I See Tired People
The biggest paradox in the provision of Healthcare is fatigue. Fatigue comes from production pressure, the need to provide care 24/7 in contravention of human circadian rhythms, and the economic desire to have the minimum number of people provide the maximum amount of care. Dawson and Reid in 1994 published this paper: https://www.nature.com/articles/40775 which found a correlation between fatigue, intoxication and performance.
Healthcare, however, has steadfastly refused to change, to the suffering of patients and clinicians alike. And whilst each hospital has a drug and alcohol policy which imposes bans on staff attending work whilst intoxicated, they make attendance whilst under the influence of fatigue intoxication not only permissible but a condition of continued employment. The easy, social and timely answer is simple: Make the drug and alcohol policy an intoxication policy and include fatigue as a cause of intoxication. The rationale is that drugs, alcohol AND fatigue similarly erode performance beyond well-established thresholds. 17 hours of wakefulness equates to a performance equivalence of a blood alcohol reading of 0.05 Therefore work hours should determine to have staff members safely off the road and removed from clinical decision making by the time they could reasonably be presumed to have been awake for 17 hours. (The worst time to make a sound decision or judgement is at a time when your ability to make a sound decision or judgement is impaired.
Self-awareness is unreliable.
If self-assessed performance was reliable, no one would ever get caught over the limit whilst driving) The airline industry upholds an
IM SAFE acronym. If you are affected by: Illness Medication Sleep deprivation or stress Alcohol Fatigue Emotion the employee should refrain from reporting for duty. The implications for healthcare are huge, but the first step is to decide to act.
Once the decision to act is made, the solutions will become apparent.
All that is then required is that we must have the will and the fortitude to embrace them.