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Found 89 results
  1. News Article
    Spending on agency staff across the NHS in England dropped by almost £1bn in the last financial year, ministers have said, after a pledge by Wes Streeting to cut the amount going to agencies by 30%. According to the Department of Health and Social Care, the total spent by trusts on agency staff during 2024-25 was nearly £1bn lower than the previous year. In a speech to the NHS Providers conference in November, Streeting, the health secretary, said a lack of permanent staff had seen gaps filled by more expensive agency-provided replacements totalling about £3bn a year. Under proposals outlined at the time, but not yet enacted, Streeting suggested that NHS trusts could be completely banned from using agency staff for lower level jobs such as healthcare assistants and domestic support workers. In addition to employing agency staff, which can mean paying a doctor thousand of pounds for a single shift, NHS trusts also routinely plug gaps by using what are known as “bank” staff – NHS employees who do extra shifts at their own workplace or one nearby, via an organisation usually run by the trust. UK-wide figures reported by the Guardian in January 2024 showed that the combined spend of hospitals and GP surgeries for agency staff was an annual £4.6bn, with another £5.8bn used for bank shifts. As part of the clampdown on agency spending, Streeting and James Mackey, the chief executive of the imminently abolished NHS England, have jointly written to all NHS providers and integrated care board executives to set out that each should target the 30% reduction, and that their progress will be monitored. Read full story Source: The Guardian, 2 June 2025
  2. News Article
    The national workplace regulator has told an ambulance trust to do more to tackle staff stress as part of a programme in which it is “selectively targeting” high-risk organisations. The Health and Safety Executive (HSE) inspected East of England Ambulance Trust for the first time in September 2024, after the NHS Staff Survey showed an increase in work-related stress. East of England has had well-documented cultural issues over the past few years and has been ordered to make improvements by the Care Quality Commission and the Equality and Human Rights Commission. However, early last year it was released from NHS England’s special measures. The trust said the HSE identified a number of actions it should take, including: Implementing measures to reduce unplanned overtime at the end of shifts. Developing protocols to protect staff from exposure to abuse. Reviewing mandatory training and ensuring appropriate line management and clinical supervision are available. Updating its work-related stress risk assessment. Read full story (paywalled) Source: HSJ, 19 May 2025
  3. News Article
    Fatigue among frontline personnel causing them to make mistakes is a “significant” risk to patients, according to the Health Services Safety Investigation Body (HSSIB). It “contributes directly and indirectly to patient harm”, yet is not properly appreciated as a risk by the NHS, possibly because of the perceived “heroism” of NHS staff. Exhaustion has led to doctors and nurses harming patients by inserting feeding tubes in the wrong place, leaving swabs inside a woman who had just given birth and mislabelling blood samples. But the NHS safety regulator for England also found that staff who are driving home after finishing a long shift could die in a road accident because they are extremely tired. “Fatigue was found to have a negative impact on staff safety,” the HSSIB said in a report, which is based on interviews with about 100 staff and evidence from national organisations. “A key risk related to this was staff driving home after a long shift and being involved in fatal car accidents or near misses.” “This report lays bare the daily reality for nursing staff. They are overstretched, understaffed and regularly work beyond their hours caring for too many patients,” said Patricia Marquis, the Royal College of Nursing’s executive director for England. “This drives dangerous levels of fatigue which not only harms patients but also follows staff home, with sometimes devastating consequences. “Nursing fatigue is deadly and in health and care services should be treated as a public safety emergency.” Read full story Source: The Guardian, 24 April 2025
  4. Content Article
    This Health Services Safety Investigations Body (HSSIB) report follows on from HSSIB's launch report, ‘Fatigue risk in healthcare and its impact on patient safety’, which introduced the concept of fatigue and outlined the risk posed to patient safety from staff fatigue. The International Civil Aviation Organization’s definition of fatigue was adopted by this investigation, where fatigue is defined as: “A physiological state of reduced mental or physical performance capability resulting from sleep loss, extended wakefulness, circadian phase [the natural daily internal body clock], and/or workload (mental and/or physical activity) that can impair a person’s alertness and ability to perform safety related operational duties.” The investigation engaged with a wide range of healthcare staff to learn what impact fatigue had on patient safety in acute NHS hospitals. The investigation explored the NHS systems and processes in place to capture and learn from the risk posed by fatigue on patient safety and staff safety. It also considered the main factors that contribute to healthcare staff being fatigued. The investigation shares findings from staff interviews, discussions and observational visits to several acute hospital trusts, combined with evidence from national bodies, forums and networks with insight on this topic. The report also refers to supporting surveys and literature. While the investigation focused on staff working in acute hospitals, the findings will be relevant to providers and staff in other health and care settings. Findings Staff fatigue contributes directly and indirectly to patient harm. However, there is little evidence available to help understand the size and scale of the risk, how it impacts on patient safety, and those staff groups who may be most at risk of fatigue. There was variation in how the concept of fatigue was understood and the impact it could have on patient safety and staff safety across the healthcare system. This inconsistent understanding prevented fatigue