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PubMed2006

Recovery, well-being, and performance-related outcomes: the role of workload and vacation experiences.

On the basis of theoretical assumptions regarding resource gain and loss (S. E. Hobfoll, 1998), the authors used a longitudinal study to examine effects of vacation on well-being and performance-related outcomes. University employees (N = 221) completed measures of well-being (health complaints and burnout) and performance-related outcomes (self-reported task performance and effort expenditure) 1 week before and 2 days and 2 weeks after vacation and measures of workload 2 days after vacation. Specific vacation experiences (positive and negative work reflection, relaxation, mastery experience, and nonwork hassles) were assessed during vacation. Results showed changes in well-being and self-reported effort expenditure from before to after vacation, revealing vacation effects and partial fade-out effects. In addition, vacation experiences and workload significantly predicted some of the outcomes. The authors discuss applicability of the theoretical approach in the context of vacation and fade-out effects, implications for future research on recovery processes, and practical implications.

Adult↗

PubMed2003

Social support and the quality of parenting under economic pressure and workload in Finland: the role of family structure and parental gender.

This study focused on how factors outside the home affect the quality of mothering and fathering. Economic pressure and workload were evaluated along with the compensating role of social support on parenting. Information was gathered from 842 mothers and 573 fathers including 139 single-mother and 21 single-father families. The results showed that the nature of the strains, together with parental gender and family structure, influenced their effects on parenting. The results further revealed some gender- and strain-specific protective functions of social support on parenting. For example, economic pressure was related to increased punitive parenting, which was compensated by instrumental and emotional support among the mothers. Workload was related to less authoritative single fathering, which was compensated by instrumental support.

Adult↗

PubMed2006

Control over the scheduling of simulated office work reduces the impact of workload on mental fatigue and task performance.

Two experiments tested the hypothesis that task-induced mental fatigue is moderated by control over work scheduling. Participants worked for 2 hr on simulated office work, with control manipulated by a yoking procedure. Matched participants were assigned to conditions of either high control (HC) or low control (LC). HC participants decided their own task scheduling, whereas LC participants had to follow these fixed schedules. For Experiment 1, fatigue was higher in LC participants who worked harder, so Experiment 2 compared control effects in high- and low-workload groups. As predicted, the impact of workload was reduced under HC conditions, for subjective fatigue, and most secondary tasks and aftereffects. The findings are interpreted within the framework of compensatory control theory.

Adult↗

PubMed2003

Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness.

National guidance and clinical guidelines recommended multidisciplinary teams (MDTs) for cancer services in order to bring specialists in relevant disciplines together, ensure clinical decisions are fully informed, and to coordinate care effectively. However, the effectiveness of cancer teams was not previously evaluated systematically. A random sample of 72 breast cancer teams in England was studied (548 members in six core disciplines), stratified by region and caseload. Information about team constitution, processes, effectiveness, clinical performance, and members' mental well-being was gathered using appropriate instruments. Two input variables, team workload (P=0.009) and the proportion of breast care nurses (P=0.003), positively predicted overall clinical performance in multivariate analysis using a two-stage regression model. There were significant correlations between individual team inputs, team composition variables, and clinical performance. Some disciplines consistently perceived their team's effectiveness differently from the mean. Teams with shared leadership of their clinical decision-making were most effective. The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians, the NHS, and the general population. This study established that team composition, working methods, and workloads are related to measures of effectiveness, including the quality of clinical care.

Adult↗

PubMed2005

The impact of implementing national hypertension guidelines on prevalence and workload in primary care: a population-based survey of older people.

