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This study analyzes the relationship between program performance and workload levels. The results indicate that program effectiveness is highest under medium workloads while efficiency is greatest under high workloads. The management dilemma resulting from these findings is discussed.
General practitioners (GPs) in the U.K. frequently cite heavy workload as a major source of work-related stress. However, there is little direct evidence either to support this claim or to suggest whether the source of this stress lies in the amount, or rather the type, of work undertaken. The present paper uses a within-subjects design to address these issues in the surgery context. Over a two-week period three GPs gave ratings of subjective workload following each of their surgeries (N = 20-23). Correlational analysis showed a wide range of surgery characteristics to predict the GPs' reactions, including the length of surgeries, the number of consultations, the number of re-presentations, and the number of follow-ups and investigations requested. The GPs' perceptions of their patients (e.g. in terms of their health status and the appropriateness of the consultation), in contrast, did not emerge as significant predictors. The results of multiple regression analyses, however, revealed that most of the first-order effects could be accounted for by surgery length. Thus while the study supported the hypothesised link between the overall level of surgery work demands and the subjective experience of workload, it failed to confirm any consistent additional effects of the type of work involved. It was also found that as the length of surgeries increased, the GPs were more likely to arrange follow-up appointments. The implications of the present findings are therefore two-fold.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper considers the impact of working with computer-based systems in terms of mental workload and the well-being of operators. In particular, the paper focuses on issues of controllability in human-computer systems as they relate to operator stress. Through the adoption of a state control model of stress regulation, it becomes apparent that while general usability criteria are necessary for the design of controllable systems, they may not be sufficient to guarantee controllability. The implications for research and system design are discussed, with reference to the assessment of operator workload, controllability and stress. A methodology for assessing computer stress is described, based on the analysis of stressful computer-related episodes and their accompanying affective and cognitive states. This technique allows the relationship between workload and controllability to be studied in particular computer work environments, in relation to individual work goals and coping strategies.
Maximal workloads in supine and sitting bicycle stress tests were compared in 12 patients with congestive heart failure during long-term therapy with the vasodilator enalapril. The response to the therapy was observed with the supine and sitting bicycle stress tests and gated equilibrium ventriculography. The maximal workload was 68 W in the supine position and 84 W in the sitting position; the mean difference was 15 W. The difference was highly significant (P less than 0.001). Both the supine and sitting workloads were significantly higher (P less than 0.02 and P less than 0.05) in the enalapril group than in the placebo group. The findings in the gated equilibrium ventriculography were not significantly different between the two groups.
OBJECTIVE: To examine the workload and work patterns of junior doctors of all grades while on call. DESIGN: Pilot study of activity data self recorded by junior doctors, with the help of students during busy periods. SETTING: A general surgical firm and a general medical firm based at University Hospital, Nottingham. SUBJECTS: Four registrars, three senior house officers, and five preregistration house officers. RESULTS: Senior house officers and preregistration house officers spent nearly half of all their on call duty time working, but less than half of that time was spent in direct contact with patients. Registrars were on call more often than the house officers but spent less than one fifth of their on call duty time working, and almost two thirds of that time was spent in direct contact with patients. CONCLUSIONS: Workload while on duty is excessive for both senior and preregistration house officers. Changes in some administrative procedures and employment of more non-medical staff during on call periods might reduce the time spent on non-clinical activities, thereby reducing the overall workload and allowing more time for patient contact.
OBJECTIVE: To assess the contribution of the most frequently performed procedures to surgical workload and to evaluate the financial implications. DESIGN: Analysis of data held on the department's computerised clinical information system. SETTING: Department of surgery in a district general hospital. PATIENTS: 4845 patients were treated by surgeons in three consultant firms over an 18 month period and 5346 patients by surgeons in a single firm over a five year period. MAIN OUTCOME MEASURES: Percentage and cumulative percentage contribution to workload in order of frequency by procedure. Costs of the commonest and costliest treatments. RESULTS: Half of the workload of the department was encompassed by eight procedures. Twenty procedures accounted for 70% of the work. For a single firm 20 procedures represented over 80% of all the surgical work. Transurethral prostatectomy was the treatment that consumed most resources (pounds 240,900 for 198 patients in 18 months). The costliest patients were those who had undergone complicated large bowel surgery, vascular reconstructions, or amputation. CONCLUSIONS: Clinicians and managers need to appreciate the importance of the most common surgical procedures. It is vital that performance and costing of these procedures are optimum as they contribute disproportionately to overall results and finance.
