The impact of electronic and self-rostering systems on healthcare organisations and healthcare workers: A mixed-method systematic review

AIM

To synthesise evidence from studies that explored the impact of electronic and self-rostering systems to schedule staff on healthcare organisations and healthcare workers.

DESIGN

Mixed-method systematic review.

METHODS

Studies were screened by two independent reviewers and data were extracted using standardised data extraction tables. The quality of studies was assessed, and parallel-results convergent synthesis was conducted.

DATA SOURCES

Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO and PsycARTICLES were searched on January 3, 2023.

RESULTS

Eighteen studies were included (10 quantitative descriptive studies, seven non-randomised studies and one qualitative study). Studies examined two rostering interventions including self-rostering (n = 12) and electronic rostering (n = 6). It was found that the implementation of electronic and self-rostering systems for staff scheduling impacted positively on both, healthcare workers and healthcare organisations. Benefits included enhanced roster efficiency, staff satisfaction, greater control and empowerment, improved work-life balance, higher staff retention and reduced turnover, decreased absence rates and enhanced healthcare efficiency. However, self-rostering was found to be less equitable than fixed rostering, was associated with increased overtime, and correlated with a higher frequency of staff requests for shift changes.

CONCLUSION

The impact of electronic and self-rostering systems to schedule staff on healthcare organisations and healthcare workers' outcomes was predominantly positive. Further randomised controlled trials and longitudinal studies are warranted to evaluate the long-term impact of various rostering systems, including electronic and self-rostering systems.

IMPLICATIONS FOR HEALTHCARE

Rostering is a multifaceted responsibility for healthcare administrators, impacting patient care quality, workforce planning and healthcare expenditure.

IMPACT

Given that healthcare staffing costs constitute a substantial portion of global healthcare expenditure, efficient and strategic resource management, inclusive of healthcare staff rostering, is imperative.

REPORTING METHOD

The 27-item Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Culture, conditions and care support mental health of healthcare workers during crises

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has presented immense challenges to health systems worldwide and significantly impacted the mental health of frontline healthcare workers.

AIMS

This study drew on the experiences of frontline healthcare workers to examine organizational strategies needed to support the mental health and well-being of healthcare workers during times of crisis.

METHODS

Semi-structured focus groups or individual interviews were conducted with healthcare workers to examine their perspectives on organizational strategies for enhancing staff mental health and well-being during crises. Data were analysed thematically. Following this, evidence for the identified strategies was reviewed to assess alignment with participant views and recommendations.

RESULTS

Thirty-two healthcare workers from diverse disciplines (10 allied health, 11 nursing, 11 medical) participated in the study. Data analysis identified three broad themes contributing to supporting mental health and well-being. These themes can be encapsulated as the 'Three Cs'-culture (building an organizational culture that prioritizes mental health); conditions (implementing proactive organizational strategies during crises) and care (ensuring fit-for-purpose strategies to support mental health and well-being).

CONCLUSIONS

Study findings underscore the necessity of an integrated and systemic organizational approach to address mental health and well-being in the healthcare workplace. This approach must be long term with the components of the 'Three Cs', particularly cultural change and conditions, viewed as a part of a suite of strategies to ensure crisis preparedness. It is imperative that organizations collaborate with their staff, providing support and fostering a safe and inclusive work environment that ultimately benefits patients, their care and staff well-being.

Self-rostering, work-life balance and job satisfaction in UK nursing: a literature review

Nursing vacancies are high across the UK, with some nurses considering leaving the profession. Evidence suggests that employers, including the NHS, need to be more flexible about working times to support employees' work-life balance and job satisfaction. Self-rostering is one approach that has the potential to enhance nurses' work-life balance and job satisfaction, enabling scope for greater autonomy. This could in turn lead to fewer nurses leaving the profession and contribute to making nursing more attractive as a career. This literature review focused on nurses in the NHS and found that self-rostering had a positive effect on their work-life balance and job satisfaction. However, a move to self-rostering can pose challenges and it should be assessed for suitability before implementation. Given the nursing vacancy crisis in the UK and many nurses' intentions to leave the profession, the potential benefits of self-rostering for nurses cannot be overlooked.

NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

Background

Policy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.

Objectives

The review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.

Design

A realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.

Participants

NHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.

Results

Workforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.

Limitations

The evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.

Conclusions and recommendations

The synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.

Study registration

This study is registered as PROSPERO CRD42016038132.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Does longer roster lead-time reduce temporary staff usage? A regression analysis of e-rostering data from 77 hospital units

AIMS

Use of temporary nursing staff is contentious and expensive. Using e-rostering data from 77 hospital units, this research investigates whether longer roster lead-times reduce temporary staff usage.

BACKGROUND

It is commonly assumed that longer roster approval lead-times, the time from when a roster is approved, to when it is worked, result in better, more cost-effective rosters. Consequently, many hospitals target lead-times of 6 weeks, a figure recommended for the UK National Health Service in a recent governmental review. This contrasts with the minimum lead-time advocated by New South Wales Ministry of Health, which advises a shorter lead-time of 2 weeks. Using data from 77 hospital units, this paper explores this assumed relationship.

DESIGN

Using data extracted from the e-rostering system of an NHS Acute Foundation Trust, this study uses linear regression analysis to explore the relationship between roster approval lead-time and temporary staff usage. The data were captured over a period of 9 months from 15 February 2016-23 October 2016, a total of 693 rosters.

RESULTS/FINDINGS

This research suggests that late roster approval may contribute to as much as 37% of temporary staff usage, while approval 4-6 weeks prior to the roster being worked reduces this to approximately 15%. However, this is only relevant under specific conditions. Importantly, this should be considered before mandating lead-times across all units.

CONCLUSIONS

This research implies that the optimum approval lead-time lies between 4-6 weeks; however, given other challenges, achieving this in practice may prove difficult.

e-Roster policy: Insights and implications of codifying nurse scheduling

Following a decade of dissemination, particularly within the British National Health Service, electronic rostering systems were recently endorsed within the Carter Review. However, electronic rostering necessitates the formal codification of the roster process. This research investigates that codification through the lens of the 'Roster Policy', a formal document specifying the rules and procedures used to prepare staff rosters. This study is based upon analysis of 27 publicly available policies, each approved within a 4-year period from January 2010 to July 2014. This research finds that, at an executive level, codified knowledge is used as a proxy for the common language and experience otherwise acquired on a ward through everyday interaction, while at ward level, the nurse rostering problem continues to resist all efforts at simplification. Ultimately, it is imperative that executives recognise that electronic rostering is not a silver bullet and that information from such systems requires careful interpretation and circumspection.

Exploring the relationship between governance mechanisms in healthcare and health workforce outcomes: a systematic review

BACKGROUND

The objective of this systematic review of diverse evidence was to examine the relationship between health system governance and workforce outcomes. Particular attention was paid to how governance mechanisms facilitate change in the workforce to ensure the effective use of all health providers.

METHODS

In accordance with standard systematic review procedures, the research team independently screened over 4300 abstracts found in database searches, website searches, and bibliographies. Searches were limited to 2001-2012, included only publications from Canada, the United Kingdom, the Netherlands, New Zealand, Australia, and the United States. Peer- reviewed papers and grey literature were considered. Two reviewers independently rated articles on quality and relevance and classified them into themes identified by the team. One hundred and thirteen articles that discussed both workforce and governance were retained and extracted into narrative summary tables for synthesis.

RESULTS

Six types of governance mechanisms emerged from our analysis. Shared governance, Magnet accreditation, and professional development initiatives were all associated with improved outcomes for the health workforce (e.g., decreased turnover, increased job satisfaction, increased empowerment, etc.). Implementation of quality-focused initiatives was associated with apprehension among providers, but opportunities for provider training on these initiatives increased quality and improved work attitudes. Research on reorganization of healthcare delivery suggests that changing to team-based care is accompanied by stress and concerns about role clarity, that outcomes vary for providers in private versus public organizations, and that co-operative clinics are beneficial for physicians. Funding schemes required a supplementary search to achieve adequate depth and coverage. Those findings are reported elsewhere.

