Impact of reforms and work environment on resident time allocation in a Swiss internal medicine division: a time motion study with a before-and-after comparison

STUDY AIMS: Increasing clinical complexity, rising admission volumes and shorter hospital stays have intensified demands on internal medicine residents. A 2015 time and motion study at our institution showed that residents spent nearly half of their day on computer work, with frequent task-switching and limited patient contact. These findings prompted organisational reforms to redistribute workload and improve workflow. We aimed to assess how resident time allocation changed after organisational reforms. METHODS: We performed a before-and-after time and motion study in the division of internal medicine in a tertiary care centre in Switzerland. Direct observations were conducted over identical periods (May–July) in 2015 (baseline, before implementation of organisational reforms) and 2018 (first assessment after full implementation of these reforms). All residents were eligible. Shifts were randomly selected and stratified by weekday, with two shifts per resident observed whenever possible. Trained observers used a standardised electronic tool to record 22 mutually exclusive activities and contextual factors. The primary outcome was time spent on administrative tasks (patient-related and non-patient-related administration, discharge summaries, information retrieval). Secondary outcomes included task-switching rate, mismatch rate (deviation from planned schedule) and shift duration. Division workload data were collected to adjust analyses. RESULTS: Seventy-five residents were observed over 142 shifts (1478 hours). From 2015 to 2018, mean administrative time increased from 92 to 139 minutes/day (p <0.001) and mean task-switching from 15 to 20 per hour (p <0.001), while mean mismatch rate decreased (38.8% to 31.7%, p <0.001). The mean shift duration shortened (11h38m to 10h45m, p <0.001), with mean personal time increasing (32 to 63 minutes, p <0.001). Mean bedside time declined (113 to 92 minutes, p = 0.011) and mean computer use slightly decreased (327 to 290 minutes, p = 0.009). Mean weekly admissions rose (96 to 146, p <0.001) and mean length of stay was halved (15.5 to 8.5 days, p <0.001). Results were consistent after adjustment for division workload. CONCLUSIONS: Targeted reforms improved schedule alignment and work–rest balance but failed to reduce administrative burden in a high-turnover environment. Local time-management interventions should be integrated with hospital-wide strategies addressing workflow complexity, interprofessional communication and task distribution. These results may inform similar initiatives in other high-pressure inpatient training settings. Trial registration: ISRCTN 69703381, https://doi.org/10.1186/ISRCTN69703381.