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Stress on the Ward – An Empirical Study of the Nonlinear Relationship between Organizational Workload and Service Quality

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  • Kuntz, Ludwig
  • Mennicken, Roman
  • Scholtes, Stefan

Abstract

We discuss the impact of organizational workload on professional service outcomes, such as survival rates in hospitals. The prevailing view in the literature is that service quality deteriorates when organizational workload increases. In contrast, we argue that the relationship between workload and service outcomes is nonlinear and that there is a quality-optimal workload level. Whilst outcomes deteriorate with increasing workload when workload levels are already high, they will improve if workload increases from a low level. We reach this hypothesis by combining three perspectives: (i) the queuing theory perspective, with its focus on congestion, (ii) a discretionary choice perspective, with a focus on decisions made by professionals in response to changes in workload, and (iii) an endocrinological perspective, with a focus on the subconscious eff ects of workload on worker performance through the cognitive impact of stress hormones. Using a patient census of 1.4 million patients in 624 departments across 101 hospitals, we provide empirical support for the nonlinearity hypothesis in the context of hospital survival rates. We further discuss the implications for hospital capacity planning and the wider implications for service operations management.

Suggested Citation

  • Kuntz, Ludwig & Mennicken, Roman & Scholtes, Stefan, 2011. "Stress on the Ward – An Empirical Study of the Nonlinear Relationship between Organizational Workload and Service Quality," Ruhr Economic Papers 277, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    • Handle: RePEc:zbw:rwirep:277
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    1. Wallace J. Hopp & Seyed M. R. Iravani & Gigi Y. Yuen, 2007. "Operations Systems with Discretionary Task Completion," Management Science, INFORMS, vol. 53(1), pages 61-77, January.
    2. McClellan, Mark & Noguchi, Haruko, 1998. "Technological Change in Heart-Disease Treatment: Does High Tech Mean Low Value?," American Economic Review, American Economic Association, vol. 88(2), pages 90-96, May.
    3. Patrick Royston & Willi Sauerbrei, 2007. "Multivariable modeling with cubic regression splines: A principled approach," Stata Journal, StataCorp LP, vol. 7(1), pages 45-70, February.
    4. Diwas S. Kc & Christian Terwiesch, 2009. "Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations," Management Science, INFORMS, vol. 55(9), pages 1486-1498, September.
    5. Gary P. Pisano & Richard M.J. Bohmer & Amy C. Edmondson, 2001. "Organizational Differences in Rates of Learning: Evidence from the Adoption of Minimally Invasive Cardiac Surgery," Management Science, INFORMS, vol. 47(6), pages 752-768, June.
    6. J. Scott Long & Jeremy Freese, 2006. "Regression Models for Categorical Dependent Variables using Stata, 2nd Edition," Stata Press books, StataCorp LP, edition 2, number long2, March.
    7. Bar{i}c{s} Ata & Jan A. Van Mieghem, 2009. "The Value of Partial Resource Pooling: Should a Service Network Be Integrated or Product-Focused?," Management Science, INFORMS, vol. 55(1), pages 115-131, January.
    8. Krishnan S. Anand & M. Faz{i}l Paç & Senthil Veeraraghavan, 2011. "Quality-Speed Conundrum: Trade-offs in Customer-Intensive Services," Management Science, INFORMS, vol. 57(1), pages 40-56, January.
    9. Xiaofang Wang & Laurens G. Debo & Alan Scheller-Wolf & Stephen F. Smith, 2010. "Design and Analysis of Diagnostic Service Centers," Management Science, INFORMS, vol. 56(11), pages 1873-1890, November.
    10. Michael S. Dahl, 2011. "Organizational Change and Employee Stress," Management Science, INFORMS, vol. 57(2), pages 240-256, February.
    11. Martin Gaynor & Harald Seider & William B. Vogt, 2005. "The Volume–Outcome Effect, Scale Economies, and Learning-by-Doing," American Economic Review, American Economic Association, vol. 95(2), pages 243-247, May.
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    Cited by:

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    More about this item

    Keywords

    Service quality; service outcomes; organizational workload; hospital capacity planning; behavioral operations; stress; Service quality; service outcomes; organizational workload; hospital capacity planning; behavioral operations; stress;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • M11 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Business Administration - - - Production Management
    • M54 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Personnel Economics - - - Labor Management

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