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

The Impact of Time at Work and Time off From Work on Rule Compliance: The Case of Hand Hygiene in Healthcare

To deliver high-quality, reliable, and consistent services safely, organizations develop professional standards. Despite the communication and reinforcement of these standards, they are often not followed consistently. Although previous research suggests that high job demands are associated with declines in compliance over lengthy intervals, we hypothesized—drawing on theoretical arguments focused on fatigue and depletion—that the impact of job demands on routine compliance with professional standards might accumulate much more quickly. To test this hypothesis, we studied a problem that represents one of the most significant compliance challenges in health care today: hand hygiene. Using longitudinal field observations of over 4,157 caregivers working in 35 different hospitals and experiencing more than 13.7 million hand hygiene opportunities, we found that hand hygiene compliance rates dropped by a regression-estimated 8.7 percentage points on average from the beginning to the end of a typical 12-hr work shift. This decline in compliance was magnified by increased work intensity. Further, longer breaks between work shifts increased subsequent compliance rates, and such benefits were greater for individuals when they had ended their preceding shift with a lower compliance rate. In addition, (a) the decline in compliance over the course of a work shift and (b) the improvement in compliance following a longer break increased as individuals accumulated more total work hours the preceding week. The implications of these findings for patient safety and job design are discussed