Shift systems are known to be associated with a variety of psychosocial and physiological problems that can affect the health of workers. This review focuses on measures that can be taken to optimize the well-being of shift workers and to identify ill-health at an early stage. The discussion includes specific aspects of the design of shift systems, taking account of variation in the views and circumstances of employees, and strategies to combat sleepiness at work and elsewhere. Although an ideal shift system does not exist, a wholistic approach comprising education of managers, employees and their families can ameliorate some of the health consequences.