Impact of healthcare strikes on patient mortality: a protocol for a systematic review and meta-analysis of observational studies

Abstract

IntroductionA strike is a collective, temporary and calculated action, which involves a temporary stoppage of work. For healthcare professionals strike action poses a unique dilemma. Perhaps most fundamentally, as strike action is designed to be disruptive it has the potential to impact the delivery of care and place patient well-being in jeopardy. The objective of this study is therefore to evaluate the impact of healthcare strike action on patient mortality outcomes globally using meta-analysis in order to provide a comprehensive evidence base that can advise healthcare professionals, governments and regulatory bodies on the impact that strike action has on patients.Methods and analysisA comprehensive literature search of major electronic databases (EMBASE, MEDLINE, CINAHL, BIOETHICSLINE, EconLit, WEB OF SCIENCE, OPEN GREY and SIGMA REPOSITORY) will be undertaken to identify observational studies of strike action among healthcare professionals where in-hospital/clinic and population/community mortality is examined, prestrike, during and poststrike. Meta-analysis will be performed to estimate in-hospital/clinic and population/community mortality during periods of strike action. The quality of evidence will be assessed using the National Institute of Health quality assessment tool for observational cohort and cross-sectional studies. Risk of bias will be assessed using the Cochrane Risk Of Bias In Non-Randomized Studies - of Interventions tool.Ethics and disseminationThis study does not require ethical approval. Findings will be submitted to an appropriate peer-reviewed journal.Trial registration numberCRD42021238879.

The impact of health care strikes on patient mortality: A systematic review and meta‐analysis of observational studies

“…Our approach followed PRISMA guidelines 9 . Our study protocol was registered on PROSPERO (registration number CRD42021238879), peer reviewed, and published 10 …”

The impact of strike action on healthcare delivery: A scoping review

“…It is also noteworthy that in many cases, emergency services were able to be maintained or contingencies put in place to continue to deliver care with minimal disruption. On the second point, patient safety, it is difficult to comment on all elements of patient safety with the findings from this review alone, however and with the evidence noted in the introduction about patient morbidity 6 and mortality 7 during strike action, this body of evidence suggests that while disruptive, strikes can generally be conducted safely. There are of course several caveats, notably the more general limitations related to this evidence and the fact that strike action can come in a range of forms and have vastly different impacts on services.…”

“…Other studies that have examined strike action have had similar difficulties, but also found that variables such as country, profession and other variables related to the nature of the strike had little impact of patient outcomes 59 . Throughout and perhaps because of this, we found a number of results that are perhaps unexpected, for example, while we might expect rural services to fare worst in low and middle income countries this was not always the case.…”

“…Overwhelmingly arguments both for and against have focused on patient mortality and other outcomes 5 . Two recent systematic reviews have shed some light on these debates, with both indicating that strike action had little impact on in-hospital patient morbidity 6 and in-hospital and population mortality 7 . These studies alone however paint a somewhat limited picture.…”

Strikes of physicians and other health care workers in sub-Saharan African countries: a systematic review

“…A strike is defined as a temporary stoppage of work by a group of employees to express a complaint or enforce a demand ( 1 ). Strikes can range from a simple interruption of the workday (for a few hours) or the reduction of non-critical services, to the complete stoppage of work as a last resort ( 2 ).…”