The impact of the introduction of the European Working Time Directive on Reducing

DECLARATION

ACKNOWLEDGEMENT

I would like to express my special thanks of gratitude to my teacher as well as our principal who gave me the golden opportunity to do this wonderful project on the topic, which also helped me in doing a lot of Research and i came to know about so many new things I am really thankful to them. Secondly i would also like to thank my parents and friends who helped me a lot in finalizing this project within the limited time frame.

Introduction:

Errors in the medical field can be very dangerous and they can have a significant negative impact on the lives of the care service users. It has been observed that medical professionals make mistake and that too mainly due to being overloaded with work.

Background:

The European Working Time Directive (EWTD) took effect in October 1998 but the final stage of implementation as the Working Time Regulations (WTRs) in the UK with working hours limited to 48 hours took place recently in August 2009.

Aim/objectives:

The aim of this study is “To Study the Impact of the Introduction of European Working Time Directive (EWTD) on Reducing Medical Errors in England and Wales”.

Method:

Qualitative design was used in the current study. The main reason for selecting and using the current design was that numerous investigations have already been carried out on the given research topic.

Result:

The European Working Time Directive (EWTD) has emerged as a way through which time related work pressure on the medical professionals can be reduced. This can also help in reducing the medical errors. The EWTD is an initiative by the European Union (EU) to prevent employers forcing their employees to work excessively long working hours under the pretext of ensuring their health and safety in the long run.

Conclusion:

UK trainees suggest that there have been some problems associated with the implementation of the WTRs. For instance, trainees in the UK report working very varied shift patterns whereby they work up to 100 hours in one week, but much fewer hours the week after. This disparity means that, on average, they are still working 48 hours per week so are compliant with the WTRs.

CHAPTER 1 INTRODUCTION

1.1 Background

Errors in the medical field can be very dangerous and they can have a significant negative impact on the lives of the care service users. It has been observed that medical professionals make mistake and that too mainly due to being overloaded with work. In this regard, the European Working Time Directive (EWTD) has emerged as a way through which time related work pressure on the medical professionals can be reduced. This can also help in reducing the medical errors (McClelland et. al., 2017). The EWTD is an initiative by the European Union (EU) to prevent employers forcing their employees to work excessively long working hours under the pretext of ensuring their health and safety in the long run. For those seeking healthcare dissertation help, getting to understand the implications of the EWTD and its impact on medical errors. It seems to be very valuable for this area of research.

Furthermore, the EWTD was developed and introduced as a means of improving the working hours and ensuring that the employees get their deserved and proper rest breaks and holidays (Dutheil and Aubert, (2019). In essence, this directive focuses on limiting the average length of working week to just hours, meaning that employees can work for a maximum of 48 hours in a week. This can also be understood through fact that employees can work eight hours a day for six days in a week. However, this directive also gives employees the option to opt out of it, if they want to. The directive was first introduced and implemented in the UK in the year 1998 with regards to senior doctors and then it was phased in for junior level doctors in the year 2004.

1.2 Aim and Objectives

The aim of this study is “To Study the Impact of the Introduction of European Working Time Directive (EWTD) on Reducing Medical Errors in England and Wales”. In order to achieve this aim, the researcher had to work on fulfilling the following objectives:

To explain the role and importance of European Working Time Directive.

To identify and explain the factors that lead to medical errors.

To analyse the impact of EWTD on reducing medical errors.

Through this study, the researcher has focused on identifying the role and importance of EWTD in the medical field in the UK. Furthermore, it also focuses on assessing the way EWTD has helped in reducing the medical errors. In this investigation the researcher has focused on assessing and evaluating the past studies to get an idea about the impact of EWTD and the ways it has helped in reducing the medical errors.

1.3 Literature Review

The European Working Time Directive (EWTD) took effect in October 1998 but the final stage of implementation as the Working Time Regulations (WTRs) in the UK with working hours limited to 48 hours took place recently in August 2009. The issue with this is thought to be that with a reduced number of hours available for training, there is a potential risk to the quality of that training. As the regulator of medical education and training in the UK, it‟s important for the GMC to understand the impact these changes may have on this matter (McClelland, 2019). The GMC has already conducted some research in this area, including an extensive literature review and reports summarising the regulatory evidence of EWTD. However there are still significant gaps in knowledge about the impact of EWTD and the GMC is keen to ensure that these are filled.

