The unrelenting demands of healthcare scheduling often create a high-pressure environment where staff feel they have little control over their work-life balance, leading to burnout and high turnover. Salisbury NHS Foundation Trust faced this exact challenge, observing a significant disconnect between its rostering practices and the wellbeing of its dedicated nursing staff. In response, the organization embarked on a transformative journey, shifting from a rigid, top-down scheduling model to a collaborative, team-based rostering (TBR) system. This strategic initiative was not merely an operational tweak but a fundamental rethinking of how to empower employees, driven by compelling evidence that a change could drastically improve job satisfaction, reduce sickness rates, and ultimately enhance the continuity of patient care. The goal was to build a more resilient and engaged workforce by placing trust and flexibility at the heart of their scheduling process.
The Catalyst for Change
Identifying the Rostering Crisis
The impetus for this large-scale transformation stemmed from a clear and quantifiable crisis in staff morale directly linked to the incumbent rostering system. A 2023 staff questionnaire delivered a stark verdict: only 55 percent of employees expressed satisfaction with the way their schedules were managed. The feedback painted a consistent picture of frustration, highlighting a profound lack of flexibility, severely limited choices for shifts, and a pervasive sense of unfairness in how schedules were allocated. This was more than just a matter of preference; it was a systemic issue contributing to a feeling of powerlessness over personal and professional lives. The organizational consequences were severe and measurable, with high rates of short-term sickness fluctuating between 5 and 12 percent across various wards and an average staff turnover rate that had climbed to a concerning 12.34 percent.
This situation represented a critical threat to operational stability and the quality of patient care. The high turnover and sickness rates placed an immense strain on the remaining staff and created significant financial burdens related to recruitment and temporary staffing. The trust’s leadership recognized that the traditional, management-led approach to scheduling was no longer sustainable. It was actively disengaging its most valuable asset—its people. The data presented a clear mandate for a fundamental change, shifting the focus from simply filling shifts to creating a working environment that actively supported employee wellbeing and retention. The problem was not a lack of effort from managers but a flawed system that failed to meet the modern workforce’s needs for autonomy and work-life integration.
A Proven Solution in Action
In stark contrast to the widespread dissatisfaction, Salisbury NHS Foundation Trust held powerful internal evidence of a superior alternative. Back in 2020, the trust had served as a pilot site for a TBR system, implementing it on two inpatient wards. The results from these pilot wards were nothing short of remarkable and provided a clear blueprint for success. An overwhelming 87 percent of the staff on these wards reported satisfaction with their rosters, a figure that stood in sharp contrast to the 55 percent satisfaction rate seen elsewhere in the trust. This dramatic improvement in sentiment was backed by equally impressive tangible benefits that addressed the organization’s most pressing workforce challenges. The data showed that short-term sickness rates on the two pilot wards had plummeted to just 1.58 percent and 1.3 percent, respectively, demonstrating a direct link between flexible scheduling and improved staff health.
Furthermore, the impact on staff retention was profound. Employee turnover on the pilot wards fell dramatically to 2.96 percent and 6.41 percent, significantly below the trust’s average. These figures were not just statistics; they represented a powerful “proof of concept” that empowered scheduling could directly combat the pervasive issues of burnout and attrition. This successful pilot provided the critical impetus to revive the expansion plan, which had been temporarily paused due to the global pandemic. When the initiative was revisited in 2023, the trust’s leadership had concrete, internal data demonstrating that team-based rostering was not a theoretical ideal but a proven strategy for fostering a healthier, more stable, and more satisfied workforce, making the case for a trust-wide rollout compelling and urgent.
The Strategic Rollout
A Structured Path to Implementation
To extend these proven benefits across the organization, the trust developed a formal and meticulously planned project, scheduled to run from May 2025 to March 2026. The ambitious scope included the implementation of TBR across 21 inpatient wards, a significant undertaking that even encompassed the high-pressure environment of the Emergency Department. Rather than a disruptive, single-event launch, the rollout was strategically broken into two core phases to ensure a controlled and successful transition. The first phase served as a refined pilot, focusing on the pediatric ward. This allowed the project team to configure specific system changes and new rostering rules based on the valuable lessons learned from the original 2020 pilot. It also provided an opportunity to deliver targeted training sessions in a contained environment, perfecting the process before scaling up.
Following a successful implementation in the pediatric ward, the project was then rolled out to the remaining wards in the second phase. This structured, phased approach was critical to managing the complexity of the change and mitigating potential risks. It allowed the project team to build momentum, demonstrate early successes, and apply an iterative improvement model to the deployment strategy. Leadership and ownership were also central to the plan. The entire initiative was championed by an enthusiastic Safe Staffing Matron who served as the project lead. The initial and most critical step involved securing buy-in from key leadership figures, including ward leads, matrons, and divisional directors of nursing. This ensured that leaders at every level would take ownership of the change and actively drive its adoption within their respective areas, fostering a sense of shared purpose from the outset.
Fostering Buy In and Providing Support
Recognizing that the shift to TBR was as much a cultural transformation as a technical one, the trust launched a comprehensive communications and support plan. The strategy was designed to ensure that the vision and benefits of the new system were clearly understood by every staff member. A multi-channel communications campaign utilized posters, a dedicated internal webpage, staff bulletins, and continuous updates to keep everyone informed. Alongside this, a detailed internal change plan was created, which included the development of an extensive suite of support materials. These resources, such as instructional videos, practical training guides, and a robust list of frequently asked questions (FAQs), were designed to be easily accessible and to address common concerns proactively, empowering staff to embrace the new system with confidence.