Recently revised UK and US hypertension guidelines have reduced thresholds for both diagnosis and treatment and differ in their recommendations. We have used data from a random, stratified community-based sample of 4784 people aged 65 years and over to compare the prevalence of treatable hypertension and the potential impact on patients and primary care from using current guidelines. BHS, NICE and JNC7 guidelines were applied to blood pressures obtained from primary care medical records (94%) or measured at a screening clinic (6%). Risk factors were obtained by questionnaire and from medical records, supplemented by epidemiological data. Workload was estimated for a representative practice population of 10 000 patients. Blood pressures were obtained on 4514 patients (94%). Prevalence of treatable hypertension was over 67%. Compared to BHS4, prevalence estimates using NICE guidelines were comparable for men but significantly lower for women (P<0.05). They were significantly higher using JNC7 compared with BHS4 and NICE guidance (P<0.05). A general practice of 10 000 patients could expect 1287 older hypertensive patients using BHS4 guidelines and 1231 patients using NICE guidelines. Under BHS4, an extra 94 patients will require annual, rather than 5-yearly review compared with that using the previous guideline. In conclusion, implementation of BHS4 guidelines, with their revised thresholds for diagnosis, will not add materially to the prevalence of treatable hypertension compared to previous BHS3 guidelines but will have a major impact on practice workload. Use of NICE guidelines in preference to BHS4 will result in GPs treating fewer patients and reviewing untreated patients less often.

Aged↗

PubMed2000

Recent changes in the workload and clinical experience of pre-registration house officers: experiences over four years in south-west England.

We aimed to measure changes in the training and workload of pre-registration house officers using a postal questionnaire. Two hundred and six pre-registration house officers in the south-western region of England were surveyed and asked to report on the education, training and workload of their posts. Results were compared with a survey conducted four years earlier. Since the previous survey, the number of hours on duty had reduced from a median of 80 h week-1 in 1992/3 to 72 h week-1 in 1996/7 (P < 0.0001). There were no statistically significant changes in the number of patients admitted or clerked in an average week, but house officers' clinical experience had fallen. All but five of 26 marker conditions showed a decline, which was statistically significant in seven cases. House officers were keener to include four months of general practice in the pre-registration year and were less adverse to extending the pre-registration year to two years. The reduction in hours of work for house officers has been accompanied by a decline in their clinical exposure to common medical and surgical emergencies. The long-term effects of these changes are unknown.

Emergency Medicine↗

PubMed2001

Colorectal surgery in rural Australia: scars; a surgeon-based audit of workload and standards.

BACKGROUND: The collection and measurement of colorectal surgical workload, case management and clinical indicators have been mainly based on metropolitan specialist institutions. The aim of the present study was to examine the workload and standards of colorectal surgery in rural Australia. METHODS: Sixty-nine rural general surgeons in Victoria, Albury and South Australia were invited to complete a questionnaire for each transabdominal colorectal operation performed over a 12-month period from 1 May 1996. Data were collected on comorbidity, operation detail, pathology, complications and intention to use adjuvant cancer therapy. RESULTS: Sixty-two surgeons contributed 877 data forms. The patient average age was 65 years with 60% having pre-existing disease. One-third of operations were emergency presentations of which bowel obstruction was the most common. An anastomosis was performed in 675 patients of whom 22 (3.3%) had a clinical anastomotic leak. For low rectal anastomosis the leak rate was 8.9%. Two-thirds of patients had colorectal cancer and 42% of these cancer patients had advanced (Australian clinicopathological stage C or D) disease. The perioperative mortality rate was 4.6% but in the presence of more than two comorbidities it was 16.4%. Mortality was higher with emergency presentations (8.3%), particularly in patients older than 80 years (15.2%). CONCLUSIONS: The study sampled a very high percentage of rural colorectal surgery performed during the audit period. Colorectal surgery clinical indicators were comparable to other Australian studies. Anti-thrombotic and adjuvant therapy were identified as two areas requiring further education. Major surgery is being performed regularly in south-eastern rural Australia at a consistently high standard by surgeons who live and work in their rural community.

Aged↗

PubMed2001

A tool to measure radiotherapy complexity and workload: derivation from the basic treatment equivalent (BTE) concept.

