free to all at the point of delivery. Part of this also involves the provision of the best possible working conditions for nurses and other staff that deliver these services.

In recent decades there has been a steady shift in focus away from patient care to “improving working lives”.

As a result, there are many NHS organisations running wards with a myriad of different types of shifts - and in extreme cases even one shift per employee.

Certainly in my experiences while working in the NHS, this situation has developed over a number of years.

Shifts have often been arranged to suit an individual’s requirements, and never reviewed.

Such practice in shift patterns often does not reflect the productivity needs of the ward or department and could be resulting in costly overstaffing - or understaffing which may adversely affect patient care.

Difficult and costly to manage

As a consequence cover arrangements across wards have become much more difficult to administer, resulting in increased use of bank staff or payment of additional hours, potentially affecting staff morale, for staff covering unsociable shifts.

Addressing the situation may risk upsetting some staff, however managers now have the evidence needed to review shift patterns to meet both patient’s needs and budget constraints.

So how could change be achieved?

Ideally shift patterns would be standardised across an organisation.

They would meet the needs of the patients in each ward and give staff flexibility in the hours they work. They would increase transparency and staff productivity with an equitable system, while reducing costs to the organisation.

This change could be achieved by reviewing the exact requirements of each ward, for example, the grade and numbers of staff required for each part of the day and day of the week.

Then a set of shifts could be agreed that meet this requirement.

Reviews should then take place on a regular basis to ensure that the working patterns are flexible enough to meet the ward’s requirements to meet patient care needs. 

Workforce Management is the solution

Implementing workforce management systems will capture the requirements of the ward – shift start times, shift lengths, contracted hours, skills mix, experience levels, shift breaks - and create the most efficient rosters for achieving these objectives.

Once set up, future fine-tuning of shifts is a relatively easy task. The system also captures staff requests to cover personal requirements in a fair and equitable way.

Having been involved in the implementation of trust-wide Workforce Management solutions, I saw many benefits to the organisation, including reduced staffing costs and improved staff morale through efficient and transparent working practices.

Cultural change is the key

Implementing new systems is not easy, however. Staff resistance to change can be difficult and time consuming.

This leads to managers taking the easier option of leaving things as they are, despite the recognised potential benefits for patients as well as Trust and Healthcare budgets. 

The key to successful implementation of such a system is to be very clear about how the system will benefit all stakeholders, including managers, staff, and patients, then to communicate those benefits clearly and regularly.

Flexibility in shift patterns can still be provided and assigned fairly, ensuring that skills mixes are optimised to meet the needs of the patients reducing potential risks associated with understaffing.

Implementing such a system can be a catalyst for cultural change.

Managers are empowered with tangible evidence to review  staff shifts - something in my opinion, they secretly have wanted to do for years, but were afraid to tackle or did not know where to start.

As well as supporting good clinical practice, managers can ensure that they provide the optimal staffing levels to ensure the organisation delivers the best quality patient care.

Surely a winning outcome for all involved.


Pam Oliver is former Assistant Director at Gateshead Health NHS Foundation Trust


Readers' comments (5)

  • I can't agree with a great deal of what's said here. There are far too many issues whitewashed and not acknowledged at all. To open with the theory that we have moved away from patient care to improving working lives. The two are not really related nor mutually exclusive now are the two things much to do with Nursing at all. We certainly don't have any influence in these areas, what with our artificially narrowed horizons. That is something more for your colleagues. Don't blame us for failed ideas, they're your failures. We just have to live with the consequences of unilateral decision making and board meeting fantasy.

    A failure to realise that one size fits all regardless of the workability or outcome or even faith in the idea has hobbled any real development. It's largely neither here nor there whether shift patterns are standardized. This is not an issue for us and is certainly something which, if given the freedom to do so, we could solve ourselves. We find that what is focused on by trust management is anything but issues that will genuinely improve the patients lot. But nicer clinical areas and enough of them are never really in the mix so trivial ideas like this are second best. An easy success that has no real area.of effect. As for lowered staff costs. It has escaped nobody that whilst clinical numbers are reduced, admin and managerial are not.

    We are not resistant to change per se. We are resistant to what is without fail pointless ot wrong changes foisted on top of us. So you show your working? Nope. Do you present your evidence? Nope.

    Its your approach that is largely responsible for your failures. Like the busybody parent that makes decisions for its teenage daughter than acts surprised because she doesn't want her Mom interfering with her life. The daughter knows the Mom is the Mom, but the Mom forgets she can't always be right and the daughter will have to make her own life decisions at some point.

    Nursing is the perpetual teenage daughter. The culture that needs to change is yours. We don't want to be the teenager but you desperately need to be the busybody mother. Whether we need you or not. Whether we want you or not. You've made it clear that you aren't going away, that you aren't going to consider us as professionals or even adults.

    We are always criticized. Always. Sometimes justifiably, sometimes not. This is the latter. Reducing staffing costs of Nursing is contrary to good care unless you can show us. But you never do. Reducing managerial costs ought to be the new project. You cost more, deliver less and of you look at the empty car parks on the weekend there's ample evidence of where budget costs could come from. The nursing care won't change day to day. It can't and we won't let it.

    Culture is fluid, but it is never decided by those within. It is often affected, considered and manipulated by those who exist in the periphery for their own desires. Is this what you mean? That you want to manipulate us in order to get what you want? Savings?

    It was this attitude that caused Mid Staffs on the whole. The drive to pursue goals that non clinicians can consider a success and ride rough shod over trivial Nursing behaviours. Lets forget that many nurses are mothers who might find their job starting 1-2 hours before school or nursery is an issue, never mind the idea that school.might finish at the same time or even five hours before their shift finishes. I'm not a woman, but as a nurse this is obvious. We don't have differing shift patterns to annoy you. We have them to attempt some kind of balance. It barely substitutes for out lousy pay and conditions.

    It will take more than think tanks and fantasy policymaking to achieve success. It will take understanding. As someone with a largely finite role you might never understand that. You'll never have to be all things to all people, nor do you largely have to explain or suffer for your failures.

    There's a good reason why Nurses have no faith in management. Its called evidence and experience.

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  • "The NHS is renowned the world over for its caring service free to all at the point of delivery."

    Free at the point of delivery is the only distinguishing feature of the NHS in this list but don't forget that tax payers pay a high price for it and for those who do use it without paying, although not all get the same level of service from it or even safe care.

    A caring service it is most certainly not although this was its original concept which lasted until the 1980s and no longer.

    Renowned the world over - again it used to be for its high standards of training but this also seems in greater part to have died out and I am not sure which countries this still includes and most likely some of the third world who do not have good services although these are improving in many parts of the world. As for western European countries, it is frequently the subject of derision. It ranked as 18 out of 100 in the WHO world ranking some years ago before they ceased comparing them.

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  • Is Pam Oliver a nurse?

    If so, has she ever visited a place called Earth?

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  • Let me guess - standardise to the cheaper (to NHS but not to patient errors or a lots of people's health) 12-hr shift patterns & exclude anyone form nursing who can't do them.
    The requests for flexible shifts under improving working lives still had to be considered vs impact on rest of staff/fit with ward workload - requests weren't just rubber stamped, in the same way as 'reasonable adjustments' for disabled staff have to be 'reasonable', whereas author talks about them as if handed out at whim. Back in the real world (the one most of us lowly hands-on nurses live in)....

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  • Surely a good shift pattern = less errors and better staff retention.

    Staff well-being is so so important and constantly overlooked.

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