OBJECTIVE: To determine the changes in incidence of and mortality from gastric cancer in Scotland between 1978 and 1987 and in the operative workload in Lothian between 1979 and 1988. DESIGN: Analysis of national incidence statistics for gastric cancer derived from the Scottish national cancer registry, deaths from gastric cancer recorded by the registrar general for Scotland, and Lothian surgical audit data. SETTING: Scotland and Lothian Health Board area. PATIENTS: Patients in Scotland with gastric cancer during 1978 to 1987 inclusive; patients in Scotland with gastric cancer recorded on their death certificate as cause of death during 1978 to 1987; patients who had an operation in Lothian for gastric cancer during 1979 to 1988. MAIN OUTCOME MEASURES: Changes in incidence of and mortality from gastric cancer in Scotland from 1978 to 1987 and in the number of operations performed for gastric cancer in Lothian from 1979 to 1988. RESULTS: Mortality from gastric cancer in Scotland fell by about 25% over the 10 years. The incidence and standardised incidence of gastric cancer showed a marginal decline of about 9%. The differences in trends between incidence and mortality were significant (p less than 0.05). CONCLUSIONS: This study shows that the surgical workload associated with gastric cancer is not declining. This is because the incidence has remained almost static, which may be due to the relative increase in the numbers of older people in the population, who are at greater risk of developing gastric cancer. Gastric cancer should not be regarded as a disease in decline. Incidence and workload should determine resources allocated to this disease rather than mortality statistics.
Twenty-four healthy male clerical workers (50-59 years of age) in an automobile manufacturing plant performed as accurately as they could a calculating task consisting of the addition or subtraction of two 2-digit numbers at five grades of task load for 5 min each. The workers' work capacities were inferior in speed but not in precision to those of male students determined previously. The resting levels of occipital midline beta-2 (Oz beta 2) amplitude were significantly lower for the workers than for the students. The workers' mental workloads were objectively shown to be lighter than the students' based on a significant difference between the percent increases in Oz beta 2 amplitude over resting levels. The workers' subjective mental workloads assessed by subjective rating of task difficulty (SRTD) were lighter than the students' at higher task loads. From the trend that there was no undue rise in either SRTD or percent increase in Oz beta 2 amplitude, it was judged that no task load could induce excessive mental workload on workers.
Workload measurement is necessary for laboratory management and planning. Adaptation of the College of American Pathologists' scheme to the requirements of a large clinical microbiology laboratory is described. Our method of applying basic work values is simpler and the calculation of workload is easily adapted to take account of alterations in laboratory method. The resulting system of workload measurement can be instituted without undue effort.
This survey was done to determine the current workload policies and practices in collegiate schools of nursing. A 40-item questionnaire was mailed to all schools holding membership in the American Association of Colleges of Nursing. Seventy-two percent of the schools responded. Analysis of the data shows that quantifiable factors which relate directly to teaching are of considerable importance to deans in determining faculty workload while less quantifiable factors such as student advisement, research, publication and involvement in direct client care are of little or no importance in determining workload.
Senior nursing executives from a representative sample of Canadian hospitals were surveyed on their attitudes and views of nursing workload measurement systems. In terms of a profile of users and their satisfaction, the survey found that about 50% of hospitals were using a system, and that among those using a system, 70% used information from the system frequently or all the time. The senior nurse respondents were generally satisfied with their current systems; slightly lower levels of satisfaction were reported for staff nurses, with the most common objection being the perception that the systems do not reflect true workload. A subsequent article--Part B--explores senior nurse executives' needs and expectations for nursing workload systems.
A review of workload in the ED setting shows trauma still account for the majority of patients, but that non-trauma emergencies nonetheless comprise a sizable proportion (45.2%) of the total workload. Resuscitation patients account for 10.1% of cases and overall 17.3% of patients require admission. Recalls are a very small and decreasing proportion of total workload.