Radiotherapy workload is poorly represented by simple parameters of patients, fractions or fields treated because these do not contain any measure of treatment complexity. However, complexity is increasing and there is an urgent need to quantify this. We have evaluated the basic treatment equivalent (BTE) model as a measure of radiotherapy workload and complexity. Radiotherapy treatment times, from the patient entering to exiting the treatment room maze, were measured for 1298 treatment sessions on 269 patients. The data were used to assess the original model and derive three new models for predicting treatment duration. The most complicated, the 'Addenbrooke's complex model', contained two additional predictor variables, including 'site/technique', in a linear additive form. Before the study, the department used a standard treatment appointment time of 10 minutes. However, 50% of the measured treatments took longer than 10 minutes, (mean 10.9). Summed over the working day, this discrepancy indicates that a standard 10-minute appointment is a poor basis for scheduling radiotherapy. The original BTE model was effective in predicting treatment times, although this was improved by refinement of the model. The Addenbrooke's complex model correctly predicted 70% of treatment times to within 2 minutes (55% for the original BTE model), 80% to within 2.5 minutes and 95% to within 4.7 minutes. The percentage of the variation in observed times accounted for by the model is 59.4%. The models can represent radiotherapy complexity, can improve scheduling on linear accelerators, and are likely to be applicable to other departments. They are thus tools to assess the impact of changes in complexity from new techniques, trial protocols (e.g. the Medical Research Council prostate radiotherapy trial RTO1), and possible time saving from advanced technology such as multileaf collimators (MLCs) or automated machine set-up. The replacement of manually-lifted shielding blocks by MLCs should save 1.1-1.5 minutes for a three- or four-field pelvic plan (i.e. 12%-13%). The models could also be used to aid planning for future linear accelerator provision and for costing radiotherapy treatment.

Efficiency, Organizational↗

PubMed2000

Lower limb occlusive arterial disease in the North of England: workload and development of management guidelines. The Northern Regional Vascular Surgeons.

BACKGROUND: in 1997 the vascular surgeons across the North of England commenced a study to examine various aspects of the management of lower limb occlusive arterial disease (LLOAD). Two aspects of this work were to assess workloads between hospitals and develop guideline parameters for managing intermittent claudication (IC) and critical limb ischaemia (CLI). The guidelines were to be developed, tested and modified by this study. METHOD: prospective inclusion of all patients admitted for investigation of LLOAD to nine hospitals by 19 surgeons over a period of 12 months. RESULTS: the hospitals admitted an average of 106 legs per 100 000 population (range 53-149) with LLOAD. Legs with IC (n=1351) were revascularised slightly less frequently than predicted (actual 76%, guideline 80%) and radiological treatment was used more frequently than predicted (radiology/surgery, actual 69/32%, guideline 40/60%). For limbs with CLI, revascularisation was undertaken more often (actual 70%, guideline 60%) and radiological intervention used more frequently (radiology/surgery, actual 45/58%, guideline 35/65%) than anticipated. Primary amputation, overall mortality and limb salvage were better than the predicted guidelines. CONCLUSION: large variations in workloads and clinical practice were observed between hospitals for the management of LLOAD. Developing guidelines for the management of limbs with IC was not considered appropriate, whereas suitable guidelines for legs with CLI were developed, tested and modified.

Amputation, Surgical↗

PubMed2001

Simplified subjective workload assessment technique.

Although the subjective workload assessment technique (SWAT) has been widely used, it has two main problems: it is not very sensitive for low mental workloads and it requires a time-consuming card sorting pretask procedure. In this study are presented five variations of SWAT in an effort to overcome the limitations. Four of the variants used the continuous SWAT subscales while one used the discrete SWAT subscale. Fifteen subjects participated in the experiment. The scales were compared with the original SWAT scale in terms of sensitivity and pretask procedure completion time when performing arithmetic tasks. The results show that all four variants are more sensitive than the conventional SWAT scale and that the pairwise comparison procedure takes significantly less pretask completion time compared with the original SWAT scale. Thus, the conventional pretask procedure can be replaced by a simple unweighted averaging to yield a scale of high sensitivity.

Adult↗

PubMed2003

Multimodal feedback: an assessment of performance and mental workload.