risks being addressed. The risks posed by staff fatigue are not always clear to trusts. The systems and processes needed to provide the information to assess staff fatigue risk are not always well developed or well used. However, some trusts were starting to explore these risks. A positive safety culture was a key enabler to support healthcare organisations to recognise and manage fatigue risk. Staff fatigue is not routinely captured as part of patient safety event reporting or routinely considered as part of patient safety event learning, or other governance processes. Fatigue was perceived by organisations and staff as an individual staff risk, with limited organisational accountability. This sometimes led to a blame culture and punitive actions when staff were fatigued, and limited actions to drive improvement. Fatigue arises from a number of personal and organisational factors, which can overlap. Organisational factors that contributed to staff fatigue included workload, long shifts, insufficient rest facilities and inadequate rest breaks during and between shifts. Personal factors that contributed to an increased risk of fatigue included caring responsibilities, menopause, pregnancy, religious practices and socioeconomic factors. Fatigue was found to have a negative impact on staff safety. A key risk related to this was staff driving home after a long shift and being involved in fatal car accidents or near misses. There are barriers to acknowledging the risk posed by staff fatigue. These include historical beliefs and norms around working long and additional hours, pride and ‘heroism’ of NHS staff. The demands on healthcare services, and workforce and financial constraints, limited the ability of some organisations to address fatigue risks. There is limited regulatory and national oversight of the risks posed to patient safety by staff fatigue in healthcare. There was limited consideration of the risk of staff fatigue in national initiatives addressing workforce challenges and care delays. The systems-based approach and supporting materials provided to trusts implementing the NHS England Patient Safety Incident Response Framework (PSIRF) helped to prompt consideration of staff fatigue in safety event learning, but this was not routine in all organisations. Safety recommendations HSSIB recommends that NHS England/Department of Health and Social Care identifies and reviews any current processes that may capture staff fatigue related data. The output of the review should identify how information about factors impacting on staff fatigue can be collated and further enhanced to aid the understanding of fatigue risk in healthcare. This data will help inform the development of any future strategy and action to address staff fatigue risk and its impact on patient safety. HSSIB recommends that the NHS Staff Council, via the Health, Safety and Wellbeing subgroup, convenes fatigue science experts and other key stakeholders to develop and test a consensus statement defining fatigue for all healthcare staff. The group should work with existing networks to promote the definition and a shared understanding of the causes and impacts of fatigue. This will help to support a consistent understanding of fatigue among healthcare providers and improve the understanding of factors that may impact on staff fatigue and patient safety. Safety observations Research funding and commissioning bodies can improve patient safety by prioritising future research to measure and assess the impact of staff fatigue on staff and patient safety. This should include patient experience and the health economics of staff fatigue due to reduced performance and productivity. Healthcare organisations and professional bodies can improve patient safety by including aspects of fatigue when conducting staff surveys in order to help build an understanding of the level of fatigue and any impact on staff performance and patient safety. This will help organisations assess and understand the risks associated with staff fatigue, and to monitor and manage the risk of staff fatigue. Healthcare regulators and professional bodies can improve patient safety by: considering how they can contribute to driving improvement in the understanding and awareness of staff fatigue; considering how they can support and share best practice on mitigations for the risk of staff fatigue; considering organisational and individual factors that may have contributed to staff fatigue when making decisions about regulatory assessment and action. Government and national organisations can improve patient safety by accounting for the impact of staff fatigue on patient safety when developing national priorities for NHS services. Healthcare organisations can improve patient safety by considering the principles and activities for a systems approach to fatigue risk management and the roadmap to implement this as described in the Chartered Institute of Ergonomics and Human Factors white paper ‘Fatigue risk management for health and social care’. Related reading on the hub: Managing fatigue as part of a safety culture – a blog from Nancy Redfern, Emma Plunkett and Roopa McCrossan Why we need to manage fatigue in the NHS – a blog from Nancy Redfern and Emma Plunkett CIEHF: Fatigue risk management for health and social care
  5. Content Article
    One of the most transformative changes to the US health care system in the last few decades has been the widespread adoption of electronic health record (EHR) systems and online patient portals. The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care use and increasing treatment adherence. The implementation of online patient portals has altered clinical practice workflows considerably, allowing the streamlining of interappointment communication. However, direct messaging between patients and their health care team is also having a negative impact on healthcare professionals. Increasing reliance on portal messaging as a primary form of communication and more patients using portals increased the volume of messages being sent. Work associated with portal messaging has fallen primarily on doctors, and many of them end up using time outside of clinical work hours to respond. Limited access to appointments has led to more complex and time-consuming messages. This trend is causing higher levels of staff burnout and female doctors are disproportionately affected. This article looks at the issues and potential solutions.
