12-h or 8-h shifts? It depends.

Since 12-h shifts were first implemented, the question has been asked - are 'twelves' better than 'eights'? People trying to answer this question invariably refer to the limited literature at their disposal, often piecemeal, small-scale studies comparing 8-h versus 12-h shifts in isolated groups of workers in which many other factors vary concurrently. The narrow perspective and sometimes 'vested interests' of the organizations, researchers, publishers and individual workers can influence both the choice of measures, the analysis of results and their interpretation. The current review suggests that it is not sufficient to evaluate a shift pattern on the basis of a single dimension of a working time arrangement, such as shift length. Numerous factors associated with the work practice influence the outcome of a shift pattern including start times, pattern of shifts and amount of overtime. Moreover, the type of work being done and the demographics or characteristics of the workforce are additional mediating factors. Finally, and perhaps most critically, the relative importance assigned to different outcome measures is an important consideration. There are situations where total sleep time might increase following a change to 12-h shifts, whereas domestic life for some workers may deteriorate. Additionally, safety measures may show improvements on 8-h shifts but physical or psychological health outcomes may be worse. The myriad combinations of work pattern, work task, worker and outcome measure under investigation mean that the best way to take account of these complexities may be to use an approach that manages 'system' risk. Given the non-linearities in the system, and the fact that current approaches either ignore, or privilege a subset of outcomes, it is perhaps more appropriate to conceptualize working time arrangements as an 'ecosystem' and to address the risks in the overall system as opposed to a single dimension such as shift length.