Falu Hospital, Sweden: Towards a balanced flexibility
The dedicated strokes unit of Falu hospital has a flexible system for scheduling work. There is a local working hours agreement which gives much flexibility and an electronic system is used for planning work schedules. This system meets the needs of the organisation while allowing employees to exercise considerable influence over their own working schedule.
Falu hospital is a medium-sized hospital in Falun, a provincial town in Sweden. It operates on a 24-hour basis, 365 days a year, so the scheduling of working time is important. To facilitate the smooth functioning of the hospital, it is essential that there is always sufficient staff of each category present.
The hospital has 500 beds and 17 units. It has several categories of employees, who belong to different unions and have different collective agreements. Union affiliation is high among all categories of employees (around 90%). There are four collective agreements in operation, each with slightly different conditions as regards working time. A full-time nurse works 38.25 hours per week and a full-time nursing assistant works 37 hours; employees on permanent night shift work fewer hours; a large proportion of all employees work part time.
Description of the initiative
Falu hospital has one unit dedicated to stroke patients. The unit has 25 employees in two categories: nurses and nurse assistants. Since 1990, the unit has practised local working time agreements for each category, and used an electronic system (Frida) for planning working time.
Work schedules are planned for six weeks at a time. The planning is structured in three phases:
- In the first phase of the planning process, the unit manager registers the number of staff of each category needed on an hourly basis.
- In the second phase, which normally lasts for three weeks, each employee registers their preferred working schedule for the coming planning period.
- The third phase is the adjustment period. Each employee can log into the system and see all their colleagues’ registered schedules; they can also see to what extent the required staff matches employee preferences. Each employee is asked to help adjust any mismatches they identify; in most cases employee input solves any problems. Two administrators are appointed to check the planning and help in the matching process. If the matching problem cannot be solved informally, a staff meeting is organised.
Each employee has the right to ‘veto’ any hours that they particularly do not want to work; this right exists to protect important family commitments and private needs.
The local working time agreement at the hospital makes it possible to vary the total number of hours worked in a month, depending on organisational needs and employee preferences. The agreement allows employees to vary the total number of hours and have an individual ‘bank’ of hours, which can vary from a credit of 40 hours to a deficit of 20 hours.
The central working time agreement stipulates extra pay for working inconvenient hours (such as nights, weekends or holidays). On top of that, the unions have negotiated an extra 10% of pay, which can be distributed locally in each unit. In the case of the strokes unit, the unions and the employer have agreed to use the money as extra pay for night work between 22.00 and 06.00.
The local working-time agreement and the use of the electronic planning system Frida is seen as a success by both the employer and employees. Before the introduction of this system, the unit manager used to hire extra staff to cover planned absences, such as study leave or holidays. Such forms of absenteeism can now, through better planning, be covered by the permanent staff.
The employees prefer this system, as it gives them more influence over when they work. The union reports that none of its members has asked to return to the previous manual planning system. Employees find they have much better possibilities for combining working life with family life, thanks to the individual planning option and the option to use the time bank and vary the number of hours worked per week.
Tensions sometimes arise among the employees, due to the perception that some employees are not doing their fair share of work during the night shift; such tensions can generally be resolved through a staff meeting.
Some employees, however, have pointed out that while the system benefits employees, it has negative consequences for patients: the system may result in each patient being dealt with by a greater number of staff members; moreover, staff members do not work the same hours each day. Some patients prefer to have the same staff member look after them on a daily basis. The less frequent use of extra staff benefits all parties, as the permanent staff are familiar with the work practices and can work more easily with one another.
Arranging work schedules is not easy in organisations that need a continuous staff presence. The task is to balance the requirements of the organisation with the varied preferences and needs of the employees. The arrangement at Falu hospital is a good example of how the problem can be solved in a way that benefits both employer and employees. The method used to reach a local working time agreement indicates that it is possible to reach a solution that takes into account both the local situation and the preferences of the local employees. Furthermore, the use of the electronic planning system Frida opens up new possibilities for matching the needs of the organisation with the preferences of the employees.
The use of Frida, combined with the local agreement, has led to lower costs for the management and has given employees more control over their working time, both in terms of when they work and in the number of hours worked per week. The degree of influence an employee can exert depends on the size of the planning group and on whether the unit is temporarily understaffed. With a larger planning group, an employee’s chances of getting their preferred work schedule increase; during times of temporary understaffing (for instance at a time of high staff turnover), their chances decrease.
Exemplary and contextual factors
Hospitals rely on having staff working day and night. The scheduling of hours is an ongoing feature of hospital work, for which many methods have been used. The Falu hospital planning system is a good example of a local agreement that contains substantial flexibility and gives employees the opportunity to influence their work schedule. Electronic planning systems require an investment in new technology and in training for staff; once the system is in place, however, such a system offers considerable benefits, as the example of Falu hospital demonstrates.
Olle Hammarström, National Institute for Working Life, Stockholm