High demand and poor staffing conditions cause avoidable pressure and stress among healthcare personnel which results in burnout symptoms and unplanned absenteeism which are hidden cost drivers. The work environment within an emergency department is commonly arranged in a flexible workload which is highly dynamic and complex for the outside observer. Using detailed simulation modeling within structured modeling methods, a comprehensive model to characterize the nurses' time utilization in such flexible dynamic workload environment was investigated. The results have been used to derive a generalized analytic expression that describes certain settings that lead to an instable queuing system with serious consequences for the healthcare facility. Thus decision makers are hence equipped with a tool which allows identifying and preventing such conditions that affect service quality level.
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