Ruhr Economic Papers

Ruhr Economic Papers #277

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

by Ludwig Kuntz, Roman Mennicken and Stefan Scholtes

RWI, 09/2011, 41 S./p., 8 Euro, ISBN 978-3-86788-322-1



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 effects 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.

JEL-Classification: I12, M11, M54

Keywords: Service quality; service outcomes; organizational workload; hospital capacity planning; behavioral operations; stress

Published as:

Kuntz, L., R. Mennicken and S. Scholtes (2015), Stress on the Ward: Evidence of Safety Tipping Points in Hospitals. Management Science 61 (4): 754-771. DOI: 10.1287/mnsc.2014.1917