Impact of 20-day strike in Polokwane Hospital (18 August-6 September 2010).
Background. Doctors' strikes have a negative effect on
hospital performance indicators. Hospital mortality during such strikes
is the most important indicator.
Objective. To determine the effects of the 2010 strike on Polokwane Hospital.
Methods. Information was collected from the Hospital Information System, Polokwane Hospital Casualty Department, wards and theatres.
Results. During the 20-day strike, a total of 262 patients were admitted to Polokwane Hospital, with 40 patients to the surgical department; 96 operations were performed in the hospital and 40 in the surgical department; and 50 deaths were reported in the hospital (8 deaths in the surgical department). During 20 days of a non-striking period in May 2010, there were 975 admissions to the hospital, with 125 to the surgical department. In the entire hospital, 340 operations were performed, and 79 in the surgical department. For this period, 61 deaths were reported in the hospital and 12 in the surgical department.
Conclusions. The total number of patients admitted to the hospital and the surgical department during the strike was significantly lower than during a non-striking situation. Total mortality during the strike in Polokwane Hospital decreased, compared with the normal situation, but it increased when judged against emergency cases. However, when mortality was qualified by the number of admissions, it showed a significant increase. Strikes seriously and significantly affect service delivery.
S Afr Med J 2012;102(9):755-756. DOI: 10.7196/SAMJ.6045
Mortality (Forecasts and trends)
Mortality (South Africa)
Surgery (Forecasts and trends)
Hospitals (Central service department)
Hospitals (Labor relations)
|Publication:||Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 South African Medical Association ISSN: 0256-9574|
|Issue:||Date: Sept, 2012 Source Volume: 102 Source Issue: 9|
|Topic:||Event Code: 010 Forecasts, trends, outlooks; 280 Personnel administration Computer Subject: Market trend/market analysis|
|Product:||Product Code: 9918320 Strikes; 8000410 Surgical Procedures NAICS Code: 62 Health Care and Social Assistance|
|Geographic:||Geographic Scope: South Africa Geographic Code: 6SOUT South Africa|
Public health sector strikes have a negative effect on all of
society, with the poor suffering the most, especially when a health
service is paralysed. In-hospital mortality during doctors' strikes
appears to be the key indicator in evaluating the consequences of such
strikes on service delivery. The literature reports decreased
in-hospital mortality during doctors' strikes, (1-3) but an
increased mortality during hospital nurses' strikes in the USA has
been reported. (5) We assessed the effect of a 20-day doctors'
strike in Polokwane Hospital, Limpopo Province, during which the
peripheral hospitals of Limpopo Province were rendered almost
non-functional, and only the Polokwane Mankweng Hospital Complex (PMCH)
provided emergency services for the entire province. PMCH is a tertiary
institution receiving patients from Limpopo Province. In 2010, the
province had an estimated population of 5.5 million, of whom 90% had no
medical aid, therefore depending heavily on public hospitals for
We studied the impact of a health professionals' 20-day strike in Polokwane Hospital, and compared performance indicators during the strike with a non-striking period.
Data were collected during the 20-day strike (18 August 2010-6 September 2010) from the Hospital Information System (HIS), Polokwane Hospital Casualty Department (PHCD), surgical wards and theatres. Coomparison data for a non-striking period were collected from HIS, PHCD, wards and theatres during a randomly selected 20-day period in May 2010. Data included the performance indicators referred to: admissions, operations and deaths.
During the 20-day strike, 262 patients were admitted to Polokwane Hospital and 40 patients to the surgical department. In the entire hospital, 96 operations were done and 40 in the surgical department; 50 deaths were reported throughout the hospital and 8 deaths in the surgical department. During the 20 days of a non-striking period in May 2010, there were 975 admissions to the hospital and 125 to the surgical department; 340 operations were done throughout the hospital and 79 in the surgical department; 61 deaths were reported throughout the hospital and 12 deaths in the surgical department (Tables 1 and 2).
Service delivery may be expected to be affected seriously and deleteriously during health professional strikes. However, the literature reports a lowering of mortality (1-3,6) or no change (4,7) when doctors strike; but a 19.4% increase in mortality during hospital striking periods by nurses in New York, USA, between 1984 and 2004 has been reported. (5)
A review by Cunningham et al. spanning 1976-2003 reported that mortality reduced or stayed the same. (1) In Israel in 1973, when doctors went on strike for a month, mortality decreased by 50%. In 1976 in Bogota, Columbia, when medical doctors went on strike for 52 days, providing only emergency care for patients, the death rate dropped by 35%. In the same year, the Los Angeles County doctors' strike resulted in an 18% drop in mortality. As soon as the strike was over, the death rate returned to its usual levels. (1-3) Available information suggests that when doctors strike, mortality is reduced. This contradiction to expectations might be cynically and inaccurately held against the medical profession. Comprehensive analysis shows that when a strike takes place, most emergency cases are attended by non-striking personnel or by other institutions substituting for striking hospitals. Elective procedures are deferred until the strike is over. Most cases are treated outside the hospitals, by general practitioners and private clinics. The mortality from elective surgical procedures, which are not performed during strikes, also reduces the figure. However, the reduction of in-hospital mortality is compensated by an increased patient death rate outside of the striking hospitals--in other institutions or in patients' homes. Reports reflect only in-hospital mortality, and not total mortality of the entire population in the striking areas. The reported mortality is represented by total number of deaths, and is not qualified by the more appropriate numbers of admissions.
