ArticleFrontiers in health services2026
From cognitive overload to institutional escalation: formalizing the supply-demand production condition in patient-safety failure.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Physician exit, unit closures, and regulatory interventions are conventionally treated as separate workforce and governance problems. The workload-patient safety literature documents the empirical relationship between system strain and deterioration in outcomes; the agency literature describes the information asymmetry governing physician behavior; the organizational safety science literature describes how systems drift toward failure under production pressure. What remains insufficiently specified is a formal account of the production conditions that may connect these literatures, and a candidate mechanism through which institutionally determined cognitive demands may translate, via physician decision-making, into outcome deterioration, recursive self-amplification, and observable institutional escalation. This paper offers a formal conceptual specification of that proposed mechanism. We represent clinical outcome quality as a function of the ratio of effective cognitive supply to cognitive demand: O = f(S/D), where S = I · f(WM, e,
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