Promoting & encouraging exception reporting (PEER) quality improvement project
In 2016, NHS England introduced Exception Reporting in the ‘Junior Doctors and Dentists in Training’ contract. This is a process whereby doctors inform their employer when ‘their day-to-day work varies significantly and/or regularly from the agreed work schedule’1 and can receive pay and other resol...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-04-01
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| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664524001772 |
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| Summary: | In 2016, NHS England introduced Exception Reporting in the ‘Junior Doctors and Dentists in Training’ contract. This is a process whereby doctors inform their employer when ‘their day-to-day work varies significantly and/or regularly from the agreed work schedule’1 and can receive pay and other resolutions. Understaffing concerns are also highlighted to facilitate appropriate resource allocation. Our aim is to improve the proportion of junior doctors in North West Anglia Foundation Trust (NWAFT) who understand how to Exception Report and complete the practice. Additionally, we aim to understand why doctors choose not to Exception Report, and the impact of overtime working on staff and perceived patient safety.A quality improvement project was completed using PDSA cycles to assess the effects of changes implemented. Data collection occurred via surveys on Exception Reporting practices distributed to NWAFT's junior doctors in February 2023 (first cycle/ PEER-1) and November 2023 (second cycle/ PEER-2). Working closely with stake holders, barriers to Exception Reporting were identified and targeted changes were enacted. Instructional posters and walk-through videos were created and shared in doctor's offices, via email and at departmental inductions. Additionally, the Chief Medical Officer emailed all supervising consultants emphasising the importance of encouraging Exception Reporting. Moreover, we facilitated the resolution of technical difficulties associated with Exception Reporting. Data collection was repeated in November 2023 to assess the impact of the interventions.There were 80 junior doctors’ responses in the first cycle and 104 responses for the second cycle. Both surveys had respondents across most grades and specialties. Awareness of how-to Exception Report rose from 56.25% to 61.54% with more doctors informed during their departmental inductions (22.5% to 29.81%). However, respondents remained unsure when it was appropriate to Exception Report (38.75% to 35.58%). The median frequency of junior doctors who Exception Reported their overtime hours shifted from 'Never to 'Rarely' in the second cycle. There was also a rise in respondents who found the process of Exception Reporting ‘Very Easy’ (6.25% to 13.46%). Amongst the barriers to Exception Reporting denoted in Figure 1, there was a reduction departmental discouragement from 8.75% to 3.85%. Yet, a significant proportion reported excess overtime hours of >15 hours per month (10% to 7.69% in second cycle). The second cycle data shows that 73.08% reported burnout/fatigue, 49.04% expressed reduced morale and lack of work/life balance was noted by 73.08%. Critically, overtime working was perceived by 33.65% to result in suboptimal patient care.The PEER quality improvement project led to a rise in the Exception Reporting understanding and utilisation among junior doctors. However, multiple barriers to Exception Reporting persist, necessitating further interventions in future PDSA cycles. To promote sustainability of our changes, we aim to appoint junior doctor and consultant Exception Reporting champion roles in every department, who can continue to promote and encourage Exception Reporting practices. This quality improvement project is pivotal to promote safe working practices in junior doctors, prevent burnout and ensure optimal patient care. |
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| ISSN: | 2514-6645 |