Staying Beyond the Shift: Junior doctors well-being QIP

Abstract

Introduction: In response to the observed increase in junior doctors voluntarily extending their working hours, a quality improvement project (QIP) was initiated to explore the qualitative aspects of overtime and gain real-time insights into their experiences and work patterns. Junior doctors face amplified stressors due to professional demands, role uncertainties, relatively modest compensation considering their extensive training, inadequate leadership or support, and the pressures of meeting assessment and training requirements 1 .Consequently, they are susceptible to burnout and have an elevated risk of developing depression and anxiety2. Tens of thousands of junior doctors are working past the end of their shifts because hospitals are so understaffed, as per NHS3. Materials and methods: Cycle 1 of the QIP was conducted from 3–10 November 2023, revealing that 70% of junior doctors reported extensions beyond 45 minutes. Concurrently, staffing shortages were identified, with 37% of junior doctors experiencing inadequate staffing levels on five or more occasions during the study week. Subsequently, interventions were implemented, including improvements in staffing levels, introduction of morning handovers, and adherence to consultant ward round schedules. A tailored data collection form was utilised to capture details of overtime occurrences, causes, and workload assessments. Data for Cycle 2 was collected from 26 January – 2 February 2024. Analysis involved utilising bar graphs for comparison and descriptive statistics to understand trends and factors influencing extended working hours. Confidentiality and voluntary participation were ensured, with ethical approval obtained prior to the study. Results and discussion: Results from Cycle 2 of the audit indicated significant improvements following the implementation of interventions. There was a marked decrease in the proportion of junior doctors exceeding their scheduled hours, with only 40% reporting extensions beyond 45 minutes compared to 70% in Cycle 1. Additionally, the percentage of junior doctors experiencing inadequate staffing levels on five or more occasions during the study week decreased from 37% to 9%. Consultant adherence to allocated round times also improved, with only 41% of the time not adhered to in Cycle 2 compared to 71% in Cycle 1. Notably, attendance at scheduled development times increased, with 72% of participants attending in Cycle 2 compared to 40% in Cycle 1. Conclusion: However, limitations of the study include the need for further exploration into individual factors contributing to overtime. Moving forward, continued monitoring and evaluation will be necessary to sustain these improvements and identify any additional areas for enhancement. Overall, this QIP has provided valuable insights into optimising junior doctors' working conditions and highlights the importance of proactive interventions in promoting a healthier and more sustainable work environment within healthcare settings.