Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations

Much of prior work in the area of service operations management has assumed service rates to be exogenous to the level of load on the system. Using operational data from patient transport services and cardiothoracic surgery—two vastly different health-care delivery services—we show that the processing speed of service workers is influenced by the system load. We find that workers accelerate the service rate as load increases. In particular, a 10% increase in load reduces length of stay by two days for cardiothoracic surgery patients, whereas a 20% increase in the load for patient transporters reduces the transport time by 30 seconds. Moreover, we show that such acceleration may not be sustainable. Long periods of increased load (overwork) have the effect of decreasing the service rate. In cardiothoracic surgery, an increase in overwork by 1% increases length of stay by six hours. Consistent with prior studies in the medical literature, we also find that overwork is associated with a reduction in quality of care in cardiothoracic surgery—an increase in overwork by 10% is associated with an increase in likelihood of mortality by 2%. We also find that load is associated with an early discharge of patients, which is in turn correlated with a small increase in mortality rate

The Effects of Focus on Performance: Evidence from California Hospitals

We use hospital-level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization—at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely, faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply “cherry-picking” easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g., operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects

An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit

This paper explores the rationing of bed capacity in a cardiac intensive care unit (ICU). We find that the length of stay for patients admitted to the ICU is influenced by the occupancy level of the ICU. In particular, a patient is likely to be discharged early when the occupancy in the ICU is high. This in turn leads to an increased likelihood of the patient having to be readmitted to the ICU at a later time. Such “bounce-backs” have implications for the overall ICU effective capacity—an early discharge immediately frees up capacity, but at the risk of a (potentially much higher) capacity requirement when the patient needs to be readmitted. We analyze these capacity implications, shedding light on the question of whether an ICU should apply an aggressive discharge strategy or if it should follow the old quality slogan and “do it right the first time.” By comparing the total capacity usage for patients who were discharged early versus those who were not, we show that an aggressive discharge policy applied to patients with lower clinical severity levels frees up capacity in the ICU. However, we find that an increased number of readmissions of patients with high clinical severity levels occur when the ICU is capacity constrained, thereby effectively reducing peak bed capacity

Accumulating a Portfolio of Experience: The Effect of Focal and Related Experience on Surgeon Performance

One key driver of improvement in surgical outcomes is a surgeon\u27s prior experience. However, research notes that not all experience provides equal value for performance. How, then, should surgeons accumulate experience to improve quality outcomes? In this paper, we investigate the differential effects of focal and related (i.e., tasks similar to, but not identical to, the focal task) experience. We open up the black box of the volume-outcome relationship by going beyond just dividing experience into focal and related categories, but also considering how subtasks and context (i.e., the organization in which the work takes place) affect performance. To understand these issues, we assemble a novel data set on 71 cardiothoracic surgeons who performed more than 6,500 procedures during a period of 10 years after the introduction of a breakthrough surgical procedure. We find that, as compared to related experience, surgeon focal experience has a greater effect on surgeon performance. We also demonstrate that subtask experience has different, nonlinear performance relationships for focal and related experience. Finally, we find that focal experience is more firm specific than related experience and that nonfirm experience reduces the learning rate for both focal and related experience. We discuss implications of our findings for healthcare delivery and operations management

Learning from My Successes and from Others' Failures: Evidence from Minimally Invasive Cardiac Surgery

Learning from past experience is central to an organization's adaptation and survival. A key dimension of prior experience is whether an outcome was successful or unsuccessful. While empirical studies have investigated the effects of success and failure in organizational learning, to date the phenomenon has received little attention at the individual level. Drawing on attribution theory in psychology, we investigate how individuals learn from their own past experiences with both failure and success and from the experiences of others. For our empirical analyses, we use ten years of data from 71 cardiothoracic surgeons who completed over 6,500 procedures using a new technology for cardiac surgery. We find that individuals learn more from their own successes than from their own failures but learn more from the failures of others than from others' successes. We also find that individuals' prior successes and others' failures can help individuals overcome their inability to learn from their own failures. Together, these findings offer both theoretical and practical insights into how individuals learn directly from their prior experience and indirectly from the experiences of others

Learning from My Success and from Others\u27 Failure: Evidence from Minimally Invasive Cardiac Surgery

Learning from past experience is central to an organization\u27s adaptation and survival. A key dimension of prior experience is whether an outcome was successful or unsuccessful. Although empirical studies have investigated the effects of success and failure in organizational learning, to date, the phenomenon has received little attention at the individual level. Drawing on attribution theory in psychology, we investigate how individuals learn from their own past experiences with both failure and success and from the experiences of others. For our empirical analyses, we use 10 years of data from 71 cardiothoracic surgeons who completed more than 6,500 procedures using a new technology for cardiac surgery. We find that individuals learn more from their own successes than from their own failures, but they learn more from the failures of others than from others\u27 successes. We also find that individuals\u27 prior successes and others\u27 failures can help individuals overcome their inability to learn from their own failures. Together, these findings offer both theoretical and practical insights into how individuals learn directly from their prior experience and indirectly from the experiences of others

Working With Capacity limitations: Operations Management in Critical Care

As your hospital\u27s ICU director, you are approached by the hospital\u27s administration to help solve ongoing problems with ICU bed availability. The ICU seems to be constantly full, and trauma patients in the emergency department sometimes wait up to 24 hours before receiving a bed. Additionally, the cardiac surgeons were forced to cancel several elective coronary-artery bypass graft cases because there was not a bed available for postoperative recovery. The hospital administrators ask whether you can decrease your ICU length of stay, and wonder whether they should expand the ICU to include more beds For help in understanding and optimizing your ICU\u27s throughput, you seek out the operations management researchers at your university

Task Selection and Workload: A Focus on Completing Easy Tasks Hurts Long-Term Performance

How individuals manage, organize, and complete their tasks is central to operations management. Recent research in operations focuses on how under conditions of increasing workload individuals can increase their service time, up to a point, in order to complete work more quickly. As the number of tasks increases, however, workers may also manage their workload by a different process – task selection. Drawing on research on workload, individual discretion, and behavioral decision making we theorize and then test that under conditions of increased workload individuals may choose to complete easier tasks in order to manage their load. We label this behavior Task Completion Bias (TCB). Using two years of data from a hospital emergency department we find support for TCB and also show that it improves short-term productivity. However, although it improves performance in the short-term we find that an overreliance on this task selection strategy hurts performance – as measured both by speed and revenue – in the long run. We then turn to the lab to replicate conceptually the task selection effect and show that it occurs due to the positive feelings individuals get from task completion. These findings provide an alternative mechanism for the workload-speedup effect from the literature. We also discuss implications for both research and the practice of operations in building systems to help people succeed in both the short and long run