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首页> 外文期刊>Journal of the advanced practitioner in oncology >Compressed Workweeks: A Model for Improved Work-Life Balance and Retention of Oncology Advanced Practitioners
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Compressed Workweeks: A Model for Improved Work-Life Balance and Retention of Oncology Advanced Practitioners

机译：压缩工作周：改善工作生活平衡和肿瘤学的保留的模型

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Background: The Bone Marrow Transplant (BMT) Advanced Practitioner (AP) service at the Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance provides high-level care to complex patients in inpatient, outpatient, and specialty clinic settings. Contribution from APs is integral to the consistent success of the program. Citing poor work-life balance largely attributed to excessive hours worked, approximately one-third of APs resigned around 2015. This staffing crisis resulted in significant workforce loss with many years of highly valuable BMT and institutional knowledge. In 2017, we implemented a comprehensive schedule modification which aimed to maintain excellent patient care while improving work-life balance and retention of APs by transition-ing to shorter workweeks. Intervention: We reviewed models in 5 major BMT centers and found that all had compressed workweeks. A schedule was designed with the following goals: maintain quality and continuity of patient care, preserve flexibility for APs to work in different settings, decrease moonlighting, limit excessive hours, and improve AP work-life balance and retention. The inpatient schedule consists of buddy pairs sharing a cohort of patients. The outpatient model is 4-day workweeks with additional rotations covering scheduling gaps and weekends. To support these changes and limit reliance on non-BMT AP staffing, the total number of APs increased. Effects: A survey of APs in 2017 who had been employed before and after the scheduling modification demonstrated that 88% said the work environment was very or moderately improved. Moonlighting cost in the 6 months pre- and post-implementation dropped from a monthly average of $38,200 to $16,400, a 57% decrease. Retention data show statistically significant improvement (p=0.037): in FY15 AP turnover rate was 22.2% (N=36), while in FY19, the turnover rate dropped to 7.1% (N=56). Conclusions: BMT APs at our center successfully transitioned to a scheduling model with shorter workweeks which resulted in more appropriate hours worked, better work-life balance, and improved retention rates. During this transition, we maintained excellent quality of care for our patients, reflected in the fact that our center is one of only 5 out of 177 transplant centers nationwide to achieve higher-than-expected survival rates. The upfront cost of this scheduling change has been mitigated by less reliance on moonlighting and improved retention rates (it is estimated that replacement of an AP costs at least $250K). The preservation of clinical and institutional knowledge is extremely valuable and, though difficult to quantify, certainly contributes to improved care for patients. Recommendations: An impending shortage of US oncologists is predicted given an aging population, higher cancer prevalence, and rapidly expanding therapeutic options. Oncology APs have been and will continue to be integral in team-based models providing high-level care to these complex patients. Centers should strive to support AP retention which can be achieved in part by limiting excessive hours and burnout by implementing a compressed workweek model. Future studies are needed to collect concrete data on work-life balance, hours worked, burnout, and retention rates to help justify the increased staffing required to support these schedule changes.
机译：背景：FRED Hutchinson Cancer Research Center / Seattle Cancer Care联盟的骨髓移植（BMT）先进的医生（AP）服务为住院患者，门诊和专业诊所环境中的复杂患者提供高级护理。 APS的贡献与程序的一致成功是一体的。在贫困的工作环境平衡差，归因于过度工作，大约三分之一的AP左右左右辞职。这一人员配置危机导致了多年的高价值BMT和制度知识的重要劳动力损失。在2017年，我们实施了一个综合安排修改，旨在通过过渡到更短的工作周，改善工作生活平衡和APS的保留，以保持优秀的患者护理。干预：我们在5个主要的BMT中心审查了模型，发现所有人都有压缩的工作周。计划采用以下目标设计：维护患者护理的质量和连续性，保持适用于AP的灵活性，以不同的设置，降低月光，限制过多的时间，并改善AP工作寿命平衡和保留。住院时间表由共享患者队列的伙伴对组成。门诊模型是4天工作周，涵盖调度差距和周末的额外旋转。为了支持这些变化和限制对非BMT AP人员配置的依赖，AP的总数增加。效果：2017年APS调查均在调度修改之前和之后雇用的，证明了88％的人表示，工作环境非常完善或中度。 6个月的月亮成本预先和实施后的每月平均每月38,200美元到16,400美元，减少了57％。保留数据显示统计学上显着的改进（P = 0.037）：在FY15的AP营业额为22.2％（n = 36），而在FY19中，流量率下降至7.1％（n = 56）。结论：我们中心的BMT APS成功转换为调度模型，较短的工作周，导致更合适的工作时间，更好的工作寿命平衡和改善的保留率。在此过渡期间，我们为患者保持了良好的照顾，体现在我们的中心是全国177个移植中心中的仅有5个以实现高于预期的生存率。这种调度变化的前期成本已经减少了对月光的依赖性和改善的保留率（估计至少250K的价格更换AP成本）。保存临床和制度知识是非常有价值的，虽然难以量化，但肯定有助于改善患者的护理。建议：在人口老龄化，癌症患病率高，迅速扩大治疗方面，预测了美国肿瘤科医师的即将缺少。肿瘤学APS已经并将在基于团队的模型中继续是一体的，为这些复杂的患者提供高级护理。中心应努力支持AP保留，通过实施压缩的工作周模型，可以部分地通过限制过度时间和倦怠来实现。未来的研究需要收集关于工作寿命平衡，工作时间，倦怠和保留率的具体数据，以帮助支持支持这些进度所需的人员所需的工作人员。

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