  6. Content Article
    On 27 February, NIHR held a SafetyNet webinar on the Impact of shift work on safety outcomes for patients with Dr Chiara Dall’Ora, Associate Professor of Health Workforce at the University of Southampton. The recording of the webinar is now available. During this webinar, you will learn about the impact of a variety of staffing and shift work configurations on safety outcomes for patients. The body of research relies mostly on objective nurse roster data, as well as patient outcomes extracted from hospital systems. Using robust longitudinal methods, we have uncovered how working long shifts and high proportions of night shifts jeopardises patient safety. You will also learn what are the ongoing research projects that the team are leading on.
  7. Event
    This Hospital at Night Summit focuses on out of hours care in hospitals, delivering high quality safe care at night, and supporting the wellbeing of those working at night. Through national updates, networking opportunities and case studies this conference provides a practical guide to delivering a high-quality hospital at night service and transforming out of hours services and roles to improve patient safety. The 2024 conference will focus on developing an effective Hospital at Night service and focus on the practicalities of supporting staff at night, improving wellbeing, and fighting fatigue. For further information and to book your place visit: https://www.healthcareconferencesuk.co.uk/virtual-online-courses/hospital-at-night-summit or email [email protected] Follow on X @HCUK_Clare #HospitalAtNight hub members receive a 20%. Email [email protected] for discount code.
  8. Content Article
    The NHS Staff survey is one of the largest workforce surveys in the world and is carried out every year to improve staff experiences across the NHS. It asks staff in England about their experiences of working for their respective NHS organisations. Of the 1.5 million NHS employees in England, 731,893 staff responded to the survey in 2024. Responses to key patient safety questions in this year’s survey included: Reporting of errors, near misses and incidents 33.60% of staff have seen errors, near misses, or incidents that could have hurt staff and/or patients/service users in the last month (2023: 33.47%, 2022: 33.69%). 59.71% of staff said their organisation treats staff who are involved in an error, near miss or incident fairly (2023: 59.51%, 2022: 58.21%). 86.43% of staff said their organisation encourages staff to report errors, near misses or incidents (2023: 86.40%, 2022: 86.14%). 68.21% of staff said that when errors, near misses or incidents are reported, their organisation takes action to ensure that they do not happen again (2023: 68.22%, 2022: 67.42%). 61.29% of staff said that they are given feedback about changes made in response to reported errors, near misses and incidents (2023: 61.05%, 2022: 59.91%). Concerns about clinical safety 71.53% of staff said they would feel secure raising concerns about unsafe clinical practice (2023: 71.45%, 2022: 72.05%, 2021: 75.13%, 2020: 72.82%). 56.83% of staff said they were confident that their organisation would address their concern (2023: 56.87%, 2022: 56.76%, 2021: 59.51%, 2020: 60.57%). Speaking up about concerns 61.82% of staff said they feel safe to speak up about anything that concerns them in their organisation (2023: 62.34%, 2022: 61.53%, 2021: 62.07%, 2020: 65.70%). 49.52% of staff said they were confident that their organisation would address their concern (2023: 50.08%, 2022: 48.67%, 2021: 49.77%). Care for patients and service users 74.38% of staff said that care of patients or service users is their organisation's top priority (2023: 75.16%, 2022: 74.07%, 2021: 75.65%, 2020: 79.54%). 70.92% of staff agree that their organisation acts on concerns raised by patients or services users (2023: 70.64%, 2022: 69.17%, 2021: 72.12%, 2020: 75.03%). Workload and resources 47.26% of staff said they are able to meet all the conflicting demands on their time at work (2023: 46.59%, 2022: 42.85%, 2021: 42.91%, 2020: 47.53%). 58.08% of staff said they have adequate materials, supplies and equipment to do their work (2023: 58.40%, 2022: 55.51%, 2021: 57.20%, 2020: 60.24%). 34.01% of staff said there are enough staff at their organisation for them to do their job properly (2023: 32.28%, 2022: 26.24%, 2021: 26.93%, 2020: 38.16%).
