Continuous work coverage in health care: challenges and solutions

Two scourges of 24 x 7 x 365 coverage may be lost on-the-job sleep and soured on-the-job peace for workers, especially for health care workers.

Traditionally, attending physicians have had the privilege of call rooms while providing coverage for overnight health care services. The Accreditation Council for Graduate Medical Education expanded that privilege to resident physicians and fellow physicians. Now, it may be time to extend that privilege to advanced practitioners and their trainees who are non-physicians and are providing coverage for overnight health care services.

Traditionally, physician and non-physician managers have had the privilege of private offices while managing health care institutions. Over time, this privilege has been extended to some, if not all, clinicians serving only in non-managerial positions. Now, it may be time to extend the privilege of private workspaces, in the form of fixed cubicles or mobile booths, to health care workers who may be expecting their own privacy while clinically managing the rapid turnover of patients via shared desks or shared desktops.

Traditionally, socioeconomically marginalized sections have had the privilege to unionize for protecting their quality of work, as well as their quality of life, while working. Over time, the privilege of unionizing among marginalized sections may have been socioeconomically neutralized by the privilege of association among non-marginalized sections. With fewer individuals concentrating all the quantifiable power among themselves within globalized modern systems, the question now becomes whether the privilege to unionize should be extended to all sections if powerlessness is the norm rather than the exception in globalized modern society.

Whether things remain the same or whether they undergo change, one thing that can easily be equalized is on-the-job sleep hygiene among health care workers. To attain such equalization, health care institutions merely need to replace some of the chairs in health care workers’ breakrooms with napping pods. This way, health care workers can ergonomically nap during breaks, whether they are physicians or not, and whether they are managers or not. Just like any other 24x7x365 worker, health care workers may not be working in concordance with their personal sleep chronotype when 24x7x365 health care work coverage expects them to be wolf-like sleepers or even dolphin-like sleepers rather than allowing them to be bear-like sleepers or lion-like sleepers. Compared to call rooms, private offices, fixed cubicles, or mobile booths, breakroom napping pods may be the most economical solution for ergonomic sleep hygiene of health care workers, whether they are marginalized or not, and whether they are unionized or not, because traditional and old-school dormitory-like beds or bunk beds may be too much to ask not only from health care institutions as their investors but also from health care workers as their users.

With 24 x 7 x 365 health care work coverage requiring health care workers to frequently rotate, on-the-job peace may be soured if health care workers do not feel welcome, especially while rotating. Interestingly, truly unwelcome health care workers may get transferred out or terminated from health care institutions as long as such transfers or terminations can be presumed as litigation-proof while aiming at patient-provider safety and judgment-proof while aiming at place-payer safety. However, when health care workers perceive themselves as unwelcome despite evidence to the contrary, or when health care institutions are limited by their socioeconomic and legal obligations, on-the-job peace gets soured, especially for sleepless health care workers. Health care workers may often wonder whether their presence at work is only rejoiced or even tolerated because 24 x 7 x 365 health care work coverage wants to remain financially solvent until the shortage of truly wanted health care workers is tided over with replacements for the unwanted ones. As perceptions may always be personal, irrespective of the actualities, health care workers’ feedback about lost on-the-job sleep and soured on-the-job peace can be preemptively addressed, because even the truly wanted health care workers may act as the unwanted ones once sleep and peace become absent.

Deepak Gupta is an anesthesiologist.