Work Roster Research Articles

Predicting neurobehavioral performance of resident physicians in a Randomized Order Safety Trial Evaluating Resident-Physician Schedules (ROSTERS)

ObjectivesMathematical models of human neurobehavioral performance that include the effects of acute and chronic sleep restriction can be key tools in assessment and comparison of work schedules, allowing quantitative predictions of performance when empirical assessment is impractical. MethodsUsing such a model, we tested the hypothesis that resident physicians working an extended duration work roster, including 24-28 hours of continuous duty and up to 88 hours per week averaged over 4weeks, would have worse predicted performance than resident physicians working a rapidly cycling work roster intervention designed to reduce the duration of extended shifts. The performance metric used was attentional failures (ie, Psychomotor Vigilance Task lapses). Model input was 169 actual work and sleep schedules. Outcomes were predicted hours per week during work hours spent at moderate (equivalent to 16-20 hours of continuous wakefulness) or high (equivalent to ≥20 hours of continuous wakefulness) performance impairment. ResultsThe model predicted that resident physicians working an extended duration work roster would spend significantly more time at moderate impairment (p = .02, effect size=0.2) than those working a rapidly cycling work roster; this difference was most pronounced during the circadian night (p < .001). On both schedules, performance was predicted to decline from weeks 1 + 2 to weeks 3 + 4 (p < .001), but the rate of decline was significantly greater on extended duration work roster (p < .01). Predicted performance impairment was inversely related to prior sleep duration (p < .001). ConclusionsThese findings demonstrate the utility of a mathematical model to evaluate the predicted performance profile of schedules for resident physicians and others who experience chronic sleep restriction and circadian misalignment.

Work Patterns and Intensity of Chinese Surgical Residents- A Multicenter Time-and-Motion Study

This study aimed to record and analyze surgical resident trainee time allocation among junior doctors in China in order to understand the training environment and optimize realistic training and patient care objectives. Multicenter observational time and motion study. Multicenter, carried out in 5 tier 3 public hospitals in 5 provinces across China. Surgical resident trainees at various stages of training were eligible to enter the study, total n = 44. Registered nurses were eligible to be observers, n = 4 from each hospital. An expert team comprising 4 chief surgeons and 10 surgical residents participated in establishing the clinical activity list. Participants were observed during working hours (08.00-17.00) for 10 consecutive working days and time spent on different activities were recorded. Work patterns between hospitals were often dissimilar. Most time was spent on direct patient care (34.1%; 95% CI, 28.0%-40.1%) followed by indirect patient care (24.4%; 95% CI, 15.5%-33.2%), scholarly activity (21.1%; 95% CI, 13.7%-28.5%) and other (20.4%; 95% CI, 14.1%-26.8%). Subcategory analysis showed that the amount of time spent each day performing certain tasks was 137 minutes for operating theatre tasks, 103 minutes for medical record-keeping, 25 minutes for direct patient contact, 20 minutes being taught, 12 minutes teaching others, 12 minutes hand-over time, and 0 minutes of outpatient clinic attendance. Inter-observer reliability of 96.5% was obtained prior to recordings. Chinese surgical resident work patterns fall within the range found in other international studies albeit with some exceptions. The training environment appears broadly suitable for competence-based surgical training in China. Inadequate outpatient activity has led to changes in trainee work rosters and trainer requirements. Both strengths and deficiencies were confirmed and addressed. Further audit is required.

Causal links behind why Australian midwifery care is missed.

The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it. Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched. A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling. Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted. Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed. While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.

Investigating the influence of shift work rosters on stress measured as cortisol in hair during the SARS-CoV-2 pandemic

The COVID-19 pandemic has increased the workload and has affected physical and mental health of many employees. Hair cortisol concentration (HCC) has proven useful as a marker for retrospective assessment of stress in epidemiological studies and was measured here in non-healthcare night-shift workers with standard shifts (8-h shifts) and extended shifts (12-h shifts) before and during the first wave of the COVID-19 pandemic in Germany. Results showed a twofold increase in HCC among shift workers during the first wave of the COVID-19 pandemic compared with previous measurements. Subjectively reported measures of psychosomatic stress were not found to be reliable predictors of HCC. No statistically significant HCC differences were found between rosters. Working 12-h shifts does not appear to be an additional stressor in the already demanding COVID-19 pandemic.

