IDEAS home Printed from https://ideas.repec.org/a/inm/ormnsc/v61y2015i12p3032-3053.html
   My bibliography  Save this article

The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay

Author

Listed:
  • Hummy Song

    (Harvard University, Boston, Massachusetts 02163)

  • Anita L. Tucker

    (Brandeis University International Business School, Waltham, Massachusetts 02453)

  • Karen L. Murrell

    (Kaiser Permanente South Sacramento Medical Center, Sacramento, California 95823)

Abstract

We conduct an empirical investigation of the impact of queue management on patients’ average wait time and length of stay (LOS). Using an emergency department’s (ED) patient-level data from 2007 to 2010, we find that patients’ average wait time and LOS are longer when physicians are assigned patients under a pooled queuing system with a fairness constraint compared to a dedicated queuing system with the same fairness constraint. Using a difference-in-differences approach, we find the dedicated queuing system is associated with a 17% decrease in average LOS and a 9% decrease in average wait time relative to the control group—a 39-minute reduction in LOS and a four-minute reduction in wait time for an average patient of medium severity in this ED. Interviews and observations of physicians suggest that the improved performance stems from the physicians’ increased ownership over patients and resources that is afforded by a dedicated queuing system, which enables physicians to more actively manage the flow of patients into and out of ED beds. Our findings suggest that the benefits from improved flow management in a dedicated queuing system can be large enough to overcome the longer wait time predicted to arise from nonpooled queues. We conduct additional analyses to rule out alternate explanations for the reduced average wait time and LOS in the dedicated system, such as stinting and decreased quality of care. Our paper has implications for healthcare organizations and others seeking to reduce patient wait time and LOS without increasing costs. This paper was accepted by Serguei Netessine, operations management.

Suggested Citation

  • Hummy Song & Anita L. Tucker & Karen L. Murrell, 2015. "The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay," Management Science, INFORMS, vol. 61(12), pages 3032-3053, December.
    • Handle: RePEc:inm:ormnsc:v:61:y:2015:i:12:p:3032-3053
    DOI: 10.1287/mnsc.2014.2118
    as

