Strategic Modelling and Business Dynamics: A Feedback Systems Approach

9.2. Medical Workforce Dynamics and Patient Care

On 1 August 2004, the European Working Time Directive (EUWTD), a measure intended to limit the working week to 48 hours for all workers within the European Union (EU), became mandatory for junior doctors working for the National Health Service (NHS) in Britain. The intuition behind this piece of health and safety legislation was to reduce the fatigue experienced by junior doctors by limiting doctor's working hours and so improve the quality of patient care. This rationale, though compelling, does not address the non-clinical effects of the EUWTD, in particular, the fundamental change that the directive has on doctors' working patterns, in-service training and work–life balance.

These concerns were of personal and professional interest to Dr Mark Ratnarajah, a paediatric specialist registrar based in London, who, at the time, was also enrolled on the Executive MBA programme at London Business School. He decided to conduct a project to consider the effects of the directive on junior doctors' career decisions and the consequences of these decisions on the medical workforce and quality of patient care. Based on his experience and knowledge of the UK National Health System (NHS), he developed a system dynamics model to consider the broad implications of the directive and to explore alternative courses of action. His work is summarised below.^[]

^[] I am grateful to Dr Ratnarajah for permission to use this material, which is based on the ...