Implementing team-based rostering across multiple wards

Overview

A 2023 staff questionnaire specifically aimed at roster reviews at ward level at Salisbury NHS Foundation Trust (SFT) revealed only 55 per cent satisfaction with traditional rostering, citing restricted choice, limited flexibility and unfairness. Building on pilot runs in 2020 across two wards, where 87 per cent of staff reported positive impacts, the trust rolled out team-based rostering (TBR) across 21 inpatient wards including Emergency Department, with the aim of improving staff wellbeing, satisfaction, and continuity of patient care.

Key benefits and outcomes

• Improved staff wellbeing and work-life balance through greater input into rostering.
• Increased staff roster satisfaction from 55 per cent to a target of 75 per cent.
• Reduced short-term sickness, aiming for a 2 per cent decrease within 12 months.
• Improved operational efficiency through better roster management.
• Maintained or improved staff retention.

What the organisation faced

SFT was a pilot site for TBR for the software provider. In 2020, the trust piloted the system on two wards and saw clear benefits from the approach, leading to a desire to roll it out more widely. However, this was paused due to Covid-19. 

In 2023, the trust identified dissatisfaction related to traditional rostering practices, as reflected by only 55 per cent of staff reporting satisfaction in a ward-level questionnaire.  Staff cited inflexible allocation, restricted choices, unfairness and limited control over schedules. These issues contributed to higher short term sickness rates (5-12 per cent across wards) and higher turnover (12.34 per cent trust average).

In contrast, the two pilot wards that implemented the TBR approach in 2020 and continued to use it reported significantly higher satisfaction levels with 87 per cent of staff expressing satisfaction with their rosters. Short term sickness reduced to 1.58 per cent and 1.3 per cent, and turnover fell to 2.96 per cent and 6.41 per cent in both wards. The trust needed a solution to extend these benefits across all inpatient wards improving workforce engagement, staff wellbeing, retention and continuity of patient care.

What the organisation did

To address the challenge the trust executed a phased project to implement TBR across 21 inpatient wards including Emergency Department, running from May 2025 to March 2026. The project lead (Safe Staffing Matron) was enthusiastic about rolling this out and supported engagement activities to gain buy-in and drive cultural change. 

The trust first secured buy-in from ward leads, matrons and divisional directors of nursing to foster ownership. A comprehensive communications plan was launched to support this using, using posters, internal web page, staff bulletins and continuous updates. The rollout was conducted in two core phases. 

• Phase 1 involved a focused implementation in our paediatric ward, which included configuring changes and new rostering rules, building on lessons learned from the 2020 pilot wards along with specifically targeted training sessions for staff.
• Phase 2 then rolled out to the remaining wards, supported by drop-in sessions and workshops for staff and ward leads.

This was supported by a detailed internal change plan, including development of videos, training guides and FAQs. The plan dedicated three roster periods post implementation for embedding the new collaborative culture and making continuous improvements, liaising with roster creators regularly to ensure optimal impact. To measure impact, a structured benefit tracking scheduled was established with reviews planned for March, June and September 2026. The approach was internally developed, adapting the trust’s own successful pilot model.

Results and benefits

Three benefit reviews are scheduled for March, June and October 2026. Staff feedback will be gathered through questionnaires to support evaluation at three-monthly intervals for the first year.

The project will deliver both direct and contributory benefits. Direct benefits will solely result from the projects outputs. Contributory benefits will be influenced by the project alongside other factors. Some benefits are directly measurable, while others will be observed improvements (non-measurable), reflecting qualitative benefits. Together these benefits will support improved service efficiency, staff wellbeing and increased staff satisfaction.

Direct benefits

• Increased staff satisfaction: Increase staff satisfaction with their rosters, aiming for at least 70 per cent satisfaction.
• Shift request fulfilment:  Increase requested duties being granted by 50 per cent.
• Percentage of requested duties: Increase number of shifts requested by staff to aid roster creation. Aim to increase to at least 25 per cent in each ward.
• Improved operational efficiency: Significant reduction in the hours spent  managing rosters by ward managers, freeing more time for value-added clinical and operational activities.
• Improved staff wellbeing and work-life balance: This is expected to result in improved overall wellbeing and work life balance for staff (non-measurable).
• Increased compliance with flexible working agreements: Improved adherence to flexible working arrangements is expected.
• Reduced reliance on flexible working agreements: Some staff may be able to come out of flexible working arrangements while still having their scheduled preferences considered through TBR.

Contributory benefits

• Reduction in short-term sickness rate: A reduction in reported short-term sickness is expected, with potential decrease of 2 per cent over 12 months.
• Maintained or improved staff retention:  Improve average staff turnover rate with potential reduction.
• Improved team building and communication: Improve staff engagement and team building through input into rostering and consistent team collaboration (non-measurable).

Overcoming obstacles

• The project relied on a small expert team: To avoid this becoming a single point of failure, weekly meetings were held to share information and ensure continuity should anything unexpected occur.
• Variable engagement and leadership: Some ward leads were initially slow to champion TBR. This was supported through targeted guidance and drop-in sessions to encourage ownership.
• Cultural change: Moving to collaborative team-based rostering required a mindset shift, emphasising shared ownership and teamwork rather than individual effort. Continuous engagement and available guides, videos and drop-in sessions helped in embedding the new approach.
• Communication: Despite multiple communications, some staff reported not being informed about the new approach. Ongoing communications, available guides and videos to help reach all staff.

Takeaway tips

• Engage early and widely: Involve ward leads, matrons, staff and other key stakeholders from the start to build ownership and encourage a collaborative culture.
• Pilot to learn and prove value: Run a controlled pilot to test the approach, identify practical adjustments, and generate local evidence of benefits. This provides crucial lessons for refinement before committing to a full, trust wide rollout.
• Build resilience into key roles: Immediately identify and mitigate single points of failure especially in technical areas. Implement knowledge sharing and shadowing from the start to protect the project timeline.
• Provide structured support: Ensure staff can access training and guidance when needed. Ensure easy access to instructional materials.
• Monitor, adapt and learn: Collect feedback, review rosters and make adjustments to embed best practice.
• Set clear objectives: Define what success looks like.
• Plan for culture change: Moving from traditional rostering to TBR requires ownership from ward leads and visible examples of success.
• Highlight benefit with evidence: Share measurable outcomes from pilots to motivate teams and reinforce value.
• Allocate sufficient time and a dedicated resource: To properly assess and monitor the effectiveness of each roster. 

Contact details

For more information about this case study, contact: 

Clare Holbrooke-Jones, Safe Staffing Matron, Salisbury NHS Foundation Trust 

• Email:  c.holbrooke-jones1@nhs.net;
• Mobile:  07734 052324

Elo Ofere, Project Manager, Salisbury NHS Foundation Trust         

• Email:  elo.ofere@nhs.net