About a month ago, the head of HO in my hospital asked me to send him opinions from paeds HOs regarding the HO shift system. These were the feedbacks I managed to gather from the team, at time with the assumption that the shift system planned for implementation is a similar one to the one used in A&E posting:
PRO:
1. Enough rest in between work
More energetic housemen and presumably less mistake. Hence, shift system is probably good with departments with expectedly non stop works, and with not much of continuation of care which need brief passing over– for example, in casualty and labour room, but not in wards where continuation of care is essential
2. No oncall allowance for housemen (*definite cons for housemen though)
A huge reduction in the money spent on the health sector by government – good as money can be spent on other healthcare needs, for example hypoallegenic gloves (as part of right and welfare of the employees with sensitive skin) or to get better equipments for treating patients
3. Working time not adhered to regular office hours might be beneficial
Ability to run any errands that need being done during office hours eg going to the bank
CONS:
1. Number of housemen in each department is labile and not fixed (due to possibility of extension)
Not enough numbers to be divided into shift hence difficulties in coordinating the shift duties
2. Limitations which makes hectic morning shift – and might lead to major dissatisfaction if shifts are not properly assigned
Morning shift will be particularly busy – with the specialist ward round, blood takings needed being done during office hours, attending clinics. Surgical based posting with elective surgeries in the morning makes it rather difficult to organise the shift system. Few housemen might be left in ward, leaving jobs passed over to the next shift, but unlikely to be done on the same day if those jobs are limited by office hours only – hence the unnecessary delay
3. Less teaching
Teaching done during office hours, some might miss the teaching
4. The pass-over tradition which in itself is time consuming and might not work well in all departments especially in ward
Those who are less responsible will become more complacent, passing over the jobs to the hardworking/more responsible ones.Either the hardworking ones will continue to suffer or a viscious circle to happen where jobs might be passed over on and on before being noticed, which might compromise the patients’ care. Also, jobs might be missed if passing over sessions are not properly conducted so, effective hand over session is very important, and a clear guideline is required. Having said that, a proper pass over can be very time consuming, hence more time spent for passing over, less work done in time, less care and time for patient
5. No oncall allowance for housemen
This is probably not too bad, providing the working hours is much less than the current oncall system. However, it is of no guarantees, and the working hours might end up with mere minute difference. These extra hours should be entitled to some compensation too
6. No more weekends or public holidays
Difficulties in arrangement of holidays as everyday is a working day, hence ending up with less rest throughout the month even if there will probably be enough rest in between shift. Cumulatively, working shifts might be more tiring
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In conclusion at that time, consensus I think was NO, DO NOT implement it until we are all ready. Or at least that was the consensus among me and my colleagues in the same hospital.
Good grief. I can still picture myself standing up in front of all housemen and DG in my earlier days of working, asking about whether or not the shift system is soon going to be implemented. And why on earth did I ever have the nerve to ask that question?
And now having been in the system for around 10 days, I can see the pitfalls here and there which I will try to conclude in another entry after having a post mortem with other colleagues of the department. Enough to say, I need daily motivation to go to work now....
The picture above was posted by a friend in my facebook - it is a wise reminder for me at time because I am so not looking forward to be responsible for HO in my department - but it's a duty I cannot run away from and I think it is failing me - I have never been a good leader, I suppose. God, help me. I should have been more grateful.