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