Team Based Rostering
Summary
Guy’s and St Thomas’ NHS Foundation Trust implemented a collaborative, team-based rostering model across Critical Care to enhance workforce wellbeing, flexibility, and staff retention for over 600 nursing staff. The pilot took place from Summer 2023 to Summer 2025.
Co-designed with frontline teams, rota coordinators, Matrons, and Heads of Nursing, the phased introduction of self-rostering empowered staff with greater autonomy over shift patterns while maintaining robust safe staffing oversight. The initiative delivered significant improvements in staff experience, operational efficiency, and retention, and has subsequently informed wider adoption across the Trust and system partners, including NHS England and Integrated Care Boards.
The Challenge
Critical Care services were operating across 10 complex nursing rosters covering more than 600 staff, presenting significant workforce and operational pressures.
High levels of flexible working, affecting over one-third of staff, created increasing complexity. Staff reported dissatisfaction with shift patterns including insufficient rest periods and clustered (“clumped”) shifts. Poor work–life balance identified in staff survey feedback, with approximately 40% of exiting staff citing this as a contributing factor. Rising sickness absence linked to stress, fatigue, and workload intensity. Significant managerial and administrative burden, with rota coordinators spending extensive time manually developing rosters while maintaining safe staffing levels.
These factors impacted staff wellbeing, morale, and retention, and posed risks to workforce sustainability and continuity of safe, high-quality patient care.
There was also an identified need to support cultural change, as traditional rostering practices were deeply embedded and there was limited confidence in alternative models.
The Solution
A collaborative and phased team-based rostering model was introduced across Critical Care, with the aim of improving staff wellbeing, increasing flexibility, reducing administrative burden, and maintaining safe staffing standards. The intervention was deliberately designed as a co-produced change programme rather than a purely operational rostering adjustment, recognising that successful implementation would require cultural change, staff engagement, and strong clinical leadership.
The approach was developed in partnership with frontline nursing teams, rota coordinators, Matrons, and Heads of Nursing to ensure the model reflected the realities of delivering safe and effective Critical Care services. Early engagement was central to the intervention. Staff were invited to take part in webinars, ward-based discussions, and feedback sessions to share their experiences of existing roster arrangements, identify key concerns, and describe what greater flexibility would mean for them in practice. This helped to surface common issues such as limited control over working patterns, insufficient rest between shifts, clumped working days, and difficulties balancing work with personal and family commitments.
To build confidence and reduce anxiety about the change, the model was introduced as a six-month pilot with clear review points. This gave staff assurance that the approach would be tested, evaluated, and refined before any long-term decisions were made. The pilot structure also helped to create psychological safety, as staff understood that their feedback would actively shape the final model. This was particularly important given previous scepticism and negative experiences associated with changes to rostering practice.
The intervention enabled staff to have greater input into their working patterns through a structured self-rostering process. However, this was not implemented as unrestricted individual choice. Instead, the model was underpinned by clear rostering principles and safe staffing parameters to ensure fairness, consistency, and service resilience. These included defined limits on shift requests, controls around annual leave, and embedded skill mix requirements to ensure that each roster continued to meet clinical acuity, staffing establishment, and patient safety requirements. Senior nursing oversight remained in place throughout, ensuring that flexibility for staff was balanced with the operational needs of the Critical Care service.
Practical implementation support was provided across clinical areas to help staff and managers adapt to the new way of working. Face-to-face support sessions were delivered to explain the process, answer questions, and provide guidance on how to engage with the self-rostering system effectively. Supporting materials, including frequently asked questions and user guidance, were developed to promote consistency and transparency. A dedicated support function was also established to provide troubleshooting, monitor engagement, and respond to issues as they emerged during the pilot.
The role of Matrons and senior nursing leaders was critical to the success of the intervention. They provided visible clinical leadership, reinforced the rationale for change, and supported consistent application of the team-based rostering principles across all 10 nursing rosters. Their involvement helped to maintain staff confidence, ensure accountability, and align the intervention with wider Trust priorities around workforce wellbeing, retention, flexible working, and safe, high-quality patient care.
The model also introduced mechanisms to monitor progress and encourage continuous improvement. Uptake, compliance, and roster quality were reviewed throughout the pilot, enabling the team to identify areas requiring additional support and to share learning across teams. This created a transparent and iterative approach, allowing the intervention to be refined in response to staff feedback and operational data.
Overall, the intervention represented a shift from traditional manager-led roster production to a more inclusive, team-based approach that gave staff greater voice and control while preserving robust governance and safe staffing oversight. By combining co-design, structured rules, senior clinical leadership, and ongoing support, the model created a sustainable framework for flexible rostering that improved staff experience while continuing to meet the needs of a complex Critical Care environment.
Results & Next Steps
The introduction of team-based rostering across Critical Care delivered significant and measurable improvements in workforce wellbeing, operational efficiency, and staff retention. The transition from a traditional, manager-led approach to a co-produced, self-rostering model resulted in a substantial reduction in administrative burden, with the time required to produce 10 rosters decreasing from approximately 230 hours to 90 hours. This released capacity for rota coordinators, ward managers, and senior nursing staff to focus on clinical leadership, staff support, and service improvement activity.
Staff experience improved markedly over the course of the pilot. While initial confidence in the model was low, reflecting previous experiences of roster change, engagement and satisfaction increased rapidly as staff began to experience the benefits of greater flexibility and autonomy. Within six months, feedback was overwhelmingly positive, with staff reporting improved work–life balance, more consistent rest periods between shifts, and greater ability to plan personal commitments, including leave and family responsibilities. This shift in experience was reflected in a significant uplift in staff morale and engagement, contributing to a more positive team culture across Critical Care.
Operationally, the model contributed to improved roster quality, enhanced shift fill rates, and more stable staffing patterns. Sickness absence reduced by approximately 15%, with team-based rostering identified as a contributing factor alongside broader wellbeing improvement. Importantly, retention also improved, with a reduction in the number of staff leaving due to concerns related to work–life balance. This has supported greater continuity within teams and strengthened the overall sustainability of the Critical Care workforce.
The impact of the initiative has extended beyond the immediate service. The model has been recognised as good practice and shared with NHS England, Integrated Care Boards, and peer organisations, contributing to the development of the NHS Flexible Working Toolkit and related programmes. Within the Trust, the approach has generated strong interest and is now being adopted or tested in approximately 20 additional clinical areas, demonstrating its scalability and relevance across different services.
Looking ahead, the focus is on embedding and sustaining the model while supporting further roll-out across the organisation. This includes continuing to incorporate staff feedback to refine the approach, strengthening digital and analytical capability to optimise roster performance, and ensuring alignment with wider workforce and wellbeing strategies. There is also an ongoing emphasis on maintaining strong clinical leadership and governance to ensure that increased flexibility continues to be balanced with safe staffing and high-quality patient care.
Overall, team-based rostering has demonstrated that a co-designed, flexible approach can deliver meaningful improvements in staff experience and operational performance, providing a sustainable model that supports both workforce wellbeing and service delivery priorities across the NHS.