  9. Content Article
    A new global survey of care workers reveals a deepening staffing crisis in the health and care sectors, with nearly 70% of workers frequently understaffed and over a third (36.4%) saying they are always working short-handed. Released on the fifth anniversary of the WHO’s Covid-19 pandemic declaration, the UNI Global Union report—based on responses from 11,233 workers across 63 countries—exposes a care system still in freefall. Despite being hailed as heroes, care workers face chronic understaffing, poverty wages, and surging workplace violence, driving many out of the profession and leaving patients at risk. Workers without union protections are affected by this trend even more intensely. The same failures that cost tens of thousands of lives during the pandemic remain dangerously ignored. UNI warns that these conditions are driving workers away from the sector, exacerbating a crisis that governments and employers have failed to address. The survey shows that union membership and collective bargaining significantly improve worker retention and satisfaction. Safe staffing levels are essential for high-quality care and safer work environments, but chronic shortages in hospitals and care homes undermine patient health – even causing preventable deaths. For care workers, understaffing leads to poor morale, increased workplace violence and injury rates, and high turnover. “Five years after the pandemic, care workers are still being overworked, underpaid and exposed to dangerous conditions,” said Christy Hoffman, General Secretary of UNI Global Union. “This report is a wake-up call. Without immediate action to raise wages, improve staffing levels, and combat workplace violence, care systems will collapse.”
  10. Content Article
    The UK's leading medical defence organisation, the Medical Defence Union (MDU), has carried out the survey of 481 doctor members. The proportion saying tiredness has impacted their ability to treat patients safely has increased from a quarter (26%) in 2022 to a third (35%) of doctors responding to the latest survey. MDU survey findings 89% of doctors felt sleep deprived at work some of the time, 22% said this happened daily and 19% weekly. 35% said tiredness had impaired their ability to treat patients and 34% said tiredness may have played a part. There were 69 near misses and 17 cases in which a patient sustained harm. 38% were rarely or never able to take breaks during the working day, including lunch breaks with 27% not having a staff room to take a break in. 62% said winter pressures had increased this year and added to tiredness levels. 90% want government to continue funding specialist practitioner support programmes. The most common reasons for tiredness were high patient demand (67%), being unable to take a break because of work pressures (65%), being unable to switch off outside work (50%) and no opportunity to eat/drink during a shift/session (29%). The most reported impacts of tiredness included poor concentration (72%) not looking after yourself (70%), difficulty switching off from work (62%), decision making difficulties (53%) and poor mental health (42%). The MDU has called on the government and NHS employers to do more to ensure there are adequate resources in place to allow exhausted doctors to take regular breaks. This is part of a package of measures needed to support the health and wellbeing of the NHS workforce including the need to continue funding support services like Practitioner Health for those experiencing burnout. Further reading on the hub: Managing fatigue as part of a safety culture – a blog from Nancy Redfern, Emma Plunkett and Roopa McCrossan Why we need to manage fatigue in the NHS – a blog from Nancy Redfern and Emma Plunkett Fatigue | Association of Anaesthetists
  11. Event
    This upcoming SafetyNet webinar on the Impact of shift work on safety outcomes for patients will featured Dr Chiara Dall’Ora, Associate Professor of Health Workforce at the University of Southampton. Chiara is an Associate Professor and leads the Health Workforce & Systems research group. Chiara leads a research programme to improve health workforce wellbeing and performance, with a specific focus on work hours and workforce configuration and patient safety. During this webinar, you will learn about the impact of a variety of staffing and shift work configurations on safety outcomes for patients. The body of research relies mostly on objective nurse roster data, as well as patient outcomes extracted from hospital systems. Using robust longitudinal methods, we have uncovered how working long shifts and high proportions of night shifts jeopardises patient safety. You will also learn what are the ongoing research projects that the team are leading on. Register
  12. News Article
