Journal of Health Economics · 2026 · Dan Han、Emma Clarke‐Deelder、Margaret Anne McConnell
中文摘要
医疗服务提供者面临的繁重工作负荷可能导致诊疗过程发生改变,进而影响医疗质量与患者结局。通过对肯尼亚三家高业务量医院阴道分娩的直接观察,我们研究了工作负荷如何影响产科病房的诊疗——这是一个高压环境,患者入院难以排程以及产程进展的不确定性可能导致一天之内工作负荷出现意外波动。我们首先记录到,相对于国际人员配置基准,这些医疗机构长期存在人员不足,意味着较高的基线工作负荷。利用该环境中医务人员工作负荷的短期变化,我们发现,以医务人员对临床指南的遵守程度和不尊重照护来衡量,工作负荷对医疗质量几乎没有甚至没有影响。我们表明,医务人员所采用的应对策略,例如使用临床干预加速产程以及将任务委派给资质较低的团队成员,可能弱化了工作负荷与我们考察的质量指标之间的关系。然而,这些应对机制可能对医疗质量的其他(未被测量的)方面产生负面影响。借助轶事性证据及其他证据,我们针对为何在这一情境中医疗质量可能对工作负荷不敏感提出了额外的假说。
Abstract
Heavy workloads facing health care providers may lead to changes in care processes that, in turn, affect quality of care and patient outcomes. Using direct observations of vaginal deliveries in three high-volume Kenyan hospitals, we study how workload affects care in maternity wards - a high-stress environment where hard-to-schedule patient admissions and uncertainty around labor progression can result in unexpected fluctuations in workload throughout the day. We first document that these facilities are persistently understaffed relative to international staffing benchmarks, implying high baseline workloads. Exploiting short-run variations in provider workload in this environment, we find that workload has little to no effect on quality, as measured by provider adherence to clinical guidelines and disrespectful care. We show that coping strategies employed by providers, such as using clinical interventions to speed up labor and delegating tasks to less qualified team members, may have weakened the relationship between workload and the quality measures we examine. However, these coping mechanisms could have negative implications for other (unmeasured) aspects of quality. Drawing on anecdotal and other evidence, we propose additional hypotheses for why quality may not be sensitive to workload in this setting.