A study on employee experience with shift work

Shift work has become necessary for many industries operating 24 hours a day, 7 days a week, affecting individual workers and their overall well-being. Based on a survey of 1049 shift workers of various industries, ages, and genders from all fourteen regions of the Czech Republic, the paper analyzes their experience with different shift work rosters to determine individually perceived advantages and disadvantages of shift work and discuss perspective ways of improving shift workers' well-being. The findings confirm the importance of effective and efficient shift work planning and organizing to achieve demanded work productivity, desired work-life balance and overall well-being of shift workers. The analysis confirmed a hypothesis that the preference for work shifts depends on the age of shift workers. Individually perceived negative impacts of shift work included physical fatigue, sleep disorders, or depression. These could be limited by more flexible shift work scheduling to harmonize work shifts with personal matters whenever possible and thus support shift workers' work-life balance and well-being.

Berth and quay crane allocation and scheduling with worker performance variability and yard truck deployment in container terminals

In a container terminal, the quay cranes (QCs) are the main equipment involved in the core activities. According to a bottleneck principle, the productivity rate of QCs is related to both worker productivity and deployed yard trucks. Yet, in the literature, the berth and quay cranes allocation and scheduling problems were addressed separately from these two parameters. In contrast, practitioners confirm their important impact on cranes productivity and efficiency. This paper proposes a new extension of the berth and quay cranes allocation and scheduling problems considering worker performance variability and yard truck deployment constraints. First, we formulate the problem as a mixed-integer linear program to minimize the vessels departure time under many practical regulations involving the work roster constraints specific to container terminals and the trucks utilization congestion targets. Additionally, the study provides a computationally efficient method to find a lower bound. We also show that integrative planning minimizes the vessels departure time compared to the separated decision-making process. Second, to build good solutions in a reasonable time, we propose a heuristic and a Variable Neighborhood Search (VNS) with a new architecture and settings designed to suit the novel issues of the tackled problem. The algorithm is tested on real time data sets and outperforms a commercial solver. This study originates from our experience with a multinational company managing a container terminal. Thus, we have embedded the proposed resolving methods in a decision-support system for our industrial partner.

Digital storytelling within the Australian mining industry: worker engagement and health literacy indicator effects.

The mining industry is a demanding context for workplace health education due to a range of factors including productivity targets, workforce diversity and work roster schedules. This project investigated the impact of digital story health communication on worker engagement and its effect on interactive and critical health literacy indicators. The study comprised a quasi-experimental parallel time series research design, with control and intervention groups at each of the mine sites (n = 2). Workers in the intervention group (n = 85) received a 'toolbox talk' presentation incorporating a digital story featuring a mining industry worker and a leading cardiovascular health expert. The control group (n = 90) received equivalent health information communicated in a non-narrative manner, reflective of typical practices within the mining industry. A significantly greater effect was evident for worker engagement within the intervention group, with substantial maintenance over the follow-up period, compared with no significant effect at follow-up within the control group. Significant effects on interactive health literacy indicators (n = 3) were evident for the intervention group with corresponding lower level or nil effects within the control group. The findings highlight the benefits of evidence-based digital stories as an efficient and efficacious worker-centred health communication strategy for complex industrial workplace environments.

Using simulation and inter-professional education to teach infection prevention during resuscitation

Introduction: During resuscitations, healthcare professionals (HCPs) find balancing the need for timely resuscitation and adherence to infection prevention (IP) measures difficult. This study explored the effects of an innovative teaching method, using in-situ simulation and inter-professional education to enhance compliance to IP through better inter-professional collaboration. Methods: The study was conducted in the Surgical Intensive Care Unit (SICU) in a 1200-beds teaching hospital. HCPs working in the SICU were conveniently allocated to the intervention or control group based on their work roster. The intervention group attended an in-situ simulated scenario on managing cardiac arrest in an infectious patient. The control group completed the standard institution-wide infection control eLearning module. Outcomes measured were: (a) attitudes towards inter-professional teamwork [TeamSTEPPS Teamwork Attitudes Questionnaire (TAQ)], (b) infection prevention knowledge test, (c) self-evaluated confidence in dealing with infectious patients and (d) intensive care unit (ICU) audits on infection prevention compliance during actual resuscitations. Results: 40 HCPs were recruited. 29 responded (71%) to the pre- and post-workshop questionnaires. There were no significant differences in the TeamSTEPPS TAQ and infection prevention knowledge score between the groups. However, ICU audits demonstrated a 60% improvement in IP compliance for endotracheal tube insertion and 50% improvement in parenteral medication administration. This may be attributed to the debriefing session where IP staff shared useful tips on compliance to IP measures during resuscitation and identified threats that could deter IP compliance in SICU. Conclusion: Learning infection prevention through simulated inter-professional education (IPE) workshops may lead to increased IP compliance in clinical settings.

