The Introduction of a 42 + 4 Hour Work Week for Surgical Residents in Switzerland – a Stakeholder Analysis

Abstract

Background The Swiss national union of residents and attendings (VSAO) has voiced its desire for a transition to a 42 + 4h work week, in which 42h be focued on patient care with the remaining 4h be dedicated solely to training purposes. This could potentially result in a decrease of 20% in surgical education time. The current study seeks to address the issues involved in its implementation as well as possible compensatory mechanisms. Methods This mixed methods study seeks to clearly underline the challenges associated with the implementation of a 42 + 4h work week. First, the major stakeholders were identified and analysed via umbrella review. Thereafter, a classic stakeholder analysis was performed. Via morphological matrix, possible models for the implementation of a 42 + 4h work week were developed and evaluated. Finally, representatives from the identified stakeholder groups were interviewed and given the opportunity to provide feedback. Results A total of 26 articles were identified by the literature search and were used to identify the major stakeholders and issues involved in the implementation of the desired work hour regulation. Overall, these showed conflicting results with regard to the effect decreased working hours would have on surgical training and patient outcomes. In the end, the morphological matrix produced three feasible and desirable models for the implementation of a 42 + 4h work week. Each included compensatory mechanisms like auxiliary staff, reduction in administrative tasks, and a switch to EPAs. In their interviews, the stakeholders generally supported these solutions. Conclusion Given the increasing emphasis on the importance of a positive work-life balance, it seems inevitable that the next few years will see the introduction of a 42 + 4h work week in Switzerland. However, it is imperative that every effort be made to preserve the quality of training and patient care for the next generations. This will require the cooperation of all stakeholders in order to find workable solutions.