Table 4 Summary of the seven-step approach to designing and implementing a new duty hour system
From: Scheduling in the context of resident duty hour reform
Step 1 – Determine why the change is being considered • Understand the impetus for the change (i.e., mandated versus voluntary) • Acknowledge the organizational and psychosocial impact of this important culture shift Step 2 – Decide who should be involved in the transition • Identify and involve the main stakeholders Step 3 – Clarify terms so everyone is speaking the same language • Review definitions of key terms • Review local regulations Step 4 – Ask for help from those who have already made the change • Identify best practice models from care units or services similar to your own • Look for schedule models that can be adapted to your needs Step 5 – Develop a model based on your clinical and educational needs • Consider your clinical needs, including manpower requirements, workload, and workflow issues • Consider your pedagogical needs, including resident learning, supervision and evaluation, and fragmentation of other rotations Step 6 – Implement and monitor • Inform all affected parties in a timely fashion before the schedule takes effect • Encourage local leaders to act as advocates for this culture change • Establish a system of active monitoring and feedback collection (including incident-driven review) prior to schedule implementation • Set a realistic timeline for evaluating and fine-tuning the system (avoid prematurely undertaking major changes or decisions) Step 7 – Routine monitoring • Continue monitoring for quality control after the initial changes • Develop institution-specific evaluation instruments for ongoing review of the new system  ο Define purpose of review (quality control versus research)  ο Determine and prioritize aspect(s) to be evaluated  ο Identify stakeholders to be involved in the review  ο Search for pre-existing evaluation instruments that may be adapted in your context  ο Determine the most suitable methodology to conduct the evaluation (review the goal of the evaluation and balance resource requirements, scientific rigour, and level of relevance) |