Culled from high-risk environments as diverse as a railroad dispatch center and the NASA Johnson Space Center, the strategies address the most critical time during any workday -- the shift change -- when incoming and outgoing workers have to exchange information and hand-off important duties.
Shift changes have became even more important for hospitals since the Accreditation Council for Graduate Medical Education instituted new rules in July 2003 cutting back residents' workload to 80 hours per week and giving them one day off in seven.
Systems engineers at Ohio State are examining the situation, with the idea that a safe and efficient hospital can be run on a shift basis just like other businesses, said Emily Patterson, a visiting researcher at Ohio State's Institute for Ergonomics.
"When research showed that extreme fatigue was causing medical residents to make errors, one of the arguments against letting them work shorter hours was that patients may not get continuity of care," Patterson said. "But there are other high-risk industries that already have a shift mindset. They could have forced people to work longer hours for continuity's sake, but they didn't. We looked at those industries to see what they could teach health care."
She and her colleagues watched workers change shifts at NASA Johnson Space Center, two Canadian nuclear power plants, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto. Hundreds of hours of observation yielded common strategies for safety and efficiency, which the authors report in the current issue of the International Journal for Quality in Health Care.