21 research outputs found
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
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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
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Blinded by Experience: Prior Experience, Negative News and Belief Updating
Traditional models of operations management involve dynamic decision-making assuming optimal (Bayesian) updating. However, behavioral theory suggests that individuals exhibit bias in their beliefs and decisions. We conduct both a field study and two laboratory studies to examine the phenomena in the context of health. In particular, we examine how an individual’s prior experiences and the experiences of those around them alter the operational decisions that the individual makes. We draw on an exogenous announcement of negative news by the Food and Drug Administration (FDA) and explore how this affects an operational decision – production tool choice – of interventional cardiologists deciding between two types of cardiac stents. Analyzing 147,000 choices over 6 years, we find that individuals do respond to negative news by using the focal production tool less often. However, we find that both individual’s own experience and others’ experience alter their responses in predictable ways. Moreover, although individual and other experience act as substitutes prior to negative news, the two types of experience act as complements following the negative announcement – leading to even greater use of the same production tool. Two controlled lab studies replicate our main findings and show that behavioral biases, not rational expectations, drive the effect. Our research contributes not only to operations management research, but also to the practice of healthcare and operations more generally