Reconciling Evolving Clinical Needs With Contractural Limitations

When our hospital entered into contract to open a medical facility in Abu Dhabi, all staff were contracted based on a 40 hour work week.   Those contracts failed to account for the variation in work patterns between medical specialties. For example, doctors in a clinic may work an 8 hour set schedule and fulfill the 40 hour requirement.  In specialties where shift work is the norm, providers have staggered start times over a 24 hour period with constant variability in their monthly schedule.  The variance significantly affects circadian rhythms and can have negative outcomes if structured poorly.   Hospitalist and emergency providers are most significantly affected.

The 40 hour work week has forced the physicians who work shifts into 18, nine hour shifts per month.  In addition the physician staff is required to be involved in hospital committees, innovation and the development of other programs.  As a result, there is very little schedule flexibility for unexpected events. As volume has increased, patient experience has declined and there has been a significant increase in clinical misses or near misses over the past 30 days.  Almost all extraclinical projects and committees have been abandoned.   Although the chief of the department is generally a reasonable person, he is either unaware of how the work hours are affecting satisfaction and performance or he is unable to rectify the contractural requirements with the evolving pressures on his physician staff while maintaining his relationship with his bosses.   What is the best approach considering the politics involved?


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Participant comments on Reconciling Evolving Clinical Needs With Contractural Limitations

  1. “People” as its called now are often the toughest issues to deal with.
    I would put this under a broader umbrella of compliance.
    Compliance is both Regulatory and Contractual. There is often not much play in regulatory compliance, but business needs are often met within contractual agreements.
    Not knowing the Law in Abu Dhabi, I would approach each department head to have conversations with their teams to re negotiate the terms of contracts. The heads would need training from “People” on how to approach the subject, what changes need to be made and how it will help the team and more importantly the individuals contract. ( concept of whats in it for me, i.e. monetary, skill and career not necessarily in that order)
    I get the sense sitting on the fence and letting it go, is leading to a catastrophe waiting to happen

  2. As the previous person noted I think in some form you will have to look into renegotiating the contracts or re-evaluating what you consider work hours. If the goal is to ensure overall implementation of extra clinical projects then a blocked portion of each team members time will have to be set. Without structure extra clinical or admin time built in the department is likely to regress as innovation will not take place.

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