Summary: This case study describes a 12‑month, data‑based initiative in a 35‑bed medical‑surgical unit at a large urban hospital that combined schedule redesign and leadership practice changes to reduce staff burnout. Data sources included validated burnout inventories, administrative records (sick days, overtime), and qualitative interviews. Findings showed meaningful reductions in burnout indicators and improved staff retention. Limitations and contextual factors are described.

Problem

In early 2023, nursing leadership in an anonymous 35‑bed adult medical‑surgical unit reported elevated reports of staff stress, increased unplanned leave, and higher-than-expected turnover compared with hospital benchmarks. To quantify the issue we used the Maslach Burnout Inventory (MBI) and unit data for a baseline period of 6 months prior to intervention. Key baseline indicators (anonymized):

• Survey response rate: 78% (n = 46 of 59 clinicians)
• Mean emotional exhaustion (MBI): 28.5 (moderate‑high range)
• Unplanned sick days / full‑time equivalent (FTE) / 6 months: 7.8 days
• Overtime hours / FTE / 6 months: 64 hours
• 12‑month projected turnover rate: 28%

These data were treated as unit‑level, anonymized indicators. The goal was to reduce burnout indicators and improve retention within 12 months while preserving patient safety and coverage.

Strategy: Interventions and Rationale

The unit implemented two complementary intervention streams simultaneously: schedule redesign and leadership practice change. The plan was co‑created with frontline staff via focus groups and a volunteer staff advisory panel to maximize feasibility and acceptability.

Schedule redesign

• Self‑scheduling windows: staff could request preferred shifts within constraints, increasing perceived control.
• Shift length and rotation adjustments: piloted a move from predominantly 12‑hour rotating shifts to a mixed model offering fixed 8‑hour day shifts and optional 12‑hour night shifts to reduce circadian disruption for some staff.
• Protected break times: formalized policies and enforcement for 30–45 minute uninterrupted breaks per shift when census allowed.
• Cap on consecutive workdays: maximum of 5 consecutive scheduled workdays, with at least 2 full days off following a block of 3 or more night shifts.

Leadership practice change

Unit managers completed a focused development program emphasizing evidence‑based leadership behaviors: regular one‑to‑one check‑ins, clear delegation, psychological safety, and rapid feedback cycles. Training drew on situational principles and practical coaching. Management actions included:

• Daily brief safety and workload huddles (10 minutes) to improve situational awareness.
• Weekly protected time for team debrief and recognition of positive events.
• Monthly leader rounding with a standardized wellbeing check tool and a documented follow‑up plan.
• Access to a peer support network and facilitated group reflection sessions.

Leaders were trained to adapt their style to situational needs, balancing task focus and emotional support—an approach aligned with situational leadership.

Measurement Methods and Observation Period

We used a mixed‑methods, repeated‑measures design over 12 months (baseline, 6 months, 12 months).

• Quantitative measures:
  • Maslach Burnout Inventory (MBI) subscales: emotional exhaustion, depersonalization, personal accomplishment.
  • Administrative metrics: unplanned sick days per FTE, overtime hours per FTE, vacancy and turnover rates, patient‑to‑nurse ratios.
• Qualitative measures: semi‑structured interviews with purposive sampling (n = 12) and monthly open comment boxes for staff.
• Process metrics: schedule adherence, break compliance logs, attendance at huddles and training.

All data were anonymized before analysis. Response rates were 76% at 6 months and 74% at 12 months. The initiative complied with the hospital’s quality improvement governance; no patient‑level data were used.

Results

After 12 months, the unit showed consistent improvement across multiple indicators. Key outcomes (anonymized):

• Emotional exhaustion (MBI): mean decreased from 28.5 to 21.4 (a 25% reduction).
• Depersonalization: mean decreased by 18%.
• Perceived personal accomplishment: mean increased modestly (9%).
• Unplanned sick days / FTE / 6 months: decreased from 7.8 to 5.2 days (33% reduction).
• Overtime hours / FTE / 6 months: decreased from 64 to 41 hours (36% reduction).
• 12‑month turnover rate (projected): decreased from 28% to 18%.
• Staff satisfaction: qualitative interviews reported improved team morale, better work–life balance, and appreciation for clearer communication.

Process measures showed high fidelity to the schedule model: >85% of shifts offered protected breaks when census allowed, and >90% completion of daily huddles. Participation in leadership training exceeded targets (100% of unit managers completed core modules).

Interpretation and Interfering Factors

These improvements suggest the combined intervention was associated with reduced burnout signals and operational benefits. However, causal attribution is limited by concurrent factors: a hospital‑wide recruitment campaign improved staffing levels during the same 12 months, and there were no major patient‑volume surges in the observation period. External contextual factors (e.g., regional public health trends) may have affected stress levels. Self‑report measures are subject to response and social desirability bias, though triangulation with administrative data strengthens confidence.

We treated the unit as a single case; results may not generalize to other specialties, smaller institutions, or different staffing models.

Lessons for Practitioners

1. Combine operational changes with leadership practice improvements. Schedule tweaks without leader support are unlikely to sustain benefits. Leaders must model and reinforce practices like protected breaks and psychological safety. For practical guidance on team engagement, see our resource on team engagement.

2. Co‑design interventions with frontline staff. Staff involvement in scheduling decisions increased buy‑in and helped avoid unintended coverage gaps.

3. Measure early and often with mixed methods. Use validated burnout tools together with administrative metrics to detect converging trends and to monitor unintended consequences (e.g., coverage holes, overtime spikes).

4. Train leaders to adapt their approach. Leadership development that emphasizes flexibility and clear communication contributes to resilience; pairing training with short, practical tools (daily huddles, one‑to‑one scripts) helped translate learning into practice. For approaches to improve communication, consider principles of effective communication.

5. Anticipate and account for confounders. When evaluating change, document concurrent organizational initiatives (hiring campaigns, policy shifts) and external factors to contextualize outcomes.

Limitations

This is a single‑unit quality improvement case study without randomized controls, so causal claims are tentative. Response bias, limited generalizability, and concurrent hospital actions are acknowledged. Future work could test the model in a controlled, multi‑site study and explore long‑term sustainability beyond 12 months.

Conclusion

Within the constraints of a real‑world hospital environment, a combined approach—practical schedule redesign plus targeted leadership changes—was associated with measurable reductions in burnout indicators, lower overtime and sick leave, and improved retention over 12 months. The case underlines the value of pairing operational tactics with leadership that supports staff wellbeing. Leaders seeking to implement similar changes should engage staff in design, measure outcomes continuously, and be transparent about limitations and adapting practices to local needs. For leadership behaviors that help motivate teams during change, review strategies for motivating your team.

Data and findings presented here are anonymized, de‑identified, and derived from a unit‑level quality improvement initiative approved by local governance. Results reflect unit experience during a defined 12‑month period and should be applied judiciously.