    Nearly 200 care providers have been given government licences to bring foreign nurses to the UK despite having previously violated labour laws, according to a study that highlights widespread employment problems in the social care sector. The report by the Work Rights Centre shows 177 companies in England have been given licences to sponsor carers, even while publicly available information shows them to have violated workers’ protections in the past. The study gives further evidence of major gaps in the government’s oversight of its foreign carer regime, under which hundreds of thousands of nurses and carers have travelled to Britain for work, only for many to experience exploitation and poor working conditions. Dora-Olivia Vicol, chief executive of the Work Rights Centre, said: “Our research finds that breaches of employment rights are endemic in the care sector. This cannot come as a surprise to the Home Office, which granted licences to companies with a history labour violations. “For those who have been exploited, the fear of retaliation from their sponsor employer is enough to force them into silence. On top of this, working conditions are barely tolerable, with work schedules either all-consuming and exhausting, or so sparse that they do not provide enough income to make ends meet.” The organisation also spoke to 92 different carers and found nearly two-thirds reported health and safety breaches, bullying or discrimination at work. Over half also said they were given unsustainable working hours, for example being asked to be on duty for as long as 100 hours a week despite only seeing clients for a fraction of that time. Read full story Source: The Guardian, 12 November 2024
  13. News Article
    Doctors at a major teaching trust are to refuse overtime and extra shifts from next week, HSJ has learned, amid escalating tensions with executives over a decision to stop paying premium rates for locum shifts. Resident doctors and consultants will cease taking up overtime, extra sessions and waiting list work at University Hospitals Birmingham unless they are paid at rates agreed by the British Medical Association. The BMA confirmed this morning that doctors were in official dispute from today, with the union officially recommending members not work outside their contracted hours for less than rates the BMA advises, laid out in local dispute cards. Rinesh Parmar, BMA West Midlands regional consultants committee chair, said: “We have been successful in negotiating with other trusts to prevent them making unilateral changes to rates for extra-contractual work and it is disappointing that managers at UHB do not see fit to follow national guidance for the benefit of their patients and staff. “Without offering appropriate rates for work, the trust runs the risk that doctors will simply not pick up these extra shifts. This will inevitably lead to burnt out doctors, understaffed wards and patients who will have to suffer with poor and delayed care.” Read full story (paywalled) Source: HSJ, 8 November 2024
  14. Content Article
    This report explores the workforce challenges facing general practice in England, and highlights the pressing need to address the reasons why GPs are leaving the profession or reducing their contracted hours.
  15. Event
    until
    This Royal Society of Medicine conference explores the latest research and best practices to mitigate risks, support employees, reduce healthcare costs, boost morale, and develop actionable solutions for healthier workplaces. The agenda will cover: Basic science of circadian rhythms. Shift working and doctors rotas. Update on shift work Medical dangers of shift work. Ramazzini award trainee presentations on "Sleep and shift work", and winner announcement. Shift work in the airline industry. Update on the treatment of sleep apnoea. Panel discussions. Register
  16. Event
    This Hospital at Night Summit focuses on out of hours care in hospitals delivering high quality safe care at night and supporting the wellbeing of those working at night. Through national updates, networking opportunities and case studies this conference provides a practical guide to delivering a high-quality hospital at night service and transforming out of hours services and roles to improve patient safety. The 2024 conference will focus on developing an effective Hospital at Night service and focus on the practicalities of supporting staff at night, improving wellbeing, and fighting fatigue. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/hospital-at-night-summit or email [email protected] We have a limited number of free places for this event for members of the hub. Email [email protected] if you are interested. Follow on Twitter @HCUK_Clare #HospitalAtNight
  17. Community Post
    Are you a GP or other healthcare professional working in primary care? Have you noticed an increase in rejected referrals to outpatient services/for scans and other investigations? How have changes to the referral system affected you? What communication relating to referrals have you received recently from the NHS? What has the impact been on your own workload and wellbeing, and the safety of patients? Please share your experiences with us so we can continue to highlight this important issue.
  18. Content Article
    Shift work can introduce additional health, safety and wellbeing challenges. This article explore some of these challenges, including the increased risk of injury or illness, sleep and fatigue problems, psychological health, and suggest ways you can ensure safe and healthy shift work.
