| Scenario: “Let’s imagine a meeting is occurring mid-morning on a normal working day and staff are considering what options are available should a situation arise when a night house officer does not arrive for handover (ie, is more than 30 min late for duty). The consequences of this scenario are that a fatigued clinician will have to work longer than their allocated hours and if/when a replacement is found it will be unlikely that a full and comprehensive handover will take place” | |||
| Resilience Element | 09:00 Monday | 22:00 Monday | 09:00 Tuesday |
| Foresight | Coping | Recovery | |
| “The ability to predict something bad happening” | “The ability to prevent something bad becoming worse” | “The ability to recover from something bad once it has happened” | |
| Individual | For example, clinician would contact your replacement before or at shift change* | For example, clinician would agree to stay on working until a replacement is found | For example, clinician makes sure supervisory staff are aware of the situation and any patient concerns that stem from that shift |
| Micro | For example, supervisory clinician identifies deficits in current workforce staffing levels and escalates issue to management for shift changes | For example, having a second on-call in cases of emergency as a standard protocol to be followed | For example, cover to reduce the workload of that individual, review patients who were reviewed overnight by a fatigued clinician and organise rota for following night |
| Macro | For example, workforce training and standard operating procedures about handover and provisions for dedicated handover time and place | For example, extensive documentation of clinical care by the day people identifying high-risk situations overnight | For example, get clinician home safely, review the micro team’s management of the service, and review clinical practice (may be via executive “walkaround”) |
*However, research shows that only ∼20% of time do people do this; see Bomba and Prakash.24