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

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

Econometric studies in healthcare service operations

The goal of this dissertation is to contribute to our understanding of how healthcare services adapt to varying levels of demand for hospital resources. As in many other service organizations, hospital capacity (beds, staff, and equipment) is fixed in the short term, while the arrival of patients and their demand for hospital resources is stochastic in nature. When confronted with an unexpected increase in demand for services, hospitals can adapt by either increasing their service rates, or by rationing capacity depending on the needs of individual patients. These adaptive responses can have implications for quality of care and access to services. It is this interplay between capacity utilization, productivity and quality in healthcare service delivery that is the primary focus of this dissertation

Econometric studies in healthcare service operations

The goal of this dissertation is to contribute to our understanding of how healthcare services adapt to varying levels of demand for hospital resources. As in many other service organizations, hospital capacity (beds, staff, and equipment) is fixed in the short term, while the arrival of patients and their demand for hospital resources is stochastic in nature. When confronted with an unexpected increase in demand for services, hospitals can adapt by either increasing their service rates, or by rationing capacity depending on the needs of individual patients. These adaptive responses can have implications for quality of care and access to services. It is this interplay between capacity utilization, productivity and quality in healthcare service delivery that is the primary focus of this dissertation