Multimodal interfaces offer great potential to humanize interactions with computers by employing a multitude of perceptual channels. This paper reports on a novel multimodal interface using auditory, haptic and visual feedback in a direct manipulation task to establish new recommendations for multimodal feedback, in particular uni-, bi- and trimodal feedback. A close examination of combinations of uni-, bi- and trimodal feedback is necessary to determine which enhances performance without increasing workload. Thirty-two participants were asked to complete a task consisting of a series of 'drag-and-drops' while the type of feedback was manipulated. Each participant was exposed to three unimodal feedback conditions, three bimodal feedback conditions and one trimodal feedback condition that used auditory, visual and haptic feedback alone, and in combination. Performance under the different conditions was assessed with measures of trial completion time, target highlight time and a self-reported workload assessment captured by the NASA Task Load Index (NASA-TLX). The findings suggest that certain types of bimodal feedback can enhance performance while lowering self-perceived mental demand.

Adult↗

PubMed2003

Reasons for adopting technological innovations reducing physical workload in bricklaying.

In this paper the adoption of technological innovations to improve the work of bricklayers and bricklayers' assistants is evaluated. Two studies were performed among 323 subjects to determine the adoption of the working methods, the perceived workload, experiences with the working methods, and the reasons for adopting the working methods. Furthermore, a comparison of the results of the studies was made with those of two similar studies in the literature. The results show that more than half of the sector adopted the innovations. The perceived workload was reduced. The employees and employers are satisfied with the working methods and important reasons for adoption were cost/benefit advantages, improvement of work and health, and increase in productivity. Problems preventing the adoption were the use of the working methods at specific sites, for instance in renovation work. The adoption of the new working methods could perhaps have been higher or faster if more attention had been paid to the active participation of bricklayers and bricklayers' assistants during the development of the new working methods and to the use of modern media techniques, such as the Internet and CD/DVD.

Construction Materials↗

PubMed1994

A rapid appraisal of occupational workload from a modified scale of perceived exertion.

A simple and rapid method of determining occupational workload among Indian women performing manual activities was developed based on the strong relationship between physiological responses and subjective feeling of exertion. A modified five point scale of perceived exertion, sequentially numbered 1 to 5, was created to simplify the complicated and time-consuming procedures using conventional methods of measuring energy expenditure, or even heart rate responses, during work of very short duration, especially in field situations. The scale denotes physiological workload: 1: very light; 2: light; 3: moderately heavy; 4: heavy; and 5: very heavy. A job-classification table based on energy expenditure and heart rate responses is also proposed, and different household activities such as grinding masalas, dish washing, sweeping, mopping, ironing, storing water, etc. have been graded accordingly.

Adult↗

PubMed1996

Identification of high-risk groups among maintenance workers in a steel company with respect to musculoskeletal symptoms and workload.

To determine priorities for ergonomic improvements in five maintenance departments of a steel company, a study was carried out to identify groups with a high prevalence of musculoskeletal problems or a high exposure to unfavourable musculoskeletal workload. All workers were asked to complete a standardized questionnaire on musculoskeletal symptoms and musculoskeletal workload. Response rate in the five departments varied between 60 and 80% (n = 436). Symptoms of low back and neck-shoulder (12-month prevalence rates of 53% and 36%, respectively) were most common, but not higher in comparison with a reference group of 396 non-sedentary workers. Self-reported exposure rates to physical and psychosocial loads as well as poor climatic conditions were comparable with the reference group; only exposure to vibration was higher. Significant differences were seen between the five departments as well as between task groups with the departments. Several task groups with relatively high symptom rates and high exposure levels could be identified. It is concluded that a questionnaire survey can constitute a valuable contribution to the selection of high-risk task groups that need ergonomic intervention.

Adult↗

PubMed1997

Information complexity--mental workload and performance in combat aircraft.

