Workforce & Health Systems publications

Nwanosike E, Dall'Ora C, Griffiths P, Saville C, Monks T, Pattison N et al

Staff wellbeing in intensive care units is essential for quality patient care, and nurse staffing configurations can impact nurse sickness absence. The COVID-19 pandemic imposed additional strain on nurses, potentially affecting sickness absence rates.

The objective of this study is to examine the association between registered nurse staffing levels, skill mix, and staff sickness absence in intensive care units spanning prepandemic (01/19–02/20), early pandemic (03/20–02/21), later pandemic (03/21–02/22), and post-pandemic (03/22–12/22).

https://doi.org/10.1016/j.ijnsa.2025.100451

November 2025

Reula   M, Parreño-Torres C, Lamas-Fernandez C, Martinez-Sykora A

In the health and social care sectors it is common for some specialized teams to travel to patients homes to provide care. These teams are typically made up of by a number of staff members with varying skills, starting locations and working hours. Patients require different types of care, during specific time windows, and may have special requirements, such as needing two staff members, or multiple visits with some sort of temporal dependency between them. Since teams need to decide which staff member will visit each patient, as well as the routes they will take to do so, this kind of planning problem is known in the literature as the Home Health Care Routing and Scheduling Problem (HHCRSP). 

We introduce a new mixed integer linear programming formulation for the HHCRSP that extends previous models. Our formulation can readily be adapted to address more specific variants in the scientific literature, proving a larger number of optimal solutions and stronger lower bounds on benchmark instances using the same computational framework. We further propose an instance generator for producing scenarios that closely resemble those of the National Health Service in the United Kingdom.

https://doi.org/10.1016/j.ejor.2025.05.055

November 2025

Dylag JJ, Zlatev Z, Boniface M

In clinical research, there is a strong drive to leverage big data from population cohort studies and routine electronic healthcare records to design new interventions, improve health outcomes and increase the efficiency of healthcare delivery. However, realising these potential demands requires substantial efforts in harmonising source datasets and curating study data, which currently relies on costly, time-consuming and labour-intensive methods. We explore and assess the use of natural language processing (NLP) and unsupervised machine learning (ML) to address the challenges of big data semantic harmonisation and curation.

https://doi.org/10.1186/s12911-025-03055-y

October 2025

Bhat S,   Gavin J, Warner M, Myall M

Musculoskeletal disorders remain a leading occupational health challenge in physically demanding sectors such as healthcare, social care, and industry. Exoskeletons – wearable devices designed to mitigate physical strain are increasingly explored as potential solutions; however, factors affecting their adoption in real-world settings remain underexplored. This novel scoping review systematically maps the existing evidence on the application of commercially available exoskeletons within real and simulated work environments, focusing on usage patterns, user experiences, and factors influencing implementation.

https://doi.org/10.1017/wtc.2025.10033

November 2025

Tavares N, Jarrett N

Studying for final exams is often regarded as difficult for nursing students, therefore, activities using game-based learning methods may increase student satisfaction. Therefore, this study aimed to understand the feasibility of a game-based learning activity on nursing students' learning and revision processes. A one-group pre and post-questionnaire design was undertaken to evaluate the effectiveness of a game-based learning activity. 

All nursing students found the game-based learning activity valuable when preparing for written exams. The learning activity increased the levels of knowledge retention and the final grades. Although two students found the activity somewhat distracting, most students believed that game-based learning should be embedded into the nursing curriculum. The game-based learning activity was well-accepted when revising for written exams in nursing. However, research at a larger scale is required to confirm the effectiveness of the activity on students' knowledge, grades and long-term retention.

https://doi.org/10.1371/journal.pdig.0001043

October 2025

Reula M, Parreno-Torres C, Lamas-Fernandez C, Martinez-Sykora A

 In the health and social care sectors it is common for some specialized teams to travel to patients homes to provide care. These teams are typically made up of by a number of staff members with varying skills, starting locations and working hours. 

Patients require different types of care, during specific time windows, and may have special requirements, such as needing two staff members, or multiple visits with some sort of temporal dependency between them. Since teams need to decide which staff member will visit each patient, as well as the routes they will take to do so, this kind of planning problem is known in the literature as the Home Health Care Routing and Scheduling Problem (HHCRSP).

