Hospital Safety Tipping Point Reached At Well Below Full Occupancy

Professor Ludwig Kuntz Seminar for Business Administration and Health Care Management University of Cologne Albertus-Magnus-Platz 50923 Cologne Interview with:
Professor Ludwig Kuntz
Seminar for Business Administration and Health Care Management University of Cologne Albertus-Magnus-Platz
50923 Cologne Germany What are the main findings of the study?

Professor Kuntz:  We have identified the point at which hospitals begin to fail, resulting in deaths of critically ill patients. The Safety Tipping Point for hospitals occurs when they reach occupancy levels far below 100%, namely we identified a tipping point strongly at around 92 per cent [patient occupancy relative to ward capacity]. Our research therefore demonstrates conclusively that far from maximizing efficiency, exceeding a capacity “tipping point” on a hospital ward can have dire consequences. This has major implications for the way we think about capacity and stress in the workplace. Were any of the findings unexpected?

Professor Kuntz: What shocked us was the size of the effect above the tipping point. In a department functioning at above 92.5 per cent capacity, one in seven of all deaths among patients could be attributed to this exposure to elevated occupancy levels during their first week in hospital. What should clinicians and patients take away from your report?

Professor Kuntz: If the tipping point is reached frequently, the hospital will experience a  sustained quality problem, which may threaten its survival. Even more worryingly, if the tipping point is only exceeded occasionally, the dangerous situation may go unnoticed because it is not statistically detectable in aggregate hospital data. We believe the hospital is safe when it isn’t.

We suggest there is a simple strategy for avoiding the tipping point – making better use of capacity pooling with neighboring hospitals. Our estimations indicate that, in our sample, more than a third of the deaths that are attributable to high occupancy could have been avoided if capacity had been pooled with nearby hospitals.

What is also of importance is flexible capacity in managing the tipping point. When hospitals reduce cost by closing beds, they can mitigate the safety effect by keeping the bed infrastructure but staffing these beds only when the department approaches the safety tipping point. We have estimated that, at the margin, flexible capacity can save up to 40% of a fully staffed bed, while maintaining comparable safety standards.

Our results provide ammunition for operations managers and clinicians when their finance colleagues argue that capacity can be reduced while activity and safety levels are maintained. What recommendations do you have for future research as a result of this study?

Professor Kuntz: These findings may mean we need to rethink our approach to employee stress and workload, not just in the healthcare sector but across the board; companies of all kinds need to examine how they respond to pressure and underperformance.


Stress on the Ward: Evidence of Safety Tipping

by Ludwig Kuntz, Roman Mennicken and Stefan Scholtes
Ruhr Economic Papers #277

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


Last Updated on April 3, 2014 by Marie Benz MD FAAD