To ensure that both staff and managers felt fully supported throughout the transition, the project team offered readily available drop-in sessions and interactive workshops. These forums provided a safe space for open dialogue, hands-on training, and personalized assistance. The implementation plan also strategically allocated three full roster periods post-launch for embedding the new collaborative culture. During this crucial time, the project team maintained regular contact with roster creators to monitor progress, gather feedback, and make continuous improvements. A structured benefit-tracking schedule was established, with formal reviews planned for March, June, and September 2026. This rigorous monitoring was designed to measure the project’s success against its initial objectives and ensure that the system was delivering its intended, transformative impact on staff wellbeing and operational efficiency.
Measuring Success and Impact
Projecting Direct and Tangible Benefits
To ensure accountability and measure the true impact of the initiative, the trust established clear metrics categorized into direct and contributory benefits. Among the direct benefits—those solely resulting from the project—the primary goal was to significantly increase staff satisfaction with rostering from the 55 percent baseline to a target of at least 70 percent. Another key aim was to enhance fairness and flexibility by increasing the number of requested duties granted to staff by 50 percent. The project also sought to foster a more collaborative environment by increasing the number of shifts requested by staff to at least 25 percent in each ward, thereby empowering teams to co-create their schedules. From an operational standpoint, a significant reduction in the administrative hours spent by ward managers on creating and managing rosters was expected, freeing them up for higher-value clinical and leadership activities.
This focus on measurable outcomes extended to the core objective of improving work-life balance. While staff wellbeing itself is a qualitative benefit, the system was designed to better support existing flexible working agreements. An interesting anticipated outcome was that the inherent flexibility of the TBR system might accommodate scheduling preferences so effectively that some staff would no longer require formal flexible working agreements. By giving employees greater control and choice, the trust aimed to create a more harmonious integration of work and personal life. This suite of direct benefits was designed not just to solve the initial problems but to create a fundamentally more efficient, equitable, and employee-centric scheduling process that would pay dividends in both staff satisfaction and organizational performance for years to come.
Wider Organizational Improvements
Beyond the direct outcomes, the team-based rostering initiative was projected to create a positive ripple effect, contributing to broader organizational health and stability. A major contributory benefit was an expected reduction in short-term sickness rates, with a target decrease of 2 percent over a 12-month period. By reducing the stress and burnout associated with inflexible scheduling, the trust anticipated a healthier and more resilient workforce. This, in turn, was expected to directly impact staff retention. The initiative aimed to maintain or improve the average staff turnover rate, helping to stabilize teams and reduce the significant costs associated with recruitment and training new personnel. A stable, experienced workforce is essential for maintaining high standards of patient care and safety.
Furthermore, the very nature of the collaborative scheduling process was expected to enhance team dynamics. By working together to build fair and effective rosters, team members would naturally improve their communication, negotiation, and problem-solving skills. This collaborative effort was projected to foster a stronger sense of camaraderie and mutual support, leading to improved team building and overall staff engagement. While these benefits are less easily quantified, their impact on the workplace culture is invaluable. A more engaged and cohesive team is more innovative, more productive, and better equipped to handle the daily challenges of a demanding healthcare environment, ultimately leading to better outcomes for both staff and patients.
Navigating Challenges and Key Takeaways
Addressing Implementation Hurdles
The implementation of such a significant change was not without its challenges, and the trust’s approach to overcoming them provided valuable insights. One key risk was the project’s reliance on a small expert team, creating a potential single point of failure. To mitigate this, the team held weekly meetings to ensure knowledge was shared continuously, building resilience and ensuring continuity even if a key member was unavailable. Another obstacle was variable engagement from leadership; some ward leads were initially hesitant to fully champion the new system. This was addressed through targeted guidance and dedicated drop-in sessions designed to build their confidence and encourage their ownership of the process. This personalized approach helped convert skepticism into advocacy, which was crucial for driving adoption at the ward level.
Managing the profound cultural change from individual requests to a collaborative, team-based approach required a significant mindset shift among staff. This was supported by a sustained engagement strategy and the provision of easily accessible support materials like guides and videos, which helped demystify the new process and reinforce its benefits. Despite a multi-channel communication strategy, it became apparent that some staff still felt uninformed, highlighting the persistent challenge of ensuring messages reach everyone in a large, busy organization. This underscored the need for ongoing and varied communication methods to saturate the environment with information. By proactively identifying and addressing these hurdles, the project team was able to navigate the complexities of the transition and keep the implementation on track.
A Blueprint for Future Success
The experience at Salisbury NHS Foundation Trust culminated in a valuable blueprint for other organizations seeking to undertake similar transformations in workforce management. The journey underscored several critical takeaways for achieving success. First and foremost was the importance of engaging stakeholders early and widely, from executive leadership to frontline staff, to build a coalition of support and ensure the solution met real-world needs. The strategic use of a pilot program proved indispensable, not only for learning and refining the approach but also for demonstrating tangible value, which in turn built the momentum needed to secure buy-in for a wider rollout. Building resilience into key project roles was another crucial lesson, ensuring that the initiative was not overly dependent on a few individuals.
Ultimately, the trust’s journey had moved beyond a simple technology implementation. It had successfully addressed a deep-seated cultural issue by placing employee wellbeing at the forefront of its operational strategy. The structured support, continuous monitoring, and clear objectives had been pivotal, but the most critical element was the intentional focus on managing the cultural shift. The evidence gathered from the pilot had not only justified the project but also served as a constant reminder of its value, reinforcing the new collaborative ethos. This comprehensive approach provided a clear path to fostering a more engaged, satisfied, and resilient workforce, offering a model of success for healthcare systems everywhere.
