Improving continuity of care in healthcare: a comprehensive guide

Healthcare systems worldwide face mounting pressure to deliver quality care while managing costs and improving patient outcomes.

At the heart of effective healthcare delivery lies a fundamental principle that's been proven to make a significant difference: continuity of care.

This comprehensive guide explores what continuity of care means, why it matters, and how healthcare organisations can implement strategies to improve it through better staff management and engagement.

What is continuity of care?

Continuity of care refers to the coordination and consistency of healthcare services delivered to patients over time.

It encompasses three key dimensions:

• Informational continuity
• Relational continuity
• Management continuity

In healthcare, these dimensions are particularly important for ICU (Intensive Care Unit) and General Medicine teams due to the complexity, acuity, and multidisciplinary nature of patient care in these settings.

1. Informational Continuity

Informational continuity is the use of consistent, accurate, and up-to-date information about a patient’s medical history, preferences, and context across different providers and encounters.

It matters because even if a patient sees different staff, continuity is preserved when all clinicians have the same understanding of the patient’s situation.

Examples of informational continuity in healthcare:

• A patient admitted for pneumonia is seen by multiple doctors over a week. Because everyone documents in the same shared EHR, each doctor has access to past test results, medication history, and notes from previous visits. In rostering, ensuring there’s time allocated for handover and documentation helps preserve informational continuity when shifts change.

2. Relational Continuity

Relational continuity in healthcare is the ongoing therapeutic relationship between a patient and one or more consistent healthcare providers.

Patients often feel safer, more understood, and better cared for when they see familiar faces - especially in chronic care, mental health, or aged care.

Examples of relational continuity in healthcare:

• A diabetic patient sees the same GP or nurse practitioner at each visit, allowing a trusting relationship to form and enabling more personalised care. In rostering, scheduling the same staff members consistently in a ward or clinic promotes relational continuity.

3. Management Continuity

Management continuity is the consistent and coherent management of a patient’s health across different conditions, providers, and time - especially during transitions (e.g. hospital discharge, referrals).

It’s important because patients with complex needs often require input from multiple services. Without coordinated management, care becomes fragmented.

Examples of management continuity in healthcare:

• A cancer patient receiving chemo from oncology, pain management from palliative care, and support from a GP - all following a shared care plan. In rostering, ensuring overlap in shifts or dedicated coordination roles (e.g. care coordinator) enables smooth transitions and aligned management care.

Today, continuity of care extends beyond individual provider relationships to include systematic approaches that ensure seamless care delivery across entire healthcare teams and organisations. Effective staff rostering is one way to ensure continuity of care.

Why is continuity of care important?

The evidence supporting continuity of care is compelling and extensive. Research consistently demonstrates that patients who receive continuous care experience better health outcomes, higher satisfaction rates, and more cost-effective treatment.

A comprehensive systematic review analysing 42 studies found that high continuity of care was associated with reduced hospitalisation in 16 out of 18 studies (89%), reduced emergency room visits in all 8 studies examined (100%), and decreased mortality rates in 6 out of 7 studies (86%). The same research showed significant reductions in disease-related complications across all seven studies that examined this outcome.

The financial benefits of continuity of care make a compelling case for investment too. High continuity of care is associated with reduced healthcare expenses across all four studies that examined this outcome, while simultaneously improving clinical results and patient satisfaction.

The quadruple aim connection

Continuity of care directly supports healthcare's quadruple aim by:

• Enhancing patient experience through consistent, familiar relationships with care providers (this is where better workforce management can help)
• Improving population health through better disease management and preventive care
• Reducing costs by minimising unnecessary tests, procedures, and hospitalisations
• Improving care team well-being through meaningful patient relationships and reduced workplace stress

Impact on healthcare utilisation

Beyond clinical outcomes, continuity of care significantly affects healthcare resource utilisation. Research shows that patients with better continuity demonstrate improved outcomes including appointment follow-through, better prescription compliance, and increased uptake of preventive services such as immunisations and cancer screening. This proactive approach to health maintenance reduces the burden on emergency services and acute care facilities.

How do you measure continuity of care?

Measuring continuity of care requires understanding different approaches and metrics that can provide insights into care coordination effectiveness.

Key measurement approaches

Administrative measures examine patterns of patient-provider interactions through data analysis. Common metrics include:

• Continuity of care index (COCI): measures the concentration of visits with a single provider
• Usual provider of care index (UPCI): calculates the proportion of visits with the most frequently seen provider
• Sequential continuity index: assesses the proportion of consecutive visits with the same provider

Patient-reported experience measures (PREMs) capture the patient's perspective on care coordination, information sharing, and relationship quality. These measures complement administrative data by providing insights into elements like information continuity and care coordination that may not be visible in visit patterns alone.

Digital tools like Rosterlab use rules to describe how continuity of care should translate to your roster, which helps teams achieve their continuity of care metrics.

What are the challenges to implement continuity of care?

• Workforce & capacity gaps

Challenge: Physician shortages, hiring freezes, funding cuts.

Fix: Strategic workforce planning and flexible staffing models to cover demand.

• Handover breakdowns in ED / ICU

Challenge: In high-acuity units like ED and ICU, time-pressured and fragmented shift handoffs can miss critical patient details - leading to duplication, delays, and safety risks.

Fix: Use rostering tools to build protected overlap time between shifts, enabling bedside, checklist-guided sign-out (e.g., SBAR). While handover content is often managed through clinical systems like the EHR, scheduling a dedicated window ensures staff have time to use those tools properly - helping teams maintain continuity and reduce preventable errors.

