KUALA LUMPUR, Nov 27 — Emergency specialist doctors have protested the 45-hour work week for health workers in a new shift system under the Sistem Saraan Perkhidmatan Awam (SSPA).
Instead, the College of Emergency Physicians (CEP) under the Academy of Medicine, Malaysia (AMM), an umbrella organisation of specialist fraternities, called for a reduction of working hours to a maximum of 40 hours a week, particularly for health care shift workers in “intense” environments.
These include doctors, nurses, and assistant medical officers on duty in the emergency department (ED), wards, intensive care unit (ICU), and operating theatres (OT) – whom CEP said work continuously with “practically no break” in between.
“Extensive working hours that require a minimum of 45 hours a week in such an intense, non-stop condition pose serious health, safety, and performance risks,” the CEP Council said in a statement today.
“There will be risks of medical error leading to medicolegal implications.”
Citing international benchmarks, CEP noted that a study commissioned by the Royal College of Emergency Medicine in the United Kingdom recommended a 40-hour work week for staff, as overworked consultants are shown to be less effective, more prone to errors, and at greater risk of leaving their profession prematurely.
Japan’s Labor Standards Act sets a limit of eight hours a day, 40 hours a week.
In Canada, the standard work week for health care professionals, as regulated by provincial labour laws and collective agreements, ranges from 37.5 to 40 hours.
Australia’s standard work week is 38 hours. Although health care professionals often work additional hours, they are compensated with overtime pay and also receive mandatory rest periods.
The standard work week in France is 35 hours. Longer hours are permitted in the health care sector under specific agreements, provided they comply with the maximum work hours limit under the European Union’s Working Time Directive.
“Health care shift workers in a highly intense environment are not comparable with normal office workers. The dangers of overworking among health care shift workers are well-documented and demand urgent attention from policymakers,” said the CEP.
“Limiting weekly work hours to 40 among health care shift workers is optimal.”
Following backlash from multiple nurses’ groups and government politicians, Health Minister Dzulkefly Ahmad sought to portray the 45-hour work week under the new SSPA work scheme – which comes into effect this Sunday (December 1) – as 40 hours of work in practice, due to one-hour daily breaks that total five hours a week.
Hence, he claimed in Parliament yesterday that the new shift system would have fewer “actual” working hours at 40 a week compared to the current system of 42 hours weekly, where nurses cannot take breaks for meals or prayers.
The Public Service Department (JPA) does not legally separate break hours from official working hours. The new SSPA work scheme is aimed at streamlining 45-hour work weeks for all civil servants, without differential treatment for health care workers.
Mental And Physical Health Risks, Decreased Patient Safety And High Risk Of Medicolegal Suits, High Staff Turnover And Workforce Unsustainability
Citing World Health Organization (WHO) research, CEP pointed out that excessive work hours are a significant contributor to ischaemic heart disease and stroke. Shift work also disrupts one’s circadian rhythm, exacerbating sleep disorders and metabolic issues. A Korean study shows increased risk of depression among shift workers who have to work at night.
“Working 45 hours or more per week in intense environments has been strongly associated with adverse health outcomes. Prolonged work hours increase the risks of burnout, anxiety, and depression among health care workers,” said CEP.
Metabolic syndrome is also higher among those who work long hours including night shifts,
leading to increased risk of heart disease, stroke and diabetes. Working more than 40 hours a week in this situation would also drive them to suffer burnout.
A 2018 study published in the Journal of the American Medical Association showed that exhaustion and sleep deprivation among health care professionals significantly impair cognitive functions, leading to increased medical errors.
In a study involving more than 11,000 nurses, greater length of average work week is associated with increased reports of patient falls, nosocomial infections, and work injuries. This study also showed that those who worked more than 40 hours per week were 28 per cent more likely to administer wrong medications or doses for patients.
“In the Malaysian context, these errors can have profound consequences, given the high patient-to-staff ratio. With the shortage of staff, many hospitals have no choice but to implement a double-shift system,” said CEP.
“All these will result in medicolegal implications and looking at the recent trends of payout meted out by courts, the government shall be at great risk for huge sums of payout following the increased working hours.”
Citing further studies, CEP noted that excessive working hours are a leading cause of staff turnover in the health care industry. This results in job dissatisfaction, increased intention to leave, reduced patient satisfaction, and even expensive job turnover (Stimpfel et al., 2012). Working long hours also causes increased anxiety, depression, and reduced care quality.
“For Malaysia, where health care worker shortages are a pressing concern, retaining skilled professionals through improved working conditions should be given strong attention,” said CEP.
Besides a 40-hour work week cap for health care shift workers in intense environments, CEP called for rotational rest days, robust mental health programmes tailored to shift workers, and monitoring systems to enforce work-hour regulations and to track their impact on worker wellbeing and patient safety.
The emergency physicians’ fraternity told the Ministry of Health (MOH) and private hospital groups to consider existing evidence, international practice, and the reality on the ground to make “reasonable considerations” for safer workplaces, patients, and staff.
“We trust the ministry shall have wisdom in making reasonable consideration with all these existing evidences and prevent medicolegal consequences.”