Evaluation of a Paediatric Trauma Social Worker Service

ABSTRACT Injury is the leading cause of hospitalisation of children in Australia and can cause ongoing physical and psychological morbidity. Hospital staff provide excellent physical care to injured children, but there is a need for models of care that improve psychosocial care. To address this gap, a trauma support social work service was trialled at an Australian paediatric trauma hospital, to guide families of injured children through the healthcare system from the day of the child’s injury to 6 months following discharge. A mixed methods approach was used to evaluate the service and used a range of data sources—trauma registry records, the Trauma Support Coordinator (TSC) journal, staff surveys, and interviews. Findings from this small study suggest the TSC was able to improve the coordination of care, provide information, and meet the emotional needs of families of injured children. Ways to improve the effectiveness and acceptance of the TSC role were also identified. IMPLICATIONS Injured children should be allocated a dedicated TSC for their entire stay in hospital to provide continuity of care for the child and their family. Situating the TSC role in the Emergency Department will allow for early contact with families when support is most crucial. Incorporation of the TSC role into the social work roster will reduce “doubling up” of psychosocial services offered to families.

Effects on resident work hours, sleep duration, and work experience in a randomized order safety trial evaluating resident-physician schedules (ROSTERS).

We compared resident physician work hours and sleep in a multicenter clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hr) shifts or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours. Three hundred two resident physicians were enrolled and completed 370 1 month pediatric intensive care unit rotations in six US academic medical centers. Sleep was objectively estimated with wrist-worn actigraphs. Work hours and subjective sleep data were collected via daily electronic diary. Resident physicians worked fewer total hours per week during the RCWR compared with the EDWR (61.9 ± 4.8 versus 68.4 ± 7.4, respectively; p < 0.0001). During the RCWR, 73% of work hours occurred within shifts of ≤16 consecutive hours. In contrast, during the EDWR, 38% of work hours occurred on shifts of ≤16 consecutive hours. Resident physicians obtained significantly more sleep per week on the RCWR (52.9 ± 6.0 hr) compared with the EDWR (49.1 ± 5.8 hr, p < 0.0001). The percentage of 24 hr intervals with less than 4 hr of actigraphically measured sleep was 9% on the RCWR and 25% on the EDWR (p < 0.0001). RCWRs were effective in reducing weekly work hours and the occurrence of >16 consecutive hour shifts, and improving sleep duration of resident physicians. Although inclusion of the six operational healthcare sites increases the generalizability of these findings, there was heterogeneity in schedule implementation. Additional research is needed to optimize scheduling practices allowing for sufficient sleep prior to all work shifts.Clinical Trial: Multicenter Clinical Trial of Limiting Resident Work Hours on ICU Patient Safety (ROSTERS), https://clinicaltrials.gov/ct2/show/NCT02134847.

0971 Methods and Schedule-Related Differences in a Multi-center Trial of Rapidly Cycling versus Extended Duration Work Rosters

0971 Methods and Schedule-Related Differences in a Multi-center Trial of Rapidly Cycling versus Extended Duration Work Rosters

Design and recruitment of the randomized order safety trial evaluating resident-physician schedules (ROSTERS) study

