title: General and visceral surgery practice in German hospitals: a real-time work analysis on surgeons' work flow.
abstract: BACKGROUND
  Surgeons have criticized the working conditions at German hospitals. They complain in particular about long working hours, an inadequate salary for their work, insufficient training/supervision, and an increasing amount of time spent on administration duties. Since these critics are only subjective perceptions, they should be compared to data that can be quantified more objectively and accurately. In this study, we sought to report precise data on surgeons' workflow in several German hospitals.
  
  
  METHODS
  General surgeons were shadowed unobtrusively over 567 h during their shifts at four urban German hospitals. All job tasks surgeons performed were recorded using a tablet PC.
  
  
  RESULTS
  The average work day of the surgeons in this study was 9 h 26 min (95% CI 09:10:30 to 09:42:44 h). Within this time span, an average of 02:03:08 h were spent on documentation and administration duties (95% CI 01:47:29 to 02:18:47 h), 01:47:40 h on operating procedures (95% CI 01:20:44 to 02:14:35 h), 01:43:46 h on internal communication (95% CI 01:32:55 to 01:54:36 h), and 0:48:25 h on ward rounds (95% CI 0:39:55 to 0:56:55 h).
  
  
  CONCLUSIONS
  For the first time, surgeons' workflow in German hospitals was studied in real time. The study results substantiate physicians' statements about their own working conditions, especially with concerns to large amount of time spent on administration tasks. The findings of this study form a basis upon which further analysis can be built and recommendations for improvements in physicians' workflows at German hospitals can be made.
authors.affiliation: Institute of Occupational Medicine, Charité, Universitätsmedizin Berlin, Free University and Humboldt University, Thielallee 69-73, 14195, Berlin, Germany. stefanie.mache@charite.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Mache
authors.forename: Ramona
authors.initials: R
authors.lastname: Kelm
authors.forename: Hartwig
authors.initials: H
authors.lastname: Bauer
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
authors.forename: David A
authors.initials: DA
authors.lastname: Groneberg
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D005858:Germany; D019538:Health Care Surveys; D006769:Hospitals, General; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013996:Time and Motion Studies; D014940:Work Schedule Tolerance; D016526:Workload / Q000706:statistics & numerical data*