Improving patient safety by implementing a new general surgical on-call rota for FY1 doctors.

Junior doctors often feel they have little control over their working environment and can feel overwhelmed by the numerous barriers to their involvement with rota design. This project aimed to overcome these barriers to change by implementing a new FY1 on-call rota, designed by junior doctors, for the surgical department at the Royal Sussex County Hospital, Brighton. A new rota was necessary since the department had recently undergone an organisational restructuring that altered the out of hours work load for FY1 doctors. To address this, the proposed new rota increased FY1 presence during weekend daytime shifts. To assess junior opinion about the old rota and the proposed new rota, a survey was sent to 32 FY1 doctors analysing their views about each rota in terms of safety, the sufficiency of cover for various shifts, and their willingness to work the rota. A direct comparison between the two rotas was also requested. A statistically significant (p<0.05, n=12, two-tailed paired T-test) increase in people agreeing with the following statements about the new rota: "The rota is safe", "This rota has sufficient FY1 cover during the weekend day shifts", and "I would be prepared to work this rota." A direct comparison revealed that FY1 doctors felt that the new rota would be safer, they would be more willing to work the new rota, and that the new rota should be implemented. Implementation occurred for the August 2014 general surgical FY1 intake and post implementation audits showed that the new FY1s felt that cover across all shifts was improved and that the new rota was safe. This project demonstrates that altering rotas can improve junior doctor's perception of patient safety, and also shows that junior team members, with departmental support, can overcome barriers to change and implement new rotas.