  19. Content Article
    This resource from the Royal College of Nursing encourages health and social care managers to ensure that nursing staff are taking their at-work breaks, are well hydrated and have access to nutritional food. It outlines the case for making improvements and the legal responsibilities of employing organisations, and provides tips and case studies to support the implementation of improvements. The document is supported by a short guide for nursing staff and posters to encourage nursing staff to self-care and take steps to rest, rehydrate and refuel.
  20. Content Article
    The relationship between management and the workforce, in very simplistic terms, can be considered one of reward in return for effort. The contracted effort is communicated through a roster. In organisations that have a continuous operation, blocks of effort are distributed to maintain the flow of output. The organisation of effort, then, is a legitimate function of management.  Norman's previous blog looked at performance variability under normal conditions. In this blog, Norman looks at the impact of physiological states and how management’s organisation of effort degrades decision-making. Fatigue The chart below shows pilot fatigue measured using the Samn-Perelli Scale (S-PS).[1] The S-PS has 7 intervals and a score of 4 indicates the onset of fatigue. The data shows how fatigue increases across the first and second sectors of the day, but, also, that fatigue is significantly higher during night-time operations. A study[2] of urology surgeons using the S-PS, reported that fatigue, as measured pre- and post-operation, increased by 67.95% across the four procedures undertaken in the day. Another study[3] looking at 29 ICU doctors found that the median S-PS score at the start of a day shift was 3 and 4 at the end; however, at the start of a night shift the median was 3 and at the end it was 5. Pilots with less than 6 hours of sleep before a duty started the day with an S-PS score of 4. In a risk assessment of night flights to Queenstown Airport, New Zealand, it was suggested that pilots with an S-PS of 4 or greater should be prohibited from flying.[4] Fatigue affects error rates. The Line Operations Safety Audit (LOSA)[5] shows that crew that slept for 6 hours or less before a duty committed more errors. In a study[6] of crew flying night cargo operations, crew acclimatised to the local day but flying during their local night had an error rate of 13.18/sector. However, crews who were flying at night in a different time zone but operating on their home daytime body clock had an error rate of 5.4 errors/sector. It is well-understood that performance is degraded during the 'window of circadian low' – that phase of the circadian cycle when humans are supposed to be sleeping – but in my previous blog, I made the point that raw error rates are not necessarily the issue, rather it was how errors shape the operation. Fatigue and decision-making The table below shows error outcomes across consecutive flights. An ‘additional risk’ is where, in dealing with the initial error, the crew either committed a subsequent error or the consequence was a ‘Undesired Aircraft State’ (UAS). It is common to see improved performance on the second sector as crew build familiarity but there is a sharp fall-off in performance on the third sector, including a significant increase in the number of mistakes made by crew. Mistakes in this context are errors of decision-making. In short, fatigue affects judgement. We see the same in other domains: in finance, traders make riskier trades when fatigued.[7] This data on fatigue and error points to job design and staff deployment as risk factors. Organisational responses to self-management of fatigue Workers absent themselves from the workplace for a variety of reasons. It could be for genuine ill-health, no-notice personal needs and disaffection (morale). Or it could be personal fatigue management. Again, the control of unplanned absence is a legitimate management activity. Workforce absenteeism places an increased burden on the attending workforce and adds to fatigue. The graph below shows the absence rate for a group of pilots and the percentage of pilots who did not take a single day of unplanned absence in a year. The absence management rules were changed to address the problem. The next graph shows how the duration of absences changed in response to the new policy: Pilot absence episode duration (days) The data suggests that management and workforce exist in a dynamic relationship and management’s attempt to exert control results in a corresponding response. The deployment of the workforce is a legitimate management function, but the way contracted effort is utilised shapes safety. Shift duration and timing induce fatigue and, importantly, fatigue can result in riskier decisions. In the previous blog, decision-making in normal operations was also seen to affect risk. Conclusion In this series of blogs, I have suggested that to understand safety we need to look at the factors that increase risk. Risk is a function of the tension between organisational controls and the need for flexibility that flows from variability in the workplace. Three areas of interest have been suggested: the preparation of staff for work, their control and, finally, their deployment. To understand ‘what goes on here’ we need to better understand the dynamics of these three domains. References Samn SW, Perelli LP. Estimating aircrew fatigue: A technique with application to airlift operations. Brooks Air Force Base. San Antonio, TX. Report No: SAM-TR-82-221, 1982. Petrut B, et al. Mental fatigue