We introduce a new mixed integer linear programming formulation for the HHCRSP that extends previous models. Our formulation can readily be adapted to address more specific variants in the scientific literature, proving a larger number of optimal solutions and stronger lower bounds on benchmark instances using the same computational framework. We further propose an instance generator for producing scenarios that closely resemble those of the National Health Service in the United Kingdom.

https://doi.org/10.1016/j.ejor.2025.05.055

September 2025

Barker HR, Griffiths P, Dall'Ora C

The nursing workforce globally faces significant challenges, including burnout, stress, and absenteeism, exacerbated by unsafe staffing levels and suboptimal working conditions. In England, many nursing staff express intentions to leave their roles, driven by work-life imbalance. 

This study explores how the preferences and constraints of nursing staff, nurse managers, and hospital directors interact to influence shift scheduling decisions within the NHS, aiming to identify strategies that reconcile individual wellbeing with organisational imperatives.

https://doi.org/10.1186/s12912-025-03705-6

August 2025

Meredith   P, Saville C, Dall'Ora C, Weeks T, Wierzbicki S, Griffiths P

Managing nurse staffing is complex due to fluctuating demand based on ward occupancy, patient acuity, and dependency. Monitoring staffing adequacy in real time has the potential to inform safe and efficient deployment of staff. Patient classification systems (PCSs) are being used for per shift workload measurement, but they add a frequent administrative task for ward nursing staff.

https://doi.org/10.2196/71666

July 2025

Griffiths P, Saville C, Ball J, Culliford D, Jones J, Lambert F, Meredith P, Rubbo B, Turner L, Dall'Ora C

Staffing shortages are a major concern for the National Health Service. A lot of research shows that low nurse staffing in hospital is correlated with worse patient outcomes, including an increased risk of death. However, a lot of this research has only looked at hospital average staffing and has not considered other staff, such as doctors and allied health professionals, so it is hard to be sure if improving nurse staffing on wards leads to better outcomes. It is also hard to know the most cost-effective approach to addressing staff shortages. 

Our study used existing data from national reports and daily staffing data from hospital wards to answer some of the main uncertainties from past research. Using data from national reports, we found low staffing levels from doctors and allied health professionals were linked to increased risk of death. Nurse staffing levels were linked to important aspects of patient experience and staff well-being, but to properly understand the effects of nurse staffing we needed to know the staffing patients experience when on hospital wards. 

Our study included 626,313 patients in 4 hospitals. We found that when patients spent time on wards with fewer-than-expected registered nurses or nursing assistants, they were more likely to die and their stay in hospital was longer. Low registered nurse staffing was also associated with more re-admissions. We looked at the cost of avoiding low staffing and the cost of gaining the equivalent of 1 year of healthy life. We compared these ‘cost-effectiveness’ estimates for different ways of avoiding low staffing and for different patient groups.

Overall, we concluded that a focus on avoiding low registered nurse staffing gave more benefits than using assistants to fill any gaps, and should be the priority, although it is still not clear what the best level of staff is.

https://doi.org/10.3310/zbar9152

July 2025

Remmington C, Camporota L, McKenzie CA, Hanks F, Sanderson B, Rose L

Changes in sedation and pain medication levels throughout the day may affect how well patients recover. But so far, there hasn’t been any research looking at how these changes happen in patients who are on ECMO, a machine that supports the heart and lungs.

This study aimed to compare how sedation and pain medication levels vary during the day in two groups of critically ill adults: those on a ventilator and those on ECMO.

10.1016/j.iccn.2025.104056

April 2025

Hurley-Wallace AL, Defty J, Richardson A, Wagland R.

