Stress on the Ward – An Empirical Study of the Nonlinear Relationship between Organizational Workload and Service Quality

We discuss the impact of organizational workload on professional service outcomes, such as survival rates in hospitals. The prevailing view in the literature is that service quality deteriorates when organizational workload increases. In contrast, we argue that the relationship between workload and service outcomes is nonlinear and that there is a quality-optimal workload level. Whilst outcomes deteriorate with increasing workload when workload levels are already high, they will improve if workload increases from a low level. We reach this hypothesis by combining three perspectives: (i) the queuing theory perspective, with its focus on congestion, (ii) a discretionary choice perspective, with a focus on decisions made by professionals in response to changes in workload, and (iii) an endocrinological perspective, with a focus on the subconscious eff ects of workload on worker performance through the cognitive impact of stress hormones. Using a patient census of 1.4 million patients in 624 departments across 101 hospitals, we provide empirical support for the nonlinearity hypothesis in the context of hospital survival rates. We further discuss the implications for hospital capacity planning and the wider implications for service operations management.Service quality; service outcomes; organizational workload; hospital capacity planning; behavioral operations; stress

Modeling and notation of DEA with strong and weak disposable outputs

Recent articles published in Health Care Management Science have described DEA applications under the assumption of strong and weak disposable outputs. As we confidently assume that these papers include some methodical deficiencies, we aim to illustrate a revised approach

Treatment speed and high load in the Emergency Department-does staff quality matter?

Research in the field of operations management and medicine analyzed how workload affects productivity and patient outcomes. However, staff quality has largely been neglected, and if staffing information has indeed been included, then it takes the form of quantitative measures like staff-to-patient ratios. We therefore seek to analyze how education and experience are directly associated with effort. How do responses to workload differ with respect to education and experience? By analyzing a single hospital unit, we are able to establish a link between staff quality and patient outcomes, allowing us to demonstrate empirically that knowledge and experience are highly relevant in staff members' responses to increasing system load. The systematic aligning of staffing with expected system load should therefore consider not only staffing quantity but also staffing quality. Provided with a reliable prediction of system load, this knowledge would allow managers to generate savings since they can assign high-quality staff more effectively

Separate and Concentrate: Accounting for Patient Complexity in General Hospitals

Scholars have recently suggested the reorganization of general hospitals into organizationally separate divisions for routine and non-routine services to overcome operational misalignments between the two types of services. We provide empirical evidence for this proposal from a quality perspective, using over 250,000 patient discharge records from 60 German hospitals across 39 high-mortality disease segments, and focusing on in-hospital mortality as outcome. Disentangling the effects of high, absolute, and relative hospital volumes in a disease group, our analysis suggests that routine and complex patients would benefit from a hospital organization with a multi-specialty hub for emergency and non-routine elective services at its core, complemented by organizationally separate disease-focused hospitals-within-hospitals for routine services. We also provide evidence that the hub hospital can further improve service quality for complex patients by adopting a disease-based rather than medical specialty-based departmental routing strategy for newly arriving patients. A counterfactual analysis, based on a simultaneous equations probit model that simultaneously controls for endogeneity of volume, focus, and routing strategy, suggests that the proposed reorganization could have reduced mortality in the sample by 13.43% (95% CI [6.87%; 18.95%]) for routine patients and by 11.67% (95% CI [6.13%; 16.86%]) for the most complex patients