Controllers and experts have various perspectives around the advantages of confining working hours and the impacts that this can have on preparing. Most members accept that some limitation on working hours is alluring as it supposedly delivers various advantages for the two patients and staff, which are all talked about in more detail in the following segment of the report (Baggaley, 2019). Nonetheless, regardless of this underlying energy corresponding to confined hours, there is a broadly held sense that such guidelines are trying to execute. Incompletely, this view is driven by the experience of those we drew in with; large numbers of the controllers and experts we addressed recommended that, as a student, they worked in conditions where there was no genuine breaking point to the hours in which learners would work. While a particularly working climate is considered possibly harming (both as far as understanding security and as to the personal satisfaction stood to the specialists who work in such conditions), for some, it is the thing that they have known and, hence, conceptualizing elective working models is hard for them (Anderson et. al., 2021). Considering this, numerous controllers and experts immediately talk about the difficulties related with the execution of confined hours. In any case, there is a lot of extremity comparable to how various gatherings of partners see the pervasiveness and degree of these difficulties and, thus, how simple they accept they are to survived. For some the difficulties are exceptionally minor, while for others there are extremely significant issues related with carrying out confined working hours (Charles-Edwards et. al., 2021).

Contrasts in assessment on this matter can be incompletely clarified by nation of beginning and, less significantly, specialism. For example, controllers from nations (like Portugal and the UK) where working hours have customarily been long, and where students have a job in overseeing emergency clinic work (as opposed to, for instance, essentially noticing and gaining from crafted by subject matter experts) the difficulties related with limited hours are by and large viewed as a lot more noteworthy (Cairney, 2021). Interestingly, controllers from nations where there is to a greater extent an emphasis on the significance of keeping a balance between serious and fun activities, (like France and Sweden) and where students have to a lesser degree a job in clinic work (like Italy) depict the progress to working confined hours as being simpler and, in this way, detailed the EWTD as being simpler to execute (Ashraf et. al., 2018).

There is likewise a wide-spread conviction that diminished working hours can further develop the balance between fun and serious activities of specialists and students permitting them to have outside interests or invest more energy with their families (Scholarios, 2017). This advantages the person as well as accepted to carry benefits to the patient; some talked about the connection between close to home fulfillment and viability in the working environment and referenced that, by working confined hours, clinical staff are bound to be actually satisfied and that this, thusly, will convert into worked on understanding consideration.

Overall terms the UK is viewed as being more customary than different nations with those working in the clinical calling seeing working extended periods as being something of a transitional experience. This feeling of custom, subsequently, goes connected at the hip with more prominent degrees of protection from expanded working hours than have been knowledgeable about numerous pieces of Europe and in different nations where limited working hours have been carried out (Jephcote and Gulliver, 2021).

Partners in the actual UK recommended that, while the New Deal 56 hours was „about right‟, limiting working hours to 48 hours goes excessively far. All the more extensively however, partners think that its a lot simpler to talk about the adverse results of working confined hours as opposed to the potential benefits that it can bring. Generally, this was on the grounds that functioning limitless hours was the framework that they had known and were utilized to and, along these lines, thought that it was difficult to envision how medication could work viably on some other premise (Jordan et. al., 2018). These worries fell into four primary classes including worries around preparing, intensity and pay. Those controllers who are more negative about the EWTD frequently contend that it is extremely difficult to prepare specialists adequately inside a more limited working week (D’Oliveira and Anagnostopoulos, 2021).

In reality, this was an issue voiced by the actual students. One concern emerging from this is that confined hours can make it hard for learners to routinely see similar patients throughout the span of their treatment. This is accepted to issue as partners contend that, without this experience, students don't will see the improvement of an ailment thus do not have an intensive comprehension of patient encounters (Elliott and Williamson, 2020). Connected in with this, controllers and experts contend that learners who work less hours are less inclined to observe more mind boggling and uncommon cases. This implies that learners are less competent at settling on quick and conceivably hazardous choices about patients‟ treatment. A potential answer for such an issue would be the more prominent utilization of reproduced conditions; something that is utilized in Australia to guarantee that no understanding is put in danger and that learners feel happy with taking care of some random circumstance (Kenawy and Kett, 2019).

