The Executive's Role in Fatigue Management Policy

The Organisational Executive Management sets up the organisational culture which

optimises and directs the way managers implement strategies, and thus improves the

way clinicians perform the safety culture.


As an executive, you direct the forces below you in a pyramidal fashion.


How your managers behave effects how your clinicians engage, and thus drives the process toward more successful (or unsuccessful) outcomes. 


In this light, you will know that there are definitive human limits beyond which fatigue occurs:


that 17 hours of continued wakefulness equals a performance equivalent of Blood Alcohol level of 0.05 g/DL, and


that greater than 12.5 hours of work per day increases error risk by 2-3 times


Therefore, it is contingent upon you to set the bar at that level, and demand of your directs that these limits are enforced by organisational systems.






Install a culture of fatigue safety by way of instigating leadership in the

culture of fatigue safety, since safety change initiatives are only effective when they are

supported from the very top, and then filtered down all the way to the lowest level.







Employ a hierarchy of risk management actions.


We have already achieved the first step, which is to recognise fatigue as a patient and staff safety risk.


The second step is to see where we fit within the range of possible outcome strategies


Do we seek to:


Eliminate as much as possible system causes of fatigue


Reduce the probability of fatigue occurring as much as is

reasonably possible (avoidance)




Control fatigue by facilitating the implementation of

restitution measures when fatigue occurs?


Given the realities of the nature of the work you are entrusted to oversee, we know it is impossible to eliminate entirely the occasioning of fatigue.


It is, after all, an emergency service, and things occur which are beyond our control.


Experience within the system, and playing the game 'Surgery Stat!' informs us that dealing with fatigue once it occurs is restrictive and economically prohibitive.


Therefore, systems of work should be set out to prevent as much as is reasonably possible (say, for example, to eliminate 80% of currently existing personnel fatigue), and then seek to control by restitution the final 20% of barely-preventable fatigue insults.


The first two actions set the bedrock of fatigue mitigation..


The first of these is workload control.


Controlling workload to within the limits of system sustainability is paramount.


Despite intrinsic and extrinsic pressures to the contrary, i.e. the number of ward beds in the hospital; the number of ICU beds; the number of people awaiting beds in Emergency; the number of radiographers available to the Operating Theatre; the number of theatres you can run with the staff available.


These and other factors form the limits to sustainable practice.



The second element of successful fatigue prevention is to staff according to ACORN Standards for all actual work practices.


The successful implimentation of these two elements alone go a long way to setting up the control of fatigue-inducing incidents.