The Effect of Workload on Patient Outcomes: An Empirical Analysis of a Maternity Unit
Dr. Nicos SAVVA
Assistant Professor of Management Science and Operations
London Business School
Extant literature provides strong evidence that service quality (e.g., patient outcomes) deteriorates at high levels of workload. In this paper, we use a detailed dataset from the delivery unit of a major teaching hospital to better understand how workload impacts quality. We consider two mechanisms: direct impact through deterioration in the quality of task execution and indirect through the choice of care pathway. First, we demonstrate that workload has an effect on the care pathway – discretionary but resource-intensive interventions, such as pain relief, are less likely to be administered at high workloads. Second, we show that workload increases the propensity of some adverse outcomes, such as perineal tears, and reduces others, such as emergency cesarean sections. The effect on perineal tears is predominantly direct, while the effect on cesarean sections is indirect. We also examine post-birth length of stay and find that the direct and indirect effects work in opposite directions; while both effects are individually significant, they cancel each other out on aggregate. Our results provide a better understanding of how workload affects quality in service settings and we demonstrate how they can be used to predict changes in outcomes and costs under different demand and staffing scenarios.