Workforce issues 17.7% felt undervalued by the public.5 Working
conditions in the NHS are a source of significant concern, with 41% of staff reporting feeling unwell as a result of work-related stress in the last twelve months. Many staff are overwhelmed by it and feel demoralised, overstretched or burnt out. Many low paid workers are leaving for better paid jobs away from healthcare. In addition, NHS staff are often required to work beyond their shift hours with little consideration for their domestic circumstances or work/life balance.
Staff fatigue and its consequences Being fatigued at the end of a shift is expected, and, if it is not present, so the overriding culture believes, you haven’t been working hard enough. Acutely, fatigue is known to impair performance and is linked subsequently to patient safety. The HSSIB undertook their investigations in a number of different Trusts and their report is intended to help healthcare organisations, regulators, policymakers, patient safety leads and the public understand the risk that healthcare staff fatigue poses to patient safety and staff safety, and to make improvements in this area. The findings are many, and some have been selected here6
to represent what is felt to
be topics of interest to the readers, together with the connection to patient safety incidents. The key findings included: l Staff fatigue contributes directly and indirectly to patient harm. However, there is little evidence available to help understand the size and scale of the risk, how it impacts on patient safety, and those staff groups who may be most at risk of fatigue.
l There was variation in how the concept of fatigue was understood and the impact it could have on patient safety and staff safety across the healthcare system. This inconsistent understanding prevented
fatigue risks being addressed.
l Staff fatigue is not routinely captured as part of patient safety event reporting or routinely considered as part of patient safety event learning, or other governance processes.
l Fatigue was perceived by organisations and staff as an individual staff risk, with limited organisational accountability. This sometimes led to a blame culture and punitive actions when staff were fatigued, and limited actions to drive improvement.
l Fatigue arises from a number of personal and organisational factors, which can overlap. Organisational factors that contributed to staff fatigue included workload, long shifts, insufficient rest facilities and inadequate rest breaks during and between shifts. Personal factors that contributed to an increased risk of fatigue included caring responsibilities, menopause, pregnancy, religious practices and socioeconomic factors.
l There are barriers to acknowledging the risk posed by staff fatigue. These include historical beliefs and norms around working long and additional hours, pride and ‘heroism’ of NHS staff.
l The demands on healthcare services, and
workforce and financial constraints, limited the ability of some organisations to address fatigue risks.
l There is limited regulatory and national oversight of the risks posed to patient safety by staff fatigue in healthcare.
As a result of the findings, the HSSIB makes a number of safety recommendations. The overarching recommendation is that the organisation asks/recommends that the Department of Health and Social Care reviews any current processes which capture staff fatigue related data. The review should identify how information about factors impacting on staff fatigue should be collated and further enhanced to aid the understanding of fatigue risk in healthcare. This data will then help to inform the development of any future strategy and action to address staff fatigue risk and it’s impact on patient safety. There is a considerable problem with reviewing present data, as there is no agreed understanding of how fatigue should be defined. HSSIB recommends that the NHS staff council, via the Health and Safety and Well-Being Group, develop and test a consensus statement, which should help to support a consistent understanding and identify the factors which might impact on staff fatigue and patient safety. At present, the definition used by HSSIB is the
one devised by the International Civil Aviation Organisation and reads as: “A physiological state of reduced mental or
physical performance capability resulting from sleep loss, extended wakefulness, circadian phase [the natural daily internal body clock], and/or workload (mental and/or physical activity) that can impair a person’s alertness and ability to perform safety related operational duties.”
Patient safety incident response framework The NHS Patient Safety Strategy was updated in 2019 by the Patient Safety Incident Response Framework (PSIRF), which sets out how the
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www.clinicalservicesjournal.com I June 2025
Maria Vitkovska -
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gpointstudio -
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