The strike in Polokwane evidently lowered the quality of service delivery; there was an overall reduction in the number of admissions and operations in the hospital. During the strike, mortality reduced but not proportionately to admissions, either in the surgical department or the entire hospital. Hospital mortality during the strike, when correlated with numbers of admissions, increased threefold for the hospital as a whole and, in the surgical department, mortality doubled. It is probable that further analysis of mortality in the population outside the hospital would elucidate the true reflection of actual mortality and hence the real consequences of a health professionals strike in our population.
The total number of patients admitted to Polokwane Hospital and the surgical department during the strike was significantly lower than during non-striking circumstances. Total mortality during the strike decreased in comparison with normal conditions, but increased when judged by emergency cases. However, when mortality was qualified by the number of admissions, a significant two- to threefold increase was apparent. The strike seriously and significantly affected service delivery (elective admissions and operations) in Polokwane Hospital. Every effort must be made to avoid strikes in health services institutions.
Acknowledgements. We thank Mrs R Mavhungu (research assistant) for her contribution to collecting data from theatres, and Mr T S Ntuli for his contribution of statistical inferences.
Accepted 15 June 2012.
(1.) Cunningham SA, Mitchell K, Narayan KM, Yusuf S. Doctors' strikes and mortality: a review. Soc Sci Med 2008;67(11):1784-1788.
(2.) Ellencweig AY, Ginat-Israeli T. Effects of the Israel physicians' strike on the treatment and outcome of acute appendicitis in Jerusalem. Isr J Med Sci 1990;26(10):559-563.
(3.) Aro S, Hosia P. Effects of a doctors' strike on primary care utilization in Varkaus, Finland. Scand J Prim Health Care 1987;5(4):245-251.
(4.) Bukovsky I, Herman A, Sherman D, Schreyer P, Arieli S, Caspi E. Perinatal outcome following physicians' strike of 1983. Isr J Med Sci 1985;21(10):804-807.
(5.) Gruber J, SA Kleiner. Do Strikes Kill? Evidence from New York State. NBER Working Paper Series, Vol. w15855. Cambridge MA, USA: NBER, March 2010.
(6.) Siegel-Itzkovich J. Doctors strike in Israel may be good for health. BMJ 2000;320(7249):1561.
(7.) Erceg M, Kujundzic-Tiljak M, Barbic-Erceg A, Coric T, Lang S. Physician's strike and general mortality: Croatia's experience of 2003. Coll Antropol 2007;31(3):891-895.
M M Z U Bhuiyan, FRCSG, MMed
A Machowski, MD, PhD
Department of General Surgery, Polokwane Mankweng Hospital Complex and University of Limpopo, Polokwane
Corresponding author: M Bhuiyan (firstname.lastname@example.org)
Table 1. Performance indicators during the 20-day strike, and 20- day non-strike in May 2010, in Polokwane Hospital, Limpopo During 20-day Durin 20 days During 20 days strike non-strike May non-strike May 2010 (combined 2010 (emergency elective and cases only) emergency) Number of 262 975 382 patients admitted to hospital Number of 40 125 73 patients admitted to surgical department Number of 96 340 177 operations in entire hospital Number of 40 79 27 operations in surgical department Number of 50 61 30 deaths in entire hospital Number of 8 12 7 deaths in surgical department Table 2. Performance indicators in Polokwane Hospital; comparison of non-striking period with strike period Non-striking situation Combined Emergency Strike elective and only (N) emergency Number of patients 975 382 262 admitted to hospital Number of patients 125 73 40 admitted to surgical department Number of operations in 340 177 96 entire hospital Number of operations in 79 27 40 surgical department Number of deaths in 61 30 50 entire hospital Number of deaths in 12 7 8 surgical department Comparison Strike/non-striking Strike/non-striking situation (combined situation elective and (emergency) emergency) Number of patients Reduced by 63% Reduced by 31% admitted to hospital during strike during strike Number of patients Reduced by 68% Reduced by 45% admitted to surgical during strike (p during the strike (p department 0.301) 0.298) Number of operations in Reduced by 72% Reduced by 46% entire hospital during the strike (p during the strike (p 0.595) 0.014) Number of operations in Reduced by 49% Increased by 48% surgical department during the strike (p during the strike (p 0.001*) 0.001) Number of deaths in Reduced by 18% Increased by 67% entire hospital during the strike (p during the strike (p 0.001) 0.001) Number of deaths in Reduced by 33% Increased by 14% surgical department during the strike (p during the strike (p 0.079 *) 0.227 *) * Fisher's exact test.
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