Right ventricular ejection fraction (RVEF) determinations at rest (R) and exercise (E) are a means of demonstrating exercise-induced RV dysfunction. Not all patients are able to maintain peak (P) cardiac workloads during a gated RVEF study or, if a first-pass study is performed, for multiple acquisitions. Reductions from P cardiac workloads have been shown to potentiate LV function; however, the effect on RVEF has not been studied. Supine exercise radionuclide ventriculography was performed on 26 patients: nine normal subjects and 17 patients with coronary artery disease (CAD) (greater than 50% stenosis of one or more coronary artery). Gated RVEF's were obtained from sequential left anterior oblique views obtained at R, P, and at a workload reduced approximately 40% from P work levels postpeak (PP). In normals, RVEFs were at R, P, and PP 27, 38 and 44. In CAD patient RVEFs were 31, 35 and 39, at R, P, and PP, respectively. The conclusions are that RVEF improves from rest to PP exercise levels in normal subjects and in CAD patients and from P to PP levels in normal subjects. This improvement must be considered in interpreting exercise RV studies to aid in the detection of patients with CAD.
This article reviews the multiple theoretical approaches to the measurement of nursing workload. A focus on current measurement issues provides direction for future research questions in this area. The underlying assumption is that workload measurement tools must focus on the complexity of the patient situation in determining nursing workload rather than on the traditional focus of tasks in which nurses are involved.
Two groups of paid male volunteers (Groups I, N = 51, tested with identical schedules on two successive days; Group II, N = 43, tested on one day only) performed over nine intervals on various combinations of the six tasks of the CAMI Multiple Task Performance Battery. Two of the tasks involved monitoring static (lights) and dynamic (meters) processes, and four more-active tasks involved mental arithmetic, elementary problem solving, pattern identification, two-dimensional compensatory tracking. Five of the nine intervals provided different complex tasks consisting of concurrent monitoring tasks and two of the active tasks. Other trials provided data on the single active tasks as well as the combined monitoring tasks. The results indicated that all performance measures--a total of 12 for the six tasks--varied significantly as a function of the different task-combination conditions. A standard psychological scaling technique (Thurstone Case V) was applied to the monitoring data (response times for green and red lights, and for meter monitoring) to develop an index of workload for the five complex task combinations. Since better performance was presumed to indicate a lower workload, workload was inferred to increase as performance declined across conditions. The best performances, which were assigned scale values of 0, were found to be associated with single-task performances, as expected. Scale values for the complex task-combination conditions were found to be consistent between groups and between the two days of testing of Group I (r's of 0.947 to 0.993). Although the scale values are specific to the task and task-combination conditions employed, the scaling-procedure application shows promise for cases in which quantitative measures of performance can be acquired with moderately large samples of subjects (N's greater than 50).
Several studies have highlighted the increase in physiological activity which occurs in pilots during flight and especially during takeoffs and landings. For example, it has been clearly demonstrated that pilots' heart rates increase during the landing approach to reach a peak at or just before touchdown. These changes have been attributed to workload and to psychological or emotional stress. This paper examines a number of test pilots' heart rate responses recorded during various flight trials involving different types of aircraft. Examples include ramp takeoffs in a VTOL fighter, automatic landings in fog, supersonic flight through monsoon rain, and a sortie in which the pilot developed acute appendicitis. It is concluded that heart rate responses in experienced pilots are influenced almost entirely by workload-related factors and not by emotional stressors, such as risk and anxiety. Because of the emotional overtones of the word "stress," it is suggested that the term workload should be used when referring to the reason for increased cardiovascular activity of pilots.
A group of U.S. scientists engaged in inflight measurements of pilot workload discussed the problems and aspects of workload; the techniques used for inflight measurements; the various workload models, such as design-oriented, operational, psychological, and physiological concepts; different experimental approaches; and experiences, results and further plans, during the 48th Annual Scientific Meeting of the Aerospace Medical Association in Las Vegas, Nv, on May 10, 1977. The contributions by the chairman and the five panel members are summarized.
Continuous recordings were made of the EEG and ECG of one pilot during a series of instrument flights in a feeder-type transport aircraft. The flights were arranged to contain epochs of distinctly differing levels of workload. In addition, some flights were made after a night of sleep deprivation and others were made as the second and third flights of the day. Subjectively, there appeared to be marked differences in performance between the two types of tired flight. The EEG analyses showed changes that correlated well with differences in workload. In the highest workload areas during fresh flights, EEG activity increased by approximately a factor of 4 over that of the preflight resting values. This large increase did not occur in the tired flights. Further experiments are planned using flights in aircraft and in simulators using several subjects.