Exception reporting: an effective way to increase compliance leading to improvements in working conditions for junior...

In 2016, the new junior doctors contract introduced exception reporting (ER) to monitor extra hours worked, report patient safety, rostering and training concerns. Unfortunately, from discussions with foundation doctors, there seems to be a reluctance to engage with ER.

This quality improvement project aims to identify reasons for reluctance among foundation doctors to engage with ER and implement changes to address these barriers with a view to improve rates of ER.

Questionnaires regarding ER were distributed to all foundation doctors at a district general hospital. Following this, a leaflet was created and disseminated to all doctors providing guidance on ER and addressing several issues highlighted by the questionnaire. Foundation doctors were re-surveyed to assess for improvement.

We found a significant improvement (p<0.05) in proportion of overtime exception reports filled from 20.3% to 33.9%. The most common barriers identified were apprehension of meeting with the consultant to discuss reports, insufficient senior encouragement and fear of appearing inefficient.

An increased awareness and understanding of ER through the leaflet achieved an improvement in rates of ER. The insight gained from this quality improvement report can be applied across other trusts to improve compliance with the ER system nationwide, in order to safeguard staff wellbeing and thereby improve patient safety.