IntroductionWhile the Accreditation Council for Graduate Medical Education limited first year resident-physicians to 16 consecutive work hours from 2011 to 2017, resident-physicians in their second year or higher were permitted to work up to 28 h consecutively. This paper describes the Randomized Order Safety Trial Evaluating Resident-physician Schedules (ROSTERS) study, a clustered-randomized crossover clinical trial designed to evaluate the effectiveness of eliminating traditional shifts of 24 h or longer for second year or higher resident-physicians in pediatric intensive care units (PICUs). MethodsROSTERS was a multi-center non-blinded trial in 6 PICUs at US academic medical centers. The primary aim was to compare patient safety between the extended duration work roster (EDWR), which included shifts ≥24 h, and a rapidly cycling work roster (RCWR), where shifts were limited to a maximum of 16 h. Information on potential medical errors was gathered and used for classification by centrally trained physician reviewers who were blinded to the study arm. Secondary aims were to assess the relationship of the study arm to resident-physician sleep duration, work hours and neurobehavioral performance. ResultsThe study involved 6577 patients with a total of 38,821 patient days (n = 18,749 EDWR, n = 20,072 RCWR). There were 413 resident-physician rotations included in the study (n = 203 EDWR, n = 210 RCWR). Resident-physician questionnaire data were over 95% complete. ConclusionsResults from data collected in the ROSTERS study will be evaluated for the impact of resident-physician schedule roster on patient safety outcomes in PICUs, and will allow for examination of a number of secondary outcome measures.ClinicalTrials.gov Identifier: NCT02134847

Employee engagement and emotional exhaustion of fly‐in‐fly‐out workers: A diary study

ObjectiveAlthough fly‐in‐fly‐out (FIFO) work practices are widely used, little is known about their impact on the motivation and wellbeing of FIFO workers across the course of their work cycles. Drawing from the job demands‐resources model, we aimed to test for the within‐person effects of time of work cycle, job demands, and job resources on emotional exhaustion and employee engagement at 3‐day intervals.MethodA total of 52 FIFO workers filled out three or more online diary surveys after every 3 days of their on‐site work roster. The survey consisted of items drawn from previously validated scales. Bayesian hierarchical modelling of the day‐level data was conducted.ResultsWorkers, on average, showed a decline in engagement and supervisor support, and an increase in emotional demand over the course of the work cycle. The results of the hierarchical modelling showed that day‐level autonomy predicted day‐level engagement and that day‐level workload and emotional demands predicted emotional exhaustion.ConclusionsThe findings highlight the importance of managing FIFO employees’ day‐to‐day experiences of job demands and job resources because of their influence on employee engagement and emotional exhaustion. To best protect FIFO worker day‐level wellbeing, employing organisations should ensure optimal levels of job autonomy, workload, and emotional demands. Practical implications, study limitations and areas for future research are outlined.

Crew Planning Optimization Model of High-Speed Railway

Crew planning with complicated constraints is decomposed into two sequential phases: crew scheduling phase, crew rostering phase. Setting a dynamic model based on set covering model, Genetic Algorithm is adopted based on feasible solution range in search of optimal scheduling set with minimum time. Constructing a node-arc TSP network, it adopts Genetic Algorithm and Simulated Annealing Algorithm to create a work roster. Based on Wuhan-Guangzhou High-Speed Railway in China, the balance degree of crew planning is measured by crew working time entropy. The proposed model proves strong practical application.

Doing Safer Masculinities: Addressing at-Risk Gendered Behaviours on Mine Sites

Doing Safer Masculinities: Addressing at-Risk Gendered Behaviours on Mine Sites

Medical doctor rostering problem in a hospital emergency department by means of genetic algorithms

Organising shifts, or work rosters, is a problem that affects a large number of businesses where employees are subject to some kind of work rotation. Researchers in the fields of Operations Research and Artificial Intelligence have resorted to several different optimisation systems to solve the problem. The motivation for the medical-staff shift-rotation research presented in this paper stems from the needs of an actual hospital emergency department (HED) and from the observed growing staff of these services in Spain. The problem approach, which has been hardly dealt with in the literature, intends to automate the creation of time-tables by applying genetic algorithms (GAs) in an actual HED. HEDs work organisation becomes different because of the combination of shifts and 24-h duties. After knowing the HED workers’ requirements (which will allow to identify the hard and soft constraints imposed to the problem) and after defining the adequate encoding to be used in the solutions, a heuristic-schedule builder –designed ad hoc to satisfy the hard constraints – produces an initial population of feasible solutions. Afterwards, iteratively, GA obtains new generations of feasible individuals, thanks to the use of a specific crossover operator, based in the exchange of whole work weeks, that operates together with a repair function. Once the optimum is reached, the results obtained are discussed as a function of the degree of satisfaction of the constraints under which the system operates and of the adaptability of the system as the constraints vary.

