Significant improvements in patient care usually require major organisational change. In reality, this inevitably means disruption and upheaval of working practices that have evolved over decades. The prospect of change creates uncertainty and an inertia that gets in the way of progress and improvement. Arguments for the status quo can often supersede the argument for change.

In the UK—and presumably throughout Europe too—hospitals are being thoroughly exercised by the urgent need to implement the European Working Time Directive (EWTD).¹ This states that the working week must be limited to 48 hours. Because doctors have traditionally worked excessively long hours, the EWTD is being applied to them in stages. But, by 1 August 2004, doctors may only work 58 hours per week. The EWTD is set within the framework of Health and Safety at Work legislation. This makes sense. Long hours of work contribute to high stress levels within the profession² and overwork is a factor in adverse clinical incidents.³ And it must be healthier to work for 58 than for 100 hours per week.

The organisational changes needed to create systems in which doctors’ working hours are within the limits …