CONCLUSIONS

The results of the review show that while there are governance mechanisms that consider workforce impacts, it is not to the extent one might expect given the importance of the workforce for improving patient outcomes. Furthermore, to successfully implement governance mechanisms in this domain, there are key strategies recommended to support change and achieve desired outcomes. The most important of these are: to build trust by clearly articulating the organization's goal; considering the workforce through planning, implementation, and evaluation phases; and providing strong leadership.

Rescheduling nursing shifts: scoping the challenge and examining the potential of mathematical model based tools

AIM

To review research in the literature on nursing shift scheduling / rescheduling, and to report key issues identified in a consultation exercise with managers in four English National Health Service trusts to inform the development of mathematical tools for rescheduling decision-making.

BACKGROUND

Shift rescheduling is unrecognised as an everyday time-consuming management task with different imperatives from scheduling. Poor rescheduling decisions can have quality, cost and morale implications.

EVALUATION

A systematic critical literature review identified rescheduling issues and existing mathematic modelling tools. A consultation exercise with nursing managers examined the complex challenges associated with rescheduling.

KEY ISSUES

Minimal research exists on rescheduling compared with scheduling. Poor rescheduling can result in greater disruption to planned nursing shifts and may impact negatively on the quality and cost of patient care, and nurse morale and retention. Very little research examines management challenges or mathematical modelling for rescheduling.

CONCLUSION

Shift rescheduling is a complex and frequent management activity that is more challenging than scheduling. Mathematical modelling may have potential as a tool to support managers to minimise rescheduling disruption.

IMPLICATIONS FOR NURSING MANAGEMENT

The lack of specific methodological support for rescheduling that takes into account its complexity, increases the likelihood of harm for patients and stress for nursing staff and managers.

Schedule quality assessment metrics

Hospital unit staff scheduling continues to be a critical challenge directly impacting unit and facility performance. The creation of a quality future work schedule that balances unit needs (providing adequate staff across multiple skills) versus employee needs (honoring as many employee requests as feasible) is the first step toward ensuring the most efficient and effective use of staff resources. As an alternative to the use of expensive computer scheduling systems, this article sets forth a set of easy-to-understand and easy-to-measure schedule quality metrics that can be used via any basic spreadsheet application. The use of these metrics allows unit leaders to assess the "goodness" of a schedule and focus on identified opportunities toward improving the schedule resulting in a better match to the unit plan of expected volume/census. Higher quality schedules lead to more efficient use of staff resources by ensuring that resources are fully scheduled before reaching out to more expensive premium labor such as overtime or agency and to more effective use of resources by ensuring that schedules are as complete as possible to cover expected volumes. Resulting decreases in last-minute staff adjustments via better planning contribute to higher staff satisfaction and better patient care.

Workforce deployment--a critical organizational competency

Staff scheduling has historically been embedded within hospital operations, often defined by each new manager of a unit or program, and notably absent from the organization's practice and standards infrastructure and accountabilities of the executive team. Silvestro and Silvestro contend that "there is a need to recognize that hospital performance relies critically on the competence and effectiveness of roster planning activities, and that these activities are therefore of strategic importance." This article highlights the importance of including staff scheduling--or workforce deployment--in health care organizations' long-term strategic solutions to cope with the deepening workforce shortage (which is likely to hit harder than ever as the economy begins to recover). Viewing workforce deployment as a key organizational competency is a critical success factor for health care in the next decade, and the Workforce Deployment Maturity Model is discussed as a framework to enable organizations to measure their current capabilities, identify priorities and set goals for increasing organizational competency using a methodical and deliberate approach.