title: Improving compliance with requirements on junior doctors' hours.
abstract: OBJECTIVE
  Compliance with UK regulations on junior doctors' working hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices. More radical solutions are needed.
  
  
  METHODS
  Audit of change.
  
  
  METHODS
  Paediatric night rota in large children's hospital.
  
  
  METHODS
  Compliance with regulations on working hours assessed by diary cards; workload assessed by staff attendance on wards; patient safety assessed through critical incident reports.
  
  
  METHODS
  Development of new staff roles, followed by change from a partial shift rota comprising 11 doctors and one senior nurse, to a full shift night team comprising three middle grade doctors and two senior nurses.
  
  
  RESULTS
  Compliance with regulations on working hours increased from 33% to 77%. Workload changed little and was well within the capacity of the new night team. The effect on patient care and on medical staff requires further evaluation.
  
  
  CONCLUSIONS
  Reduction of junior doctors' working hours requires changes to roles, processes, and practices throughout the organisation.
authors.affiliation: Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH. cassh@gosh.nhs.uk
authors.forename: Hilary D
authors.initials: HD
authors.lastname: Cass
authors.forename: Isabel
authors.initials: I
authors.lastname: Smith
authors.forename: Cheryl
authors.initials: C
authors.lastname: Unthank
authors.forename: Colin
authors.initials: C
authors.lastname: Starling
authors.forename: Jane E
authors.initials: JE
authors.lastname: Collins
mesh_terms: D001291:Attitude of Health Personnel; D006776:Hospitals, Pediatric; D006801:Humans; D007588:Job Satisfaction; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000600:supply & distribution*; D009551:Night Care; D016272:Occupational Health / Q000331:legislation & jurisprudence; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000592:standards*; D013997:Time Factors; D006113:United Kingdom; D014940:Work Schedule Tolerance; D000078329:Workforce; D016526:Workload