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

• Published in: The International journal of health planning and management 2023-05, Vol.38 (3), p.599-627
• Main Authors: Essex, Ryan, Ahmed, Salina, Elliott, Helen, Lakika, Dostin, Mackenzie, Laura, Weldon, Sharon Marie
• Format: Article
• Language: English
• Subjects: Action; Behavior change; Clinical outcomes; Delivery of Health Care; Emergency medical services; Empirical analysis; Ethical dilemmas; Fallout; health; Health care; Health care delivery; Health Personnel; Health services; Health services utilization; healthcare; Help seeking behavior; Hospitalization; Hospitals; Humans; Length of stay; Medical personnel; Medical screening; Patients; protest; strike; Waiting times
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.3610

Background Strike action carried out by healthcare workers raises a range of ethical issues. Most fundamentally, as a strike is designed to disrupt, it has the potential to impact patient outcomes and healthcare delivery. This paper synthesises and analyses the empirical literature that details the impact of strike action on healthcare delivery. Methods A systematic scoping review was utilised to examine the extent, range and nature of research activity. Embase, Medline, CINAHL, Bioethicsline, EconLit and Web of Science were searched, yielding 5644 results. Papers were included if they examined the impact that strike action had on healthcare delivery (i.e., admissions, presentations, waiting time). After screening, 43 papers met inclusion criteria. Results Nineteen studies explored presentations to emergency or admissions to hospital. Both dropped dramatically when comparing non‐strike to strike periods. Ten studies examined length of stay in hospital and waiting times. No clear relationship was found with strike action, with some studies showing that wait times decreased. Nine studies examined the impact of strike action in facilities that were not on strike, but were impacted by nearby strike action along with the impact that strike action had on treatment seeking. Hospitals dealing with these upstream impacts often saw increase in presentations at hospitals, but results relates to treatment seeking during strike action were mixed. Conclusion Strike action can have a substantial impact on the delivery of healthcare, but this impact is not felt uniformly across services. While many services are disrupted, a number are not, with several studies reporting increased efficiency. Highlights Strike action has substantial impact on healthcare delivery. The impact that strike action has differs across services; this appears to be impacted by several factors, for example, the staff on strike. Facilities dealing with the fallout of nearby strike action faced significant increases in presentations. The literature was unclear whether patients change treatment seeking behaviour because of strike action.