• Access vs Continuity Trade-Off

Challenge: Prioritising same-day access can disrupt continuity, making it harder for patients to see their usual provider - especially for chronic or complex care.

Fix: Use hybrid scheduling to balance both needs: reserve slots for follow-ups with a patient’s regular clinician, while keeping others open for same-day or urgent appointments. This maintains relationships without sacrificing timely access.

• Information & Communication Silos

Challenge: Fragmented systems and documentation create coordination gaps between shifts or departments.

Fix: While tech solutions like shared EHRs help, rostering can ensure continuity by keeping familiar staff on recurring shifts - so knowledge stays close to the patient.

How does staff rostering impact the continuity of care?

Effective scheduling ensures that the right mix of skilled personnel is always available, reducing the risk of medical errors and enhancing patient outcomes. When scheduling is poorly managed, it can lead to fragmented care, missed follow-ups, and decreased patient satisfaction.

Poorly managed rosters can lead to uneven workload distribution, excessive overtime, and burnout, which directly affects the quality of care provided. When healthcare workers are stressed and overworked, their ability to maintain meaningful patient relationships and provide attentive care diminishes significantly.

Incomplete or inconsistent shift overlap forces incoming clinicians to reconstruct patient context, adding mental strain and often prolonging their hours. Implementing a brief overlap buffer together with a concise, templated electronic handoff note finished with a quick read ensures critical details are transferred efficiently. This reduces after-shift catch-up work, eases cognitive load, and protects both staff well-being and patient safety.

Six tips to roster for better continuity of care

Implementing strategic rostering practices can significantly improve continuity of care delivery while supporting staff satisfaction and operational efficiency.

1. Implement patient-centred scheduling

Prioritise consistency by assigning patients to the same care providers whenever possible. Use scheduling software that tracks patient-provider relationships and flags when continuity might be disrupted. This approach helps maintain the therapeutic relationships that are essential for effective care.

2. Balance skill mix and experience

Ensure optimal staffing by having every shift include the right mix of skills and experience to optimise patient outcomes. Automated scheduling systems can help match staff qualifications with patient needs while maintaining continuity of assignments.

3. Build protected overlap time for safer handover

Hospitals can improve continuity and patient safety by using rostering rules to build protected overlap time between shifts. Scheduling a 15–30 minute buffer where outgoing and incoming teams are simultaneously on duty enables structured handovers - such as SBAR checklists at the bedside or in the EHR - and allows time to clarify pending tasks and answer questions in real time.

From a patient care perspective, this extra time ensures that notes are completed thoroughly and transitions are handled with care. For staff, it reduces after-hours follow-ups, prevents missed information, and promotes both safety and wellbeing.

4. Build in flexibility with structure

Create scheduling frameworks that accommodate both planned and unplanned variations while maintaining core continuity assignments. This might include protected time slots for continuity patients and flexible coverage arrangements for routine care.

5. Leverage technology for real-time adjustments

Implement systems that provide real-time visibility into coverage gaps and worker availability. Modern scheduling platforms can automatically fill last-minute openings with qualified staff while preserving existing continuity relationships.

6. AI-Powered Continuity & Fairness

AI-driven rostering tools enhance continuity of care by ensuring consistent staff presence across shifts - for example, by keeping at least one team member who worked the previous day. This helps maintain familiarity with patients, reduce handover errors, and support better outcomes.

From a clinician’s perspective, the AI also ensures fairness and safety by intelligently distributing long or undesirable shifts. It balances the continuity-of-care needs specific to each ward with safe working hours, promoting both clinical effectiveness and staff wellbeing.

Staff engagement strategies for sustaining continuity

Successful continuity of care requires engaged healthcare workers who understand and value their role in patient relationships.

1. Foster understanding of continuity benefits

Educate staff about the evidence-based benefits of continuity of care, including improved patient outcomes, job satisfaction, and care efficiency. When healthcare workers understand how their consistency impacts patient health, they're more likely to prioritise continuity in their practice.

2. Recognise and reward continuity efforts

Acknowledge healthcare workers who consistently maintain patient relationships and demonstrate commitment to continuity principles. This recognition can include formal performance metrics, awards, or professional development opportunities.

3. Provide adequate resources and support

Ensure that staff have the tools, time, and resources necessary to maintain quality patient relationships. This includes overlap buffers for shift handovers, adequate consultation time, access to patient information systems, and support for complex care coordination.

4. Address workload and burnout prevention

Implement practices that prevent excessive overtime and ensure adequate rest periods between shifts.

5. Facilitate peer support and collaboration

Create opportunities for healthcare workers to share experiences and best practices related to continuity of care. Peer mentoring programs and regular team meetings can help reinforce the importance of patient relationships.

Organisational commitment

True continuity of care requires organisational commitment that goes beyond individual provider efforts. Healthcare leaders must:

• Invest in technology and systems that support care coordination
• Develop policies that prioritise continuity alongside access
• Create measurement systems that track and reward continuity achievements
• Ensure adequate staffing levels to support relationship-based care

How do you turn continuity of care into a daily practice?

The path forward for healthcare organisations lies in recognising continuity of care as both a clinical necessity and an operational advantage. The evidence overwhelmingly demonstrates that patients who receive continuous care have better health outcomes and higher satisfaction rates.

By implementing strategic rostering practices, engaging staff in continuity efforts, and creating organisational cultures that value patient relationships, healthcare organisations can achieve better outcomes for patients while creating more sustainable and satisfying work environments for their teams.

Adopting modern rostering tools where rules can be set to ensure continuity of care is one of many initial steps you could take. See how it could work in your unit with a quick 30-minute demo.