Partners from various nations report that learners have looked to make up some of preparing time lost by going to extra instructional classes or by expanding the measure of time they spend concentrating past their authority working hours. While this might be agreeable with the functioning time guidelines, learners propose that there is a danger that they may in any case become exhausted which, thusly, could think twice about security (Stuetzle and Weston, 2018). A few students additionally recommend that they currently have less an ideal opportunity to examine while accessible if the need arises than they recently had, ordinarily on the grounds that they are presently working in more occupied periods because of the changes in their rotas that have been made because of the execution of the EWTD. Therefore, it may not generally be feasible for learners to go to outside courses because of their shift designs (West and Coia, 2019).

UK students recommend that there have been a few issues related with the execution of the WTRs. For example, learners in the UK report working extremely changed shift designs whereby they work as long as 100 hours in a single week, however many less hours the week after. By and large, they are as yet working 48 hours out of each week so are agreeable with the WTRs (Dincer et. al., 2018).

Moreover, while they perceive that functioning such extended periods of time might actually represent a danger to patient security they express that what it takes into account is congruity of care. Accordingly, according to their point of view, they accept that there are issues here with confined hours prompting brokenness of care which thus contrarily impacts on quiet insight (Dincer and Aksakal, 2018). When examining concerns identified with the execution of the EWTD, various controllers and experts notice the danger that, by working confined hours, clinical experts from the UK can not rival those from nations where no such working impediments are set up. This supposedly is especially the situation for junior specialists and it is imagined that, by diminishing the quantity of hours accessible for preparing, they will be in a tough spot to their companions universally (Birks and Bloor, 2018).

This is a greater amount of an issue in those nations where preparing principles are seen as being higher and, furthermore, where a huge extent of specialists communicate in English, regardless of whether not as a first language (Jones and Mercer, 2018). Denmark is frequently referenced by partners in such manner where the worry is that, subsequent to being prepared, specialists will leave to propel their profession somewhere else.

Expanding on this however, the Danish controller accepted that one benefit of more noteworthy harmonization would be that it would be simpler for specialists to work abroad – and medical clinics utilizing them would be more sure that those specialists had been prepared adequately. Besides, this worry about specialists leaving to work somewhere else is anything but a generally held view (De Baetselier et. al., 2021). Surely, some recommended that such an effect is only brief and that, on schedule, specialists settle down to work in their own country.

CHAPTER 2 METHODOLOGY

2.1 Introduction

A very important part of any research study is that of research methodology. In this section the researcher has presented the various tools and methods that have been used on carrying out the study (Alomari, 2018). Through this section, readers can understand the way the study was conducted.

2.2 Study Population

In the current study, the population members were medical professionals who had experience of working in the sector of more than four years. Identifying the study population is an important part of the overall methodology of the study (Anderson and Price, 2017). By selecting and recruiting the participants, the researcher was able to obtain the necessary information about the research topic.

2.3 Study Design

Qualitative design was used in the current study. The main reason for selecting and using the current design was that numerous investigations have already been carried out on the given research topic. Through this design the researcher focused on examining the different studies have been conducted on the subject matter and analyse them in a thorough and detailed manner (Gibson, 2020). Using the qualitative design enabled the researcher to explore different aspects of the subject matter and thereby perform a deep assessment of the research topic.

Subjective examination strategies are intended to evaluate the client experience. In particular, how the client communicates with the item. A few techniques incorporate meetings, centre gatherings, ethnography (which is examining the individual's normal conduct in their own current circumstance) to expound approaches, for example, intuitive conflict games. How and what individuals feel is an inherent piece of any experience and feelings are the biggest driving component behind all that individuals do (Gibson et. al., 2020). Subjective exploration sets up an establishment of profound experiences that empowers the specialist to delineate how the crowd identifies with specific circumstances, situations, ideas or items.

Taking advantage of what persuades a specific conduct, explicitly why somebody has done, does or is intending to accomplish something bears the cost of analysts with significant hints into what the individual necessities and needs. This is perhaps the most convincing advantages of subjective investigation (Mousteri and Delaney, 2020). Interestingly, mathematical study information, while supportive in their capacity to foresee the probability of a result, do not have the setting around the thing is driving the result. Additionally, one might not have asked the "right" question in a review and be fostering the item and showcasing procedure because of "some unacceptable" answer.