The purpose of the present study was to analyse the effects of information complexity on Pilot Mental WorkLoad (PMWL) and Pilot Performance (PP), and to analyse the structure of PMWL. Eighteen pilots performed 72 simulated low level-high speed emissions. The complexity of the Head Down Display (HDD) information varied as a function of the tactical situation. Flight data were recorded continuously. The pilots' eye movements were video taped and psychophysiological activation data, Heart Rate (HR), were obtained. The pilots rated PMWL according to the psychological content of three scales (Bedford Rating Scale, Subjective Workload Assessment Technique, NASA-Task Load indeX) and answered a questionnaire tapping aspects of performance, information load, motivation and mood. It was found that even a moderate complexity of information interfered with the flight task. Altitude and variation in altitude were increased and corrections of altitude errors were delayed, when complexity increased. Changes in information load reached its maximum influence on flight performance (r = 0.60, p < 0.001) after a time delay of 20 to 40 seconds. Performance of the flight task correlated positively (r = 0.59, p <0.001) with the performance of the information handling task (Tactical Situation Awareness, TSA). Durations and frequencies of eye fixations Head Up (HU) versus Head Down (HD) changed as a function of information load. A structural equation model implied that PMWL was affected by mission complexity and that PMWL affected objective and subjective aspects of flight performance and information handling. Heart rate (sortie means) correlated positively with PMWL (r = 0.34, p <0.05) and perceived complexity of mission (r = 0.37, p < 0.01). Heart rate (running means) covaried with variations in information complexity for those pilots who performed well. From spectral analyses of cardiac interval times it was found that the amplitude of the 0.10 Hz component tended to decrease during high as compared to low levels of information load.

Adult↗

PubMed1999

Level of automation effects on performance, situation awareness and workload in a dynamic control task.

Various levels of automation (LOA) designating the degree of human operator and computer control were explored within the context of a dynamic control task as a means of improving overall human/machine performance. Automated systems have traditionally been explored as binary function allocations; either the human or the machine is assigned to a given task. More recently, intermediary levels of automation have been discussed as a means of maintaining operator involvement in system performance, leading to improvements in situation awareness and reductions in out-of-the-loop performance problems. A LOA taxonomy applicable to a wide range of psychomotor and cognitive tasks is presented here. The taxonomy comprises various schemes of generic control system function allocations. The functions allocated to a human operator and/or computer included monitoring displays, generating processing options, selecting an 'optimal' option and implementing that option. The impact of the LOA taxonomy was assessed within a dynamic and complex cognitive control task by measuring its effect on human/system performance, situation awareness and workload. Thirty subjects performed simulation trials involving various levels of automation. Several automation failures occurred and out-of-the-loop performance decrements were assessed. Results suggest that, in terms of performance, human operators benefit most from automation of the implementation portion of the task, but only under normal operating conditions; in contrast, removal of the operator from task implementation is detrimental to performance recovery if the automated system fails. Joint human/system option generation significantly degraded performance in comparison to human or automated option generation alone. Lower operator workload and higher situation awareness were observed under automation of the decision making portion of the task (i.e. selection of options), although human/system performance was only slightly improved. The implications of these findings for the design of automated systems are discussed.

Adult↗

PubMed2001

Development of the Workload Analysis Scale (WAS) for the assessment and rehabilitation services of Ballarat Health Services.

This study describes the development of the Workload Analysis Scale (WAS), designed to predict the likely workload involved for social workers working with clients in the assessment and rehabilitation areas of Ballarat Health Services (BHS). Such a scale would allow more equitable case allocation, flagging of difficult cases, better work prioritisation, training of new staff and tracking changes over time. Items for the scale were developed in consultation with workers. Initially the scale consisted of 33 items divided into five subscales, relating respectively to treatment factors, demographics, psychosocial complexity, planned interventions and variable staff factors. Eight staff members of BHS contributed to the completion of the scale for 111 clients seen over a four month period on the rehabilitation and assessment wards. Initial analysis of the data led to a modification of the scale and subsequent satisfactory measures of reliability and validity.

Adult↗

PubMed2003

Influence of early discharge after hysterectomy on patient outcome and GP workloads.

This paper examines the impact of early discharge following hysterectomy on patient outcome and GP workload. Results are presented from a survey of patient attitudes on care and recovery, pain relief and contacts overall with their general practitioner (GP) surgery. The findings are compared with those of a previous study where a policy of early discharge had been shown to increase GP workloads. The paper discusses the importance of preparing patients adequately for their surgery and postoperative recovery, and highlights the beneficial effects on patient attitudes of the introduction of patient information leaflets, a preadmission clinic and a telephone advice service following discharge.

Adult↗