Impact of day‐case gastroscopy on children and their families

Increasing numbers of endoscopies are being carried out in children. The purpose of our study was to evaluate the provision of information about the admission and procedure and the functional and economic impact of day-case gastroscopy on children and their families. We administered a structured questionnaire to families of children undergoing elective gastroscopy, with daily follow up by telephone over the next 3 days. One-hundred-and-three children were recruited. All had seen a consultant gastroenterologist (usually the proceduralist) prior to the endoscopy, who had obtained signed consent; 89% of families remembered receiving an explanation from the doctor carrying out the procedure. Nearly all (94%) described the information they received as adequate. However, only one-third of families recalled receiving an explanatory brochure and very few had toured the Day Surgical Unit or seen the complimentary video. Thirty percent were unhappy with the time spent at the Day Surgical Unit and an apparent failure to warn of possible delays, 8% felt that they were not given adequate information prior to discharge, and 39% of children failed to attend school the day after the procedure. Although tiredness or sleepiness was common, no correlation was found between the presence of symptoms and school absence. Complaints about the admission included overcrowding, lack of privacy, excessive noise, and failure to cater for adolescents. Fifty percent of parents took leave from work, but most manipulated work rosters and holidays so that costs to them and to the workplace were minimal. Information provision about the procedure and admission appears to be adequate in most families of children undergoing day-case gastroscopy, but may be improved in some areas. Failure to remember elements of the consent and explanatory process is common. Minor morbidity is also common after the procedure.

Consideration of the determinants of women's mental health in remote Australian mining towns

Families in remote mining towns constitute a specific sociological group living under unique geographical and sociocultural circumstances. Isolation from friends and relatives and limited resources and opportunities for family members of mine workers are some of the distinct disadvantages of these towns. Decades ago it was observed that a large number of women in new and remote mining towns suffered from neurotic problems. In contemporary times there is a deficit of knowledge about the mental health of women in remote mining towns. However, there are certain indicators of significant mental distress among women living in these particular environments. Deriving from a review of literature, this paper explores various mining work-related issues and sociocultural settings and processes within remote mining towns that could possibly exert coercive pressures on the psychological health of female partners of mine workers and their relationship well-being. The paper suggests that work schedules and preponderance of men in mining jobs help promote a patriarchal culture within the community and the family; thereby marginalising women to a secondary status. Limited opportunities and resources within the community isolate women to domestic lives; while atypical work rosters associated with mining employment could negatively impact on the relationship well-being of couples. The paper recommends that an inquiry into psychiatric well-being among women of remote mining communities needs to consider the sociocultural structure and processes within these communities, and the structural nature of the mining job that could be responsible for role strain-induced stress and mental health problems among these women.

Impact of worktime arrangements on work-home interference among Dutch employees.

This study examined the effects of different worktime arrangements on work-home interference while taking into account other work-related factors, private situation and health status, explored gender differences in this relation, and examined reciprocal effects between workhours and work-home interference. Data from the Maastricht cohort study on fatigue at work were used with 8 months of follow-up (N=6947 at baseline). Worktime arrangements were related to work-home interference among the men and women, even after control for confounding. As compared with daywork, baseline shiftwork was associated with higher work-home interference over time. Within daywork, full-time work was prospectively related to higher work-home interference than part-time work was. For full-timers, baseline overtime work, hours of overtime work, change in number of workhours, and commuting time were related to higher work-home interference over time, whereas compensation for overtime work, familiarity with work roster, ability to take a day off, and a decrease in workhours at own request were associated with less work-home interference. For the part-timers, baseline overtime work and commuting time were related to higher work-home interference over time, whereas compensation for overtime, flexible workhours, and ability to take a day off were protective against work-home interference. Reciprocal relations between work-home interference and workhours were also found. Worktime arrangements are clearly related to work-home interference. Because reciprocal effects exist as well, important selection processes may exist. Nevertheless, specific characteristics of worktime arrangements could constitute useful tools for reducing work-home interference.