Further Executive Level Recommendations

Of course, any policy which hopes to address fatigue requires mutual understanding and collaboration.


Executive services need to accept that there are things beyond their understanding and lived experience.

Former clinical nurses may have 'lived experience', however that memory is historical in nature and plastic.


Just because you have been there doesn't mean that you understand the perspectival nature of the 'now'.


Similarly, just because you 'think' you 'know' management, doesn't mean that you fully understand the pressures and limitations, both organisational and personal, that being in a position of responsibility entails.


Therefore, collaboration is essential if meaningful outcomes are to be achieved.


The next step in a fatigue management policy is for each group to actively 'listen', explore the common ground and seek outcomes.


This is difficult, because 'Fatigue' is a new agenda, and neither the solutions nor the measures, are readily apparent at this point in time.




Deciding on Concrete Measures:




The first action here is to set desired fatigue safety outcomes and find a way to measure progress.


Once you have decided on your targets, the next step is to go about achieving them.


Consequently, as we stipulated previously, it is important to optimise your organisational resources, that is to optimise the infrastructure, time and human resources at your disposal.


Then it is contingent to develop Fatigue Safety Systems which complement those resources.


You may wish to aim towards sustainable workloads both day and night.

Find out where things go pear-shaped with respect to this, and train the relevant staff with the skills required to manage evolving situations better.

Then identify obstacles, find and teach the leverage that is required to navigate through those obstacles, then review and feed back and continually monitor.


Finally, you might want to identify and mitigate black spots for fatigue safety, for example, the known danger zones of 2 AM- 5 AM in the morning.


The interesting question then is: "What can you and what do you do about this?"



Now That Fatigue Has Occurred....



This is where it gets complicated.


Now that we know that fatigue is dangerous, and now that we know that we have been unable to prevent it, what measures do we put in place?


This is where it gets truly interesting as a manager, because behaviour around fatigue mitigation can be actually or perceptually obfuscated.


Firstly, we know the science and the parameters, and therefore we know that we should have systems in place to stop people from making their own subjective judgements on their ability to perform.


On the operating room floor, clinical safety systems processes and infrastructure require your attention, direction and budgetary discretion in order to occur.


Thus the use of taxis to convey perioperative staff safely to and from work when fatigue boundaries may reasonably be expected

to be exceeded should be mandatory.


Other options may include, but not be limited to the:


• provision of sleep/quiet rooms

• provision of sleep pods


Of course, clinical napping is a new phenomenon (for us, anyway!), and in order to prevent conflict it is important to have set rules which optimise clinical napping.


Strategically it is important for the executive managers to provide the middle managers responsible for implementation of these systems with the tools and skills necessary for the employment and enforcement of resource boundaries and fatigue safety measures.


What a mouthful!


Lastly, since we must traverse this path with, I presume, a resultant increase in expense, we must know if we are doing the right thing in the right way for the right results.


Thus research pertinent to the economic effects, positive or negative; and the operational effects, positive or negative is a must in order to further understand fiscal and clinical outcomes related to fatigue safety.



In conclusion, in order for fatigue mitigation safety behaviours to be realised, it is important that the Executive make the commitment to set up the cultural and directive frameworks that allow the clinical frameworks to be realised.


You already have all the authority and permission you need to undertake this mission.


It it embedded in the Charter of Patient Rights;

And it is embedded in the Accreditation Standards


Both under Clinical Governance and the Right to Safety,


And finally, it is embedded in Workplace Health and Safety Law.


To your Action Stations!