Impact of structural and organizational reforms on resident physicians’ daily work
| ISRCTN | ISRCTN69703381 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN69703381 |
| Secondary identifying numbers | N/A |
- Submission date
- 19/04/2018
- Registration date
- 24/04/2018
- Last edited
- 16/08/2022
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English Summary
Background and study aims
Due to an increasing number of patients with multiple or complex illnesses, a heavier administrative burden, and the evolution of young residents’ expectations, organization of work in internal medicine wards is of utmost importance. In a 2015 study, we showed that residents spent 1.5 hours on administrative tasks and 1.7 hours with patients per day. In addition, residents switched activity on average 15 times per hour. This study investigated major reforms: task delegation to non-medical professionals, reorganization of the workday’s schedule, and implementation of an early morning inter-professional decision meeting. An associated reduction in administrative and working hours and increased time with patients could greatly improve job satisfaction and attractiveness for internal medicine. We aim to quantify the impact of the organizational and structural reforms implemented in our department between 2016 and 2017 on residents’ administrative workload, continuity and adequacy of work, duration of shifts, and time spent with patients.
Who can participate?
Resident physicians at an internal medicine ward at Lausanne University Hospital.
What does the study involve?
The residents will be observed for two 11-hour shifts. The 'before reform' group was observed in 2015 and results are already published. The 'after reform' group will be observed in 2018, using the same methods and tools. The intervention is made of major reforms implemented between 2016 and 2017, which will be reported in detail. The primary outcome will be time spent for administrative tasks. We will also measure the amount of task switching per hour, the mismatch between observed activities compared to the departmental work schedule, the effective duration of observed shifts, and the time spent in presence of patients. We added a qualitative part by means of focus groups composed of observed residents.
What are the possible benefits and risks of participating?
There are no additional risks or benefits from participating in the study, because the physicians will be working as normal.
Where is the study run from?
Lausanne University Hospital
When is the study starting and how long is it expected to run for?
May 2018, with recruitment for 3 weeks.
Who is funding the study?
An external funding application has been submitted.
Who is the main contact?
Dr Antoine Garnier, antoine.garnier@chuv.ch
Contact information
Scientific
CHUV
Rue du Bugnon 46
Lausanne
1011
Switzerland
Study information
| Study design | Observational cross-sectional study |
|---|---|
| Primary study design | Observational |
| Secondary study design | Cross sectional study |
| Study setting(s) | Hospital |
| Study type | Other |
| Participant information sheet | No participant information sheet available. |
| Scientific title | Impact of structural and organizational reforms on residents’ daily work |
| Study acronym | MED2DAY |
| Study hypothesis | Because of an increasing number of complex polymorbid patients, a heavier administrative burden, and the evolution of young resident physicians’ expectations, organization of work in internal medicine wards is of utmost importance. In a 2015 study, we showed that residents spent 1.5 hours on administrative tasks and 1.7 hours with patients per day. In addition, residents switched activity on average 15 times per hour. This study motivated major reforms: task delegation to non-medical professionals, reorganization of the workday’s schedule, and implementation of an early morning inter-professional decision meeting. An associated reduction in administrative and working hours and increased time with patients could greatly improve job satisfaction and attractiveness for internal medicine. |
| Ethics approval(s) | The local ethical committee confirmed that this study is not subject to ethical approval. |
| Condition | Organization of healthcare and and physicians' work in a hospital setting. |
| Intervention | Organizational and structural reforms, including task delegation to non-medical professionals, reorganization of the workday’s schedule, and implementation of an early morning interprofessional decision meeting, implemented in our department between 2016 and 2017. We expect to include 35 residents. Each resident being observed twice (meaning 2 shifts of approx. 11 hours per resident), we will gather between 700 and 900 hours of observation. |
| Intervention type | Other |
| Primary outcome measure | Time spent for administrative tasks (primary outcome), assessed by time-motion study with observation of residents’ activities during shifts, by observers using a dedicated tablet application |
| Secondary outcome measures | 1. Amount of task switching per hour 2. Mismatch between observed activities compared to the departmental work schedule 3. Effective duration of observed shifts 4. Time spent in presence of a patient |
| Overall study start date | 01/01/2018 |
| Overall study end date | 31/12/2018 |
Eligibility
| Participant type(s) | Health professional |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | 35 |
| Participant inclusion criteria | 1. All residents registered in the internal medicine department at CHUV during the study, having graduated from a medical school, and with informed consent |
| Participant exclusion criteria | Inclusion criteria not met |
| Recruitment start date | 01/05/2018 |
| Recruitment end date | 21/05/2018 |
Locations
Countries of recruitment
- Switzerland
Study participating centre
Switzerland
Sponsor information
Hospital/treatment centre
CHUV
Rue du Bugnon 46
Lausanne
1011
Switzerland
| Website | www.chuv.ch |
|---|---|
"ROR" |
https://ror.org/05a353079 |
Funders
Funder type
Not defined
No information available
Results and Publications
| Intention to publish date | 01/06/2019 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| Publication and dissemination plan | Planned publication in a high-impact peer reviewed journal. |
| IPD sharing plan | The data sharing plans for the current study are unknown and will be made available at a later date. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol file | version 1.0 | 26/02/2018 | 16/08/2022 | No | No |
Additional files
Editorial Notes
16/08/2022: Uploaded protocol (not peer-reviewed) as an additional file.
