Lay summary
New Zealand hospitals have found it challenging to organise care at night that is safe, inclusive, and efficient while supporting staff wellbeing. This deficiency potentially increases patient mortality and morbidity and contributes to unmet healthcare needs and inequitable healthcare outcomes for Māori. Hospital at night work is recognised as a workplace hazard with adverse effects on staff health and wellbeing The underlying issues are multifaceted and often involve breakdowns among individuals, teams, processes and systems, making them difficult to address. As a first step toward an evidence-based and contextualised approach to improvements, we seek to develop a systematic understanding of issues, impacts, potential solutions and their efficacies in organising and delivering hospital at night care. Our goal is to identify factors contributing to the deterioration of patient safety and staff wellbeing during hospital at night care and highlight potential solutions that can be adapted and customised for New Zealand hospitals.