National recommendations for shift scheduling in healthcare: A 5-year prospective cohort study on working hour characteristics

Abstract

Background: National recommendations to decrease the health and safety risks of working hours are often given based on the increasing knowledge of the associations between working hour characteristics and health. However, the utilization of the recommendations, and their potential to change the actual working time patterns in healthcare sector is unclear.

Objective: We investigated the extent to which the national recommendations are utilized in shift scheduling, when they are integrated as a shift schedule evaluation tool into the shift scheduling software. Second, we examined whether the use of the tool results in changes that are in line with the recommendations.

Design: A prospective cohort study with a 5-year follow-up.

Participants: A total of 36,663 healthcare workers with objective data on daily working hours in 10 hospital districts and 6 large cities.

Methods: We investigated the annual use of the evaluation tool, and the effects of using the tool on annual changes in working hour characteristics from 2015 to 2019 while adjusting for the hierarchical structure of the data, age, sex, shift work, night work, work contract days and the type of shift scheduling software. Utilizing intention-to-treat principle, the employees in wards using the tool were compared to non-users by multi-level generalized linear models.

Results: Continuous use (during at least 10 scheduling periods) of the evaluation tool increased from 2% in 2015 to 20% in 2018. In the fully adjusted model, the use of the evaluation tool was associated with the decrease of >6 consecutive workdays (OR 0.73, 95% CI 0.66, 0.81), >4 consecutive night shifts (OR 0.86, 95% CI 0.77, 0.95), and proportion of <11-hour shift intervals (difference 0.63, 95% CI 0.43, 0.83). The proportion of single days off (difference 0.33, 95% CI 0.15, 0.51), and >40-hour work weeks (OR 1.16, 95% CI 1.10, 1.22), as well as the proportion of ≥12-hour work shifts (OR 1.22, 95% CI 1.07, 1.38) increased. Realized shift wishes decreased (difference 0.76, 95% CI 0.12, 1.41). The use of the tool was associated with more frequent changes towards the recommendations in the cities compared to the hospital districts, and among the older age groups compared to the ≤30-year-old employees.

Conclusions: National recommendations embedded in the shift schedule evaluation tool were used continuously by one fifth of the employees, and were associated with several, albeit modest changes towards the given recommendations. Changes in working hour characteristics depended on organization indicating for differences in the implementation of the recommendations.

Tweetable abstract: The national recommendations for safer working hour characteristics embedded in a shift schedule evaluation tool are associated with several, albeit modest changes in working hour characteristics.

Keywords: Healthcare; Occupational health; Organizational ergonomics; Recommendations; Shift scheduling; Shift work.