    Download full text from publisher

    File URL: http://dx.doi.org/10.1287/mnsc.2014.2118
    Download Restriction: no
    File URL: https://libkey.io/10.1287/mnsc.2014.2118?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Tom Fangyun Tan & Serguei Netessine, 2014. "When Does the Devil Make Work? An Empirical Study of the Impact of Workload on Worker Productivity," Management Science, INFORMS, vol. 60(6), pages 1574-1593, June.
    2. Esther Duflo, 2001. "Schooling and Labor Market Consequences of School Construction in Indonesia: Evidence from an Unusual Policy Experiment," American Economic Review, American Economic Association, vol. 91(4), pages 795-813, September.
    3. Wallace J. Hopp & Seyed M. R. Iravani & Gigi Y. Yuen, 2007. "Operations Systems with Discretionary Task Completion," Management Science, INFORMS, vol. 53(1), pages 61-77, January.
    4. Michael H. Rothkopf & Paul Rech, 1987. "Perspectives on Queues: Combining Queues is Not Always Beneficial," Operations Research, INFORMS, vol. 35(6), pages 906-909, December.
    5. Avishai Mandelbaum & Martin I. Reiman, 1998. "On Pooling in Queueing Networks," Management Science, INFORMS, vol. 44(7), pages 971-981, July.
    6. Kenneth L. Schultz & David C. Juran & John W. Boudreau & John O. McClain & L. Joseph Thomas, 1998. "Modeling and Worker Motivation in JIT Production Systems," Management Science, INFORMS, vol. 44(12-Part-1), pages 1595-1607, December.
    7. Achal Bassamboo & Ramandeep S. Randhawa & Jan A. Van Mieghem, 2010. "Optimal Flexibility Configurations in Newsvendor Networks: Going Beyond Chaining and Pairing," Management Science, INFORMS, vol. 56(8), pages 1285-1303, August.
    8. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    9. van Dijk, Nico & van der Sluis, Erik, 2009. "Pooling is not the answer," European Journal of Operational Research, Elsevier, vol. 197(1), pages 415-421, August.
    10. Benjaafar, Saifallah, 1995. "Performance bounds for the effectiveness of pooling in multi-processing systems," European Journal of Operational Research, Elsevier, vol. 87(2), pages 375-388, December.
    11. Noah Gans & Ger Koole & Avishai Mandelbaum, 2003. "Telephone Call Centers: Tutorial, Review, and Research Prospects," Manufacturing & Service Operations Management, INFORMS, vol. 5(2), pages 79-141, September.
    12. Oualid Jouini & Yves Dallery & Rabie Nait-Abdallah, 2008. "Analysis of the Impact of Team-Based Organizations in Call Center Management," Management Science, INFORMS, vol. 54(2), pages 400-414, February.
    13. Xiaofang Wang & Laurens G. Debo & Alan Scheller-Wolf & Stephen F. Smith, 2010. "Design and Analysis of Diagnostic Service Centers," Management Science, INFORMS, vol. 56(11), pages 1873-1890, November.
    14. Loch, Christoph, 1998. "Operations management and reengineering," European Management Journal, Elsevier, vol. 16(3), pages 306-317, June.
    15. Alberto Abadie, 2005. "Semiparametric Difference-in-Differences Estimators," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 1-19.
    16. Mor Armony & Amy R. Ward, 2010. "Fair Dynamic Routing in Large-Scale Heterogeneous-Server Systems," Operations Research, INFORMS, vol. 58(3), pages 624-637, June.
    17. Gérard P. Cachon & Fuqiang Zhang, 2007. "Obtaining Fast Service in a Queueing System via Performance-Based Allocation of Demand," Management Science, INFORMS, vol. 53(3), pages 408-420, March.
    18. Gary D. Eppen, 1979. "Note--Effects of Centralization on Expected Costs in a Multi-Location Newsboy Problem," Management Science, INFORMS, vol. 25(5), pages 498-501, May.
    19. Stephen M. Gilbert & Z. Kevin Weng, 1998. "Incentive Effects Favor Nonconsolidating Queues in a Service System: The Principal--Agent Perspective," Management Science, INFORMS, vol. 44(12-Part-1), pages 1662-1669, December.
    20. John Boudreau & Wallace Hopp & John O. McClain & L. Joseph Thomas, 2003. "On the Interface Between Operations and Human Resources Management," Manufacturing & Service Operations Management, INFORMS, vol. 5(3), pages 179-202, September.
    21. Rogelio Oliva & John D. Sterman, 2001. "Cutting Corners and Working Overtime: Quality Erosion in the Service Industry," Management Science, INFORMS, vol. 47(7), pages 894-914, July.
    22. Laurens G. Debo & L. Beril Toktay & Luk N. Van Wassenhove, 2008. "Queuing for Expert Services," Management Science, INFORMS, vol. 54(8), pages 1497-1512, August.
    23. Sameer Hasija & Edieal Pinker & Robert A. Shumsky, 2010. "OM Practice--Work Expands to Fill the Time Available: Capacity Estimation and Staffing Under Parkinson's Law," Manufacturing & Service Operations Management, INFORMS, vol. 12(1), pages 1-18, September.
    24. Thomas J. Best & Burhaneddin Sandıkçı & Donald D. Eisenstein & David O. Meltzer, 2015. "Managing Hospital Inpatient Bed Capacity Through Partitioning Care into Focused Wings," Manufacturing & Service Operations Management, INFORMS, vol. 17(2), pages 157-176, May.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Song, Lina & Saghafian, Soroush, 2019. "Do Hospital Closures Improve the Efficiency and Quality of Other Hospitals?," Working Paper Series rwp19-006, Harvard University, John F. Kennedy School of Government.
    2. Masha Shunko & Julie Niederhoff & Yaroslav Rosokha, 2018. "Humans Are Not Machines: The Behavioral Impact of Queueing Design on Service Time," Management Science, INFORMS, vol. 64(1), pages 453-473, January.
    3. Tom Fangyun Tan & Serguei Netessine, 2014. "When Does the Devil Make Work? An Empirical Study of the Impact of Workload on Worker Productivity," Management Science, INFORMS, vol. 60(6), pages 1574-1593, June.
    4. Mor Armony & Guillaume Roels & Hummy Song, 2021. "Pooling Queues with Strategic Servers: The Effects of Customer Ownership," Operations Research, INFORMS, vol. 69(1), pages 13-29, January.
    5. Nur Sunar & Yichen Tu & Serhan Ziya, 2021. "Pooled vs. Dedicated Queues when Customers Are Delay-Sensitive," Management Science, INFORMS, vol. 67(6), pages 3785-3802, June.
    6. Delasay, Mohammad & Ingolfsson, Armann & Kolfal, Bora & Schultz, Kenneth, 2019. "Load effect on service times," European Journal of Operational Research, Elsevier, vol. 279(3), pages 673-686.
    7. Wenhui Zhou & Dongmei Wang & Weixiang Huang & Pengfei Guo, 2021. "To Pool or Not to Pool? The Effect of Loss Aversion on Queue Configurations," Production and Operations Management, Production and Operations Management Society, vol. 30(11), pages 4258-4272, November.
    8. Michael Freeman & Nicos Savva & Stefan Scholtes, 2017. "Gatekeepers at Work: An Empirical Analysis of a Maternity Unit," Management Science, INFORMS, vol. 63(10), pages 3147-3167, October.
    9. Maria R. Ibanez & Jonathan R. Clark & Robert S. Huckman & Bradley R. Staats, 2018. "Discretionary Task Ordering: Queue Management in Radiological Services," Management Science, INFORMS, vol. 64(9), pages 4389-4407, September.
    10. Jingqi Wang & Yong-Pin Zhou, 2018. "Impact of Queue Configuration on Service Time: Evidence from a Supermarket," Management Science, INFORMS, vol. 64(7), pages 3055-3075, July.
    11. Diwas S. KC & Bradley R. Staats & Maryam Kouchaki & Francesca Gino, 2020. "Task Selection and Workload: A Focus on Completing Easy Tasks Hurts Performance," Management Science, INFORMS, vol. