Dr Mary Lavelle, Dr Benjamin Brew, Miss Francesca Cibelli, Dr Trisha Forbes, Miss Olivia Lounsbury, Dr Gary McKeown, Prof Gabriel Reedy, Dr Natalie Sanford & Prof Janet E Anderson, Queen’s University of Belfast.
This presentation shares evidence-based insights into workforce planning, staffing assurance and governance structures, based on findings from a sustained programme of ethnographic observational research across physical and mental health inpatient settings. The research was conducted in partnership with leading experts in Human Factors and Patient Safety and examined routine clinical practice in-situ, supported by theoretical models and analytical frameworks explaining how staffing, teamwork and safety interact within complex systems. The presentation highlights potential opportunities to align workforce policy with robust, inter-disciplinary academic research findings regarding the delivery of care in real clinical environments, and thereby support safe, high quality and sustainable care across Northern Ireland’s health and social care system. It is relevant to Assembly deliberations concerning the forthcoming Safe and Effective Staffing Bill.
While highlighting widespread workforce shortages, it explains the uneven impacts of those shortages across services and teams and how safe, high-quality care is shaped not only by staffing numbers, but by teams’ ability to coordinate, adapt and manage complexity under resource constraints. The presentation further explains how healthcare staff operate amid multiple competing pressures, including organisational targets, documentation requirements and performance measures; and in practice, those system-level demands often take precedence over staff well-being, manageable workloads, and direct care quality. Research revealed how these daily trade-offs are largely invisible in formal staffing metrics, yet they have significant consequences for fatigue, moral distress and patient safety. For example, observational research undertaken in mental health wards showed organisational priorities frequently drew staff away from patient engagement and safety critical work and contributed to increased use of restrictive practices such as physical restraint and seclusion when responding to patients’ distress.
Moreover, research showed not all teams experience staffing pressures equally. It identified five distinct team types, varying in purpose, membership stability and co-location, and how those characteristics shape teams’ resilience when there are staffing shortfalls. The evidence indicated stable, co-located teams with shared purpose and regular communication were better able to absorb shortages through adaptive coordination. In contrast, teams with fluid or transient membership struggled to maintain situational awareness and manage risk.
This research is funded by the NIHR Imperial Patient Safety Translational Research Centre (PSTRC) the NIHR Research for Patient Benefit fund (NIHR201508) and the Health and Social Care Research and Development Division, Public Health Agency, Northern Ireland (Award reference COM/5807/24). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
This seminar took place on 10 June 2026.
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