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BACKGROUND: Subjective workload in healthcare employees is suspected to be important for the performance and safety of healthcare delivery. This study investigates associations between workflow interruptions and hospital doctors' capability to manage their perceived workload in a safe and efficient manner. AIM: To examine the relationship of observed workflow interruptions with hospital doctors' perceived workload during day clinical shifts. METHODS: A prospective study of 43 full shift observations with 29 doctors working in internal medicine and surgical specialties. Workflow interruptions were assessed via observation using a previously validated observation instrument. Doctors assessed their workload twice throughout their day shift using three items of the validated NASA-Task Load Index (NASA-TLX; mental demands, effort, frustration). RESULTS: Hospital doctors were on average disrupted 3.66 times per hour. Most frequent were interruptions by nursing staff, telephone/beeper interruptions and by fellow doctors. Senior doctors reported higher workload than their junior colleagues. Overall workflow interruptions were significantly related to doctors' workload (β = 0.22; p = 0.03). Further analyses revealed that doctors' workload was associated particularly with interruptions by nursing personnel (β = 0.23; p = 0.03). CONCLUSIONS: Frequent workflow interruptions may be linked with increased workload in doctors. Healthcare environments need to be better designed to reduce unnecessary interruptions and distractions so that hospital doctors can manage clinical work efficiently and safely.

Original publication




Journal article


BMJ Qual Saf

Publication Date





399 - 407


Adult, Efficiency, Organizational, Female, Germany, Humans, Internal Medicine, Male, Middle Aged, Physicians, Process Assessment, Health Care, Prospective Studies, Qualitative Research, Quality Improvement, Self Report, Specialties, Surgical, Stress, Psychological, Surveys and Questionnaires, Task Performance and Analysis, Workflow, Workload