The European Working Time Directive (EWTD) has placed a check on working hours for most UK employees since 1998, but only since August 2009 has the legislation been applied to trainee doctors. The hours that this group works in the early stages of a career in medicine have long been considered an endemic problem. So, on the surface, a cap on hours looks like a welcome change but, perhaps surprisingly, the Royal College of Surgeons (RCS) has opposed the move for several reasons. First among them is the claim that it is actually putting patients at risk because reducing hours means the number of handovers between doctors increases. More handovers means more potential for important information to be ‘lost’ or for mistakes to be made. The RCS believes that there has also been a detrimental effect on the progress of the training of junior doctors because they are not getting the required number of hours of experience – as a result, future patients are at risk. Finally, they argue that many doctors are now simply working extra ‘hidden’ hours to fill the gaps anyway – this shows the power of the long hours culture that has existed for years and undermines the benefits that were intended by the EWTD in the first place.
While the risk to patient safety is obviously the immediate concern, there is something else that this situation highlights. That is the importance of tailoring work improvement initiatives to the job role or sector they affect. The EWTD has a laudable aim – to protect employees from overload and consequently stress – but in this instance it’s not working. The intentions were good, as doctors were expected to perform better when working shorter shifts. But, in reality, the change has resulted in doctors being under pressure to work extra ‘hidden’ hours with the fear of being under-trained hanging over them. The overall result is not likely to be positive for anyone’s well-being.
To be clear, no one’s saying we should ignore the hours that junior doctors work. In my view, this example shows the importance of working closely with those in the job when planning significant changes. Organisations run employee focus groups after a staff survey to create solutions / actions because they understand that those doing the job know what works best. It’s the same here – while reducing hours may be important generally, it’s perfectly feasible that there are broader, more important factors to be addressed in this instance. The fact is that when it comes to employee well-being there is no ‘one size fits all’ solution. Sticking to a fixed series of steps or a blanket prescription is not the way to optimise well-being. We must make sure that interventions are appropriate and proportionate, while trying hard to anticipate both positive and negative outcomes. Most importantly, we should always involve those who will be affected.
You can read more about Doctors’ hours at http://news.bbc.co.uk/1/hi/health/8302053.stm
