The demands of 24/7 coverage: using faculty perceptions to measure fairness of the schedule

Ensuring fair, equitable scheduling of faculty who work 24-hour, 7-day-per-week (24/7) clinical coverage is a challenge for academic emergency medicine (EM). Because most emergency department care is at personally valuable times (evenings, weekends, nights), optimizing clinical work is essential for the academic mission. To evaluate schedule fairness, the authors developed objective criteria for stress of the schedule, modified the schedule to improve equality, and evaluated faculty perceptions. They hypothesized that improved equality would increase faculty satisfaction.

Perceived stress was measured for types of clinical shifts. The seven daily shifts were classified as weekday, weekend, or holiday (plus one unique teaching-conference coverage shift). Faculty assigned perceived stress to shifts (ShiftStress) utilizing visual analog scales (VAS). Faculty schedules were measured (ShiftScores) for two years (1998-1999), and ShiftScore distribution of faculty was determined quarterly. Schedules were modified (1999) to reduce interindividual ShiftScore standard deviation (SD). The survey was performed pre- and postintervention.

Preintervention, 26 faculty (100% of eligible) assigned VAS to 22 shifts. Increased stress was perceived in progression (weekday data, 0-10 scale) from day to evening to night (2.07, 5.00, 6.67, respectively) and from weekday to weekend to holiday (day-shift data, 2.07, 4.93, 5.87). The intervention reduced interindividual ShiftScore SD by 21%. Postintervention survey revealed no change in perceived equality or satisfaction.

Faculty perceived no improvement despite scheduling modifications that improved equality of the schedule and provided objective measures. Other predictors of stress, fairness, and satisfaction with the demanding clinical schedule must be identified to ensure the success of EM faculty.