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Working too hard for too long – Not only an issue for doctors

The Australian Medical Association (AMA) released its Safe Hours Audit 2011 last week, investigating the working hours and patterns of junior and salaried doctors over a one week period in August 2011.  This is the third survey assessing the fatigue risk of doctors’ current working arrangements to be conducted by the AMA since 2001. Whilst the audit indicated there had been some improvements regarding the fatigue-related risk amongst doctors since the previous survey in 2006, such as an overall reduction in the number of doctors being identified as a high fatigue risk, there were also some discouraging findings, such as the longest recorded shift recorded by one doctor increasing from 39 to 42 hours. The audit also found that even doctors identified in the lower fatigue-risk category were still working shifts of up to 19 hours. This finding raises some concern as research indicates that after working 17 hours straight, an individual’s performance is likely to be impaired to the same extent as having a blood-alcohol concentration of between 0.04% and 0.05%, and at 24 hours, similar impairments to having a reading of 0.1%.

Fatigue is an issue of particular significance amongst health care professionals because scientific evidence demonstrates a link between fatigue and declines in cognitive functioning, such as poor judgment, poor performance on skilled tasks and slower reaction times, all of which have the potential to increase the risk of patient harm. In recognition of this, and driven also by the need to provide safe systems of work and a safe and healthy workplace for staff, Departments of Health around Australia have invested significant resources and funding over the past few years to address and mitigate fatigue-related risk. There has, however, been resistance to the implementation of such systems. Amongst doctors, as with other high achieving professionals, cultural sentiments are harboured such as “I rose through the system and survived – they should be able to cope too” and “training standards will be diluted if working hours are reduced”. That said, cultural change amongst medical officers appears to be evolving over time, as investigations such as the audit conducted by the AMA indicate that fatigue-related efforts are moving in the right direction.

The issue of fatigue, however, is not unique to the healthcare industry. Industries such as transport, rail, mining and aviation have long engaged fatigue risk management strategies to increase employee and community safety with mandatory training for staff and clear regulations, policies and protocols in place. At TMS Consulting, the importance of safe work practices and the mitigation of fatigue-related risks is recognised, and the company has been working with industry leaders to better understand roster design, fatigue, sleep and work-life balance.  TMS is currently conducting a Fatigue Management Study in the Pipeline industry investigating the impact of fatigue and fatigue management strategies within a 28 day on/nine day off roster. Specifically the study aims to determine how such a work cycle may be worked safely taking into consideration environmental and outside-of-work factors. The results of this study will not only provide valuable intelligence for the Pipeline industry, but also guide fatigue risk management strategies in other industries where extended roster cycles are utilised.

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