Safe staffingBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3152 (Published 19 July 2018) Cite this as: BMJ 2018;362:k3152
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Significant variability exists in workloads of doctors between organisations, whether it be in medical units, surgery, or other specialties. The absence of defined guidelines and regulations predisposes the medical workforce to huge fluctuations in patient numbers and subsequent workload, with the greatest impact felt by junior and after hours medical staff. Consequently, care quality is subject to compromise, manifested by increased frequency and severity of incidents, failure to complete discharge summaries and potentially increased lengths of stay (1).
Issues relating to adequacy of staffing have significant implications for supervision and training, physician morale and risks for burnout and can also affect perceived desirability of organisations as preferred places for training and work (2,3).
We are in complete agreement that staffing issues are much more complex than just the number of onsite medical staff. Care integration to ensure the best possible management of the increasing complexity of our ageing patient population is essential. Busy emergency departments unfortunately become points of access for many patients who may be best managed through primary or community care with greater supports and care coordination (4). The burden that this places on health care organisations skews the balance towards relative understaffing and high workloads for individual doctors. Further compounding this, mechanisms to adequately predict and manage fluctuations in patient demand are underdeveloped and based on historical and seasonal data. Ensuring consistently adequate rostering and safe workloads becomes both a dynamic and challenging problem.
There is no single and easy solution. Opportunities may however exist in ensuring continued focus on and addressing important social determinants of health, maximising care integration to reduce work duplication and flexible staffing models that optimise control of workload variability to deliver a rewarding and safe work environment.
1. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA. Effect of reducing interns' work hours on serious medical errors in intensive care units. New England Journal of Medicine. 2004 Oct 28;351(18):1838-48.
2. Gander PH, Purnell HM, Garden A, Woodward A. Work patterns and fatigue-related risk among junior doctors. Occupational and environmental medicine. 2007 Mar 26.
3. BMA Junior Doctors Committee. Implications for health and safety of junior doctors' working arrangements. London: British Medical Association. 2000.
4. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. Jama. 2002 Oct 9;288(14):1775-9.
Competing interests: No competing interests