Subjective examination basically runs like a meeting with an intelligent series of inquiries and answers. A key advantage is that, not normal for an overview which is fixed, changes in non-verbal communication or tone in light of an inquiry can provoke a progression of extraneous inquiries which test on why the individual responded how they did (Soukup, 2019). This constant adaptability empowers analysts to find sudden subtleties on how clients may identify with an item and can bring about powerful mid-stream changes to an examination plan.

2.4 Inclusion and Exclusion Criteria

For the current study, the researcher relied on using only those research studies and papers that were published in English language. Another inclusion criteria that the scholar focused on using was to ensure that the studies published between years 2010-2020, i.e., during the last ten years. Studies that consisted of keywords like EWTD, and medical errors were searched for.

2.5 Search Flow Chart

Critical appraisal is essential to the cycle of Evidence Based Practice. Basic evaluation expects to distinguish likely dangers to the legitimacy of the examination discoveries from the writing and give purchasers of exploration proof the chance to settle on educated choices about the quality regarding research proof (Brennan, 2020). Basic evaluation can happen through a non-organized methodology where one fundamentally read the investigation as one reads it, or through an organized methodology using a Critical Appraisal Tool (CAT). Feline's are organized agendas that permits one to check the methodological nature of an investigation against a bunch of rules. A benefit of utilizing a CAT is that one can apply a degree of consistency while inspecting various investigations. Notwithstanding a potential inconvenience is that they may not get some information about an expected wellspring of inclination that is significant for the particular exploration questions being inquired.

CHAPTER 3 RESULTS

3.1 Data Collection

In the current study, data from 1125 past research studies and papers was collected. These were selected from different online sources and databases. However, after removing the duplicates, researcher was left with 1000 studies, out of which 238 were excluded, leaving the scholar with 762 studies. Out of this 195 studies were then excluded, thus the researcher had 567 studies, out of which 432 studies were included in the qualitative synthesis and finally these 432 investigations were used in the current study.

3.2 Data Presentation

From the below graph it can be seen that the study types used by the researcher were interrupted time series (n = 79), observational studies (n = 137), randomised controlled trials (n = 65), exploratory study (n = 77) and comparative study (n = 74).

From the above image it can be seen that majority of the participants in the studies believed that implementation of EWTD has benefited the NHS (44%), while 32% believed that it has benefited the senior doctors and least (23%) were of the opinion that it has benefited the junior doctors.

The above image shows that implementation of EWTD has helped in enhancing work life balance of the doctors (n = 132), then came quality of patient care (n = 100), efficiency in managing patient care (n = 83), training opportunities for junior doctors (n = 79) and continuity of patient care (n = 38).

CHAPTER 4 DISCUSSION

4.1Overall Summary of the findings from the articles selected for review

Errors in the medical field can be very dangerous and they can have a significant negative impact on the lives of the care service users. It has been observed that medical professionals make mistake and that too mainly due to being overloaded with work. In this regard, the European Working Time Directive (EWTD) has emerged as a way through which time related work pressure on the medical professionals can be reduced. This can also help in reducing the medical errors (Sundler et. al., 2018). The EWTD is an initiative by the European Union (EU) to prevent employers forcing their employees to work excessively long working hours under the pretext of ensuring their health and safety in the long run.

Controllers and experts have various perspectives around the advantages of limiting working hours and the impacts that this can have on preparing. Most members accept that some limitation on working hours is alluring as it supposedly delivers various advantages for the two patients and staff, which are all talked about in more detail in the following segment of the report. Notwithstanding, despite this underlying energy according to confined hours, there is a broadly held sense that such guidelines are trying to carry out (Lawler et. al., 2019). Incompletely, this view is driven by the experience of those we drew in with; a significant number of the controllers and experts we addressed proposed that, as a student, they worked in conditions where there was no genuine cutoff to the hours in which learners would work. While a particularly working climate is considered possibly harming (both as far as tolerant wellbeing and as to the personal satisfaction stood to the specialists who work in such conditions), for some, it is the thing that they have known and, hence, conceptualizing elective working models is hard for them (McClelland, 2019). Considering this, numerous controllers and experts unexpectedly discuss the difficulties related with the execution of limited hours. Nonetheless, there is a lot of extremity comparable to how various gatherings of partners see the commonness and degree of these difficulties and, thus, how simple they accept they are to survived. For some the difficulties are exceptionally minor, while for others there are extremely significant issues related with executing limited working hours (Cairney, 2021).

