Do Compressed Work Schedules Compromise Care Quality? A Five-Year Case Control Study in the Norwegian Long-Term Care Sector.

BACKGROUND: In a compressed work schedule, employees work extended shifts (≥10 hours) in exchange for fewer workdays. This shift schedule has been argued to both improve and compromise the quality of care. However, existing research remains limited and inconclusive. OBJECTIVE: To assess whether extended shifts within compressed work schedules impact the risk of adverse outcomes among care recipients. DESIGN: Quasi-experimental case control study. METHOD: We combined a nationwide organizational survey from 1,072 long-term care institution in Norway with registry data on service users from 2018-2022. At baseline, all participating organizations operated either a two-shift rotation (day/evening) with fixed night workers or a three-shift rotation (day/evening/night). The intervention group comprised organizations (n=320) that introduced a compressed schedule during the study period; the control group retained their existing shift rotations. Using difference in difference with multiple treatment times we analysed changes in proportion of service users within each organization experiencing at least one adverse outcome per month. Adverse outcomes were identified via diagnostic codes from the Norwegian Registry for Primary Health Care, including infections, chronic ulcers, accidents, and depression. RESULTS: Overall, we found no difference in the risk of adverse outcomes (b -0.46, 95% CI -0.97 to 0.05). Stratified analyses indicated a significant reduction in adverse outcomes in nursing homes (b -0.79, 95% CI -1.48 to -0.10). However, we found no significant change in residential care (b 0.20, 95% CI -1.11 to 0.70) or home care (b -0.42, 95% CI -1.20 to 0.36). CONCLUSION: The findings neither discourage the use of compressed work schedules due to adverse outcomes nor indicate broad improvements. However, the results suggest potential context-specific benefits that warrant further investigation.