Patients with oncological emergencies require immediate specialist cancer care to ensure optimum outcomes. This is often a stressful, time-sensitive situation for patients and their families who describe having to navigate complex care pathways to access urgent treatment. Acute oncology was established as a subspecialty in the UK in 2009, with the goal to streamline emergency cancer care. Patient experiences of urgent care in acute oncology contexts have not specifically been explored; hence, it is unknown whether patient experiences of emergency cancer care have improved. This may be due to lack of a patient-reported experience measure for this purpose.

https://doi.org/10.1007/s00520-025-09245-8

February 2025

Simons G, Klepacz N, Baldwin DS

Doctors globally are increasingly experiencing high workloads and challenging working conditions and, consequently, are reporting high levels of stress, anxiety, depression,1 emotional distress, burn-out risk and suicidal feelings. This negatively impacts patient care quality, safety and satisfaction and leads to declining job satisfaction and doctors leaving the workforce. In a UK context, the 2023 National Health Service (NHS) staff survey found that 44% of doctors felt unwell in the previous 12 months because of work-related stress, and 38% often or always found their work emotionally exhausting. Emphasis is often placed on doctors to be more resilient, with stigma and a fear of potential repercussions preventing doctors from speaking up about their well-being. However, there is an emerging consensus that some aspects of doctors’ training, working conditions and organisational support negatively impact well-being. The well-being of doctors significantly impacts workforce planning, cost, healthcare quality and patient outcomes. Dissatisfaction with role/place of work or NHS culture was cited as the top reason for leaving the workforce in a General Medical Council survey, with burn-out/work-related stress as the third most cited reason behind retirement. Poor mental well-being of staff is estimated to cost the NHS at least £12.1 billion per year; tackling poor mental well-being and reducing the number of staff leaving the NHS could save up to £1 billion. The UK’s health system prioritises patient care—often over staff well-being—but long-term patient care and safety depend on staff well-being.

The need to address doctor well-being is well recognised, with government and industry reports highlighting the need for improvement. While recognising the urgent need to address doctors’ well-being, these reports often fail to operationalise well-being or specify the outcome or measurement tools required to gauge the success of their recommendations. For example, the ‘NHS Long Term Plan’ aims to make the NHS ‘the best place to work’ but provides little detail on implementation or how success will be captured or measured. The NHS Long Term Workforce Plan commits to implementing actions from the NHS People Plan to ensure that staff have access to well-being services and support; however, the British Medical Association has questioned how this ambition will be made a reality. Many employers and education deaneries now provide well-being programmes for doctors and implement the NHS health and well-being framework. However, evidence of the success of these (and similar) programmes—often aimed at individual coping strategies, resilience and productivity—suggests limited effect. The lack of consensus on what doctor well-being is and how it should be measured means that the monitoring and evaluation of these strategies are inconsistent.

The ongoing and accurate measurement of doctors’ well-being is necessary to understand local and specific needs and ensure the effective delivery of staff services. It is, therefore, vital for both research and governance to take a consistent data-driven and evidence-based approach to doctors’ well-being, taking account of the many dimensions (ie, social, cultural, environmental and economic) and levels (ie, individual, organisational and societal) that comprise this complex issue. However, work has not yet been undertaken to standardise the definition and measurement of doctor well-being. In addition, ‘well-being’ has often been used interchangeably with, or to describe, mental health, with previous research focusing largely on ‘pathologies’ such as depression, anxiety and burnout rather than positive measures of well-being. Consequently, workplace well-being has become a measure of the absence of mental health disorders. A salutogenic approach that measures positive determinants, context, mechanisms and individual and group well-being should be preferred when considering doctor well-being. A salutogenic approach is a positive approach that looks prospectively at how to create, enhance and improve well-being; as opposed to a pathogenic approach that looks retrospectively at the disease burden of doctors (usually mental health diagnoses).

Our systematic review found well-being outcomes and measurement tools used in doctor well-being research were heterogeneous, demonstrating the need for a core outcome set (COS). COSs are consensus minimum groups of outcomes with recommended reliable and valid measurement tools. Reaching agreement among stakeholders—including NHS doctors—ensures a consistent and comprehensive focus, facilitating comparison between organisations through the generation of ‘big data’, and in doing so, provides decision-makers with the evidence needed to inform future workforce strategies, interventions and actions. We used a salutogenic and consensus-based approach to develop a COS to capture and report on the well-being of doctors in the NHS. To our knowledge, this study represents the first time a non-pathological concept—well-being—has been applied to the COS-STAndards for Development (COS-STAD) guidance.

https://doi.org/10.1136/bmjopen-2024-094973

May 2025