PubMed · 12026678
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M Banks. 2001. But whose art frames the questions?. https://pubmed.ncbi.nlm.nih.gov/12026678/
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PROBLEM: Compliance with UK regulations on junior doctors' working hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices. More radical solutions are needed. DESIGN: Audit of change. SETTING: Paediatric night rota in large children's hospital. KEY MEASURES FOR IMPROVEMENT: Compliance with regulations on working hours assessed by diary cards; workload assessed by staff attendance on wards; patient safety assessed through critical incident reports. STRATEGIES FOR CHANGE: Development of new staff roles, followed by change from a partial shift rota comprising 11 doctors and one senior nurse, to a full shift night team comprising three middle grade doctors and two senior nurses. EFFECTS OF CHANGE: Compliance with regulations on working hours increased from 33% to 77%. Workload changed little and was well within the capacity of the new night team. The effect on patient care and on medical staff requires further evaluation. LESSONS LEARNT: Reduction of junior doctors' working hours requires changes to roles, processes, and practices throughout the organisation.