Abstract
BackgroundChanges in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms.MethodsThe academic literature was searched through the SCOPUS database using the search terms “resident duty hours” and “European Working Time Directive,” together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome.ResultsTwenty-five articles were included from the United States (n = 18), the United Kingdom (n = 5), Hong Kong (n = 1), and Australia (n = 1). They all described single-site projects; the majority used post-intervention surveys (n = 15) and audit techniques (n = 4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously.ConclusionsLittle research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.
Highlights
Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations
Little research has assessed the organizational impact of duty hour reforms; the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care
Future research in this area should focus on both micro and macro organizational aspects to aid in our understanding of how best to respond to these duty hour reforms
Summary
Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. To date, no Organizational challenges arising from reforms The major emphases of research examining the consequences of duty hour reforms have been patient safety, resident training, and resident well-being Some of these studies have examined aspects of organizational functioning affected by duty hour reforms, including costs [3,4,5], policy compliance [6,7,8,9,10,11], changes in work processes [12,13,14,15,16,17], and faculty satisfaction [14,18,19,20]. The majority of these studies relied solely on survey results related to staff perceptions of the impact of duty hour reforms; only a few assessed measurable, objective organizational outcomes [4,5,10,16]
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