evaluation of surgical teams during a regular workday in a high-volume tertiary healthcare center. Urol Int 2020; 104(3-4): 301–308. Bihari S, et al. ICU shift related effects on sleep, fatigue and alertness levels. Occup Med (Lond) 2020; 70(2):107-112. Navigatus Consulting (2017). Queenstown Airport Night Operations Foundation Safety Case. Klinect JR. Line Operations Safety Audit: A Cockpit Observation Methodology for Monitoring Commercial Airline Safety Performance. Unpublished PhD thesis, 2005. University of Texas. Unpublished PhD thesis. University of Texas. MacLeod N. Crew Resource Management Training: A Competence-based Approach for Airline Pilots. CRC Press, 2021. Dickinson DL, Chaudhuri A, Greenaway-McGrevy R. Trading while sleepy? Circadian mismatch and mispricing in a global experimental asset market. Exp Econ 2019; 23:526–553. Further reading from Norman Can you measure safety? Part 1 Errors as clues in the search for safety measures: Measuring safety part 2
  21. Content Article
    US healthcare organisations continue to grapple with the impacts of the nursing shortage—scaling back of health services, increasing staff burnout and mental-health challenges, and rising labour costs. While several health systems have had some success in rebuilding their nursing workforces in recent months, estimates still suggest a potential shortage of 200,000 to 450,000 nurses in the United States, with acute-care settings likely to be most affected.1 Identifying opportunities to close this gap remains a priority in the healthcare industry. This article highlights research conducted by McKinsey in collaboration with the ANA Enterprise on how nurses are actually spending their time during their shifts and how they would ideally distribute their time if given the chance. The research findings underpin insights that can help organizations identify new approaches to address the nursing shortage and create more sustainable and meaningful careers for nurses.
  22. Content Article
    This study from Allan et al. investigates whether nurses working for a national medical telephone helpline show evidence of “decision fatigue,” as measured by a shift from effortful to easier and more conservative decisions as the time since their last rest break increases. The study found that for every consecutive call taken since last rest break, the odds of nurses making a conservative management decision (i.e., arranging for callers to see another health professional the same day) increased by 5.5% from immediately after 1 break to immediately before the next. Decision-making was not significantly related to general or cumulative workload (calls or time elapsed since start of shift). The authors concluded that every consecutive decision that nurses make since their last break produces a predictable shift toward more conservative, and less resource-efficient, decisions. Theoretical models of cognitive fatigue can elucidate how and why this shift occurs, helping to identify potentially modifiable determinants of patient care.
  23. Content Article
    The Community Hospitals Association (CHA) has designed a suite of resource packs as a way of sharing some of the learning in an accessible way. This resource pack focuses on the topic of safer staffing in community hospitals. This resource pack has been compiled because of requests from members of the CHA and the Special Interest Group in Q The resource pack covers the following: Methods. The context for safer staffing in terms of legislation and regulation requirements. The differences across devolved countries such as Scotland and Wales. The principles of safer staffing. Evidence and tools. What is different about Community Hospitals? Case Studies from CHA Community Hospitals COVID-19 Study. What next? References.
  24. Content Article
    In a world where most people wake up with the sun and head to their ‘9 to 5’, night shift work can be a challenge – but can it also be bad for your health? What do those health effects mean for your risk of cancer? Can working night shifts cause cancer? Worldwide Cancer Research presents the evidence. In 2007, the International Agency for Research on Cancer (IARC) classified shift work that follows an irregular time pattern as a probable cause of cancer. This was based on some animal and human studies that found that people who worked shifts or during the night were more likely to develop some types of cancer, such as breast and prostate cancer. It also came from the idea that not following the natural day/night cycle and disrupting that natural rhythm in your body, called your ‘circadian rhythm’, could have a negative impact on health. This is somewhat true, as there are biological processes that are triggered by exposure to daylight, or by hormones that fluctuate over the course of the day. However, more recent studies on night shift work and cancer risk factor in information like this, such as BMI and waist size, and have not found that shift work itself makes someone more likely to cause cancer. In 2016, a meta-analysis (which combines the data of many different studies together) found no link between night shift work and breast cancer. In 2020, another meta-analysis that included data from 57 different studies and at least nine different types of cancer found no increased risk with night shift work. So no, night shift work does not itself increase your risk of developing cancer. Instead, this type of working pattern may lead to other health behaviours or factors that increase your risk, such as being overweight or obese, or not doing enough physical activity.
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