Case study

Changing shifts: evaluating the impact of extending working hours

We worked with a large NHS mental health trust to study the impact of changing staff shift patterns. Our findings allowed us to make recommendations for implementing changes for the benefit the organisation and its staff.

The issue

The NHS is struggling to cope with record demand for services and a chronic shortage of staff. Under mounting financial pressure, healthcare providers are looking for ways to reduce costs, improve patient care and boost staff wellbeing.

Condensing the working week into fewer, longer shifts might help. The adoption of 12-hour shifts can aid in supporting 24-hour service provision and is often implemented in pursuit of financial goals as staff spend less time on handovers. Staff may be satisfied with these shifts as they get more days off. However, longer shifts are also associated with increased fatigue, and could have adverse effects on staff health and performance.

The research

We worked with Tees, Esk and Wear Valleys NHS Foundation Trust as they moved from an 8-hour to a 12-hour shift pattern.

In collaboration with academics at the Centre for Health Economics, we measured the quantitative impact of the new shifts on sickness absence. Interviewing staff allowed us to understand how they adapted to the new shift patterns and what it meant for their wellbeing and job satisfaction.

Our findings indicated that the introduction of 12-hour shifts increased sickness absences. Our qualitative analysis suggested that the changes to working hours had intensified the demands of the job and increased levels of stress.

There were other, unforeseen consequences too: fewer opportunities for staff to reflect on stressful incidents and gain the support of their colleagues, limits to employee voice, lower quality handovers, and disruption to patient routines and continuity of care.

However, the interviews showed that staff had mixed views towards 12-hour shifts. Some preferred the new, longer shifts as they appreciated the additional time off and the flow of their work over a 12-hour shift. However, for others, extended time away from the workplace did not improve work-life balance and provoked anxiety around retuning to work.

The outcome

By combining statistical data with semi-structured interviews, we were able to shed light on nuances of work conditions. We documented individual responses to organisational change which are often overlooked when evaluating the impact of job strain on employee wellbeing.

Through our research, the Trust gained a better understanding of the effects of moving to a new shift pattern. They were able to ensure that they were meeting the needs of staff and could work to mitigate the negative effects of longer hours.

This study demonstrates how organisational context and resultant downstream effects of 12-hours shifts can exacerbate job strain and raises important implications for Health Service managers.

Without the [School for Business and Society at the University of York], we wouldn't have been able to do this. From the research, we can look at what changes we need to make to ensure that we're supporting our staff, meeting the needs of our organisation, and that we've got a healthy workforce.

Anthony Davison
Head of Nursing, Tees, Esk and Wear Valleys NHS Foundation Trust

Additional information

This work is part funded by the Wellcome Trust [ref 204829] through the Centre for Future Health at the University of York.

The research team acknowledges the support of the National Institute for Health Research Clinical Research Network.

Featured researcher

Jane Suter

Dr Suter's research focuses on employee voice and engagement, the role of line managers, and managing mental health and wellbeing in different workplace contexts.

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Featured researcher

Tina Kowalski

Dr Kowalski's research covers employee health and wellbeing, the psychosocial work environment, and the health effects of organisational change.

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