4.2 How these findings relate to relevant literature?

The European Working Time Directive (EWTD) produced results in October 1998 yet the last phase of execution as the Working Time Regulations (WTRs) in the UK with working hours restricted to 48 hours occurred as of late in August 2009. The issue with this is believed to be that with a decreased number of hours accessible for preparing, there is a likely danger to the nature of that preparation (Jephcote and Gulliver, 2021). As the controller of clinical instruction and preparing in the UK, it‟s significant for the GMC to comprehend the effect these progressions may have on this matter. The GMC has effectively led some examination around here, including a broad writing audit and reports summing up the administrative proof of EWTD. Notwithstanding there are as yet huge holes in information about the effect of EWTD and the GMC is quick to guarantee that these are filled (Kenawy and Kett, 2019)

4.3 Limitations

Overall terms the UK is viewed as being more customary than different nations with those working in the clinical calling seeing working extended periods of time as being something of a transitional experience. This feeling of custom, thusly, goes connected at the hip with more prominent degrees of protection from expanded working hours than have been knowledgeable about numerous pieces of Europe and in different nations where limited working hours have been executed (Dincer and Aksakal, 2018). Partners in the actual UK proposed that, while the New Deal 56 hours was „about right‟, limiting working hours to 48 hours goes excessively far. All the more extensively however, partners think that its a lot simpler to talk about the unfortunate results of working confined hours as opposed to the potential benefits that it can bring. To a great extent, this was on the grounds that functioning limitless hours was the framework that they had known and were utilized to and, consequently, thought that it was difficult to envision how medication could work successfully on some other premise (Scholarios, 2017). These worries fell into four fundamental classifications including worries around preparing, seriousness and pay. Those controllers who are more negative about the EWTD frequently contend that it is extremely difficult to prepare specialists adequately inside a more limited working week

4.4 Bias and Confounding

Contrasts in assessment on this matter can be part of the way clarified by nation of beginning and, less significantly, specialism (Jephcote and Gulliver, 2021). For example, controllers from nations (like Portugal and the UK) where working hours have customarily been long, and where students have a job in overseeing clinic work (as opposed to, for instance, essentially noticing and gaining from crafted by subject matter experts) the difficulties related with limited hours are for the most part viewed as a lot more noteworthy. Interestingly, controllers from nations where there is to a greater degree an attention on the significance of keeping a balance between fun and serious activities, (like France and Sweden) and where students have to a lesser extent a job in medical clinic work (like Italy) depict the change to working confined hours as being simpler and, in this way, revealed the EWTD as being simpler to carry out (Jones and Mercer, 2018)./p>

There is additionally a wide-spread conviction that decreased working hours can further develop the balance between fun and serious activities of specialists and learners permitting them to have outside interests or invest more energy with their families (Anderson and Price, 2017). This advantages the person as well as accepted to carry benefits to the patient; some talked about the connection between close to home fulfilment and viability in the work environment and referenced that, by working limited hours, clinical staff are bound to be by and by satisfied and that this, thus, will convert into worked on quiet consideration.

4.6 Conclusion and Recommendations for Further Study

UK learners recommend that there have been a few issues related with the execution of the WTRs. For example, learners in the UK report working extremely changed shift designs whereby they work as long as 100 hours in a single week, however many less hours the week after. By and large, they are as yet working 48 hours of the week so are agreeable with the WTRs. Besides, while they perceive that functioning such extended periods of time might actually represent a danger to patient wellbeing they express that what it considers is coherence of care (Mousteri and Delaney, 2020). Subsequently, according to their point of view, they accept that there are issues here with limited hours prompting intermittence of care which thusly adversely impacts on understanding experience. When examining concerns identified with the execution of the EWTD, various controllers and experts notice the danger that, by working confined hours, clinical experts from the UK can not rival those from nations where no such working restrictions are set up. This supposedly is especially the situation for junior specialists and it is felt that, by decreasing the quantity of hours accessible for preparing, they will be in a difficult spot to their friends globally (Baggaley, 2019).

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