Self-financing implementation of the working time directive without opt-out but with a 9 % increase in efficiency - Experience at a German university hospital in 2007

Waurick R, Roeder N, Volkert T, Van Aken H

Abstract

Background: As of 01.01.2007, following the expiration of an interim arrangement, German hospitals had to implement the (European) working time directive. This directive stipulates that time on-call must be regarded in its entirety as working time, and overall working time is limited to 48 hours a week. The tariffs for doctors at university hospitals permit opt-out agreements between employer and employee with an extended weekly working time of 54 or 58 hours. Methods: On the basis of the results of an opinion poll among the medical staff and of a workload analysis, a working time model excluding opt-outs was implemented at the Department of Anaesthesiology and Intensive Care Medicine of the University Hospital of Munster. This model is geared to the daytime-dependent staff requirements of the various clinical sectors. Fifty percent of the former hospital-based on-call service was converted to a home-based on-call service. Individual working time accounts were introduced and a data base-supported workload analysis of the on-call events was carried out. Former hospital-based emergency physicians were re-organised on a self-employed basis. Results: The introduction of seven different workload-adapted standard working times resulted in an increase in the cumulative incision-to-suture time and the number of anaesthesias performed by more than 9 %. The increase in staff requirements resulting from the reduction in weekly working time, was financed by savings in the hospital-based on-call service. In this way the implementation of the working time directive and tariffs was rendered self-financing. The working-hours limits for staff providing hospital-and home-based on-call services stipulated in the tariff agreement for university hospital doctors were more than complied with. A 4.5 % decrease in earnings by the medical staff can be compensated by optional work on a self-employed emergency physician basis. Conclusions: Depending on the individual situation, the working time directive and local tariff agreements for doctors can be implemented on a self-financing basis through the introduction of daytime-dependent and workload-adapted working time models. Moreover, such modern working time models may result in an improvement of efficiency.