Using system dynamics modelling to show the effect of nurse workload on nurses' health and quality of care.

The objective of the current study is to explore System Dynamics modelling to quantify and understand the effects of nursing workload on nurse burnout, absenteeism, and quality of patient care. A literature search was performed to identify the causal relationships between factors related to the problem and build a conceptual causal loop diagram. Each of these factors was then operationalised and a simulation model was built using quantitative empirical data from the literature, supplemented with expert input. The model results showed that long nurse shifts and work weeks double nurse fatigue levels, while increasing burnout by up to 6 times, absenteeism by up to 5 times, and medical errors for the patients increasing by up to 150%. The study demonstrates a novel application of System Dynamics in healthcare to examine the impact of management strategies and healthcare system design on nurses' wellbeing and on care quality. Practitioner summary: System Dynamics Modelling allows for the integration of available scientific evidence and expertise to reveal the relationship between nurse workload, burnout and care quality in terms of medical errors. Such models can reveal possible responses from proposed policy or system design changes that could not be quantified with conventional approaches. Abbreviations: HF: human factors; SD: system dynamics; CLD: causal loop diagram; OFAT: one factor at a time.