Strategy 3: Individual absenteeism and counselling Each month, managers would analyse the pattern of absence of staff with excessive sick leave (greater than ten days per year for full time employees). Characteristic patterns of potential ‘voluntary absenteeism’ such as absence before and after days off, excessive weekend and night duty absence and multiple single days off were communicated to all ward nurses and then, as necessary, followed up by action.

Results Absence rates for the six months prior to the incentive scheme ranged from 3.69 percent to 4.32 percent. In the following six months they ranged between 2.87 percent and 3.96 percent. This represents a 20 percent improvement. However, analysing the absence rates on a year-to-year basis, the overall absence rate was 3.60 per cent in the first year and 3.43 per cent in the following year. This represents a 5 per cent decrease from the first to the second year of the study. A significant decrease in absence over the two-year period could not be demonstrated.

Discussion The non-financial incentive scheme did appear to assist in controlling absenteeism in the short term. As the scheme progressed it became harder to secure prizes and this contributed to the program’s losing momentum and finally ceasing. There were mixed results across wards as well. For example, in wards with staff members who had long-term genuine illness, there was little chance of winning, and to some extent the staff on those wards were disempowered. Our experience would suggest that the long-term effects of incentive awards on absenteeism are questionable.

Over the time of the study, staff were given a larger degree of control in their rosters. This led to significant improvements in communication between managers and staff. A similar effect was found from the implementation of the third strategy. Many of the nurses had not realised the impact their behaviour was having on the organisation and their colleagues but there were also staff members who felt that talking to them about their absenteeism was ‘picking’ on them and this usually had a negative effect on management-employee relationships.

Conclusion Although there has been some decrease in absence rates, no single strategy or combination of strategies has had a significant impact on absenteeism per se. Notwithstanding the disappointing results, it is our contention that the strategies were not in vain. A shared ownership of absenteeism and a collaborative approach to problem solving has facilitated improved cooperation and communication between management and staff. It is our belief that this improvement alone, while not tangibly measurable, has increased the ability of management to manage the effects of absenteeism more effectively since this study.