Staff unavailability and safe staffing: Are headroom allowances 'realistic'?

Background “Hours per patient day” (HPPD) is an internationally recognised resourcing metric used to measure direct nursing care hours. However, hospitals often under-estimate indirect time (unavailability) and specify unrealistic targets for planned unavailability (“headroom”). Aims To investigate the disparities between planned unavailability (“headroom”) and actual staff unavailability. Methods Data were collected from the e-rostering systems of 87 NHS Trusts. This was compared with published data from 35 roster policies. Results Many hospitals use headroom as a Key Performance Indicator (KPI) and set targets for its components in their roster policies. This research highlights large variations in unavailability (15.8% to 33.6%) and lower variations in headroom (16-26%). Conclusions Hospitals operationalise headroom around an idealised ‘target’ value. This may be detrimental. Compelling a unit with unavailability between 28-30%, to adopt an institution-wide headroom of, say, 22% may, at best, increase spending on bank/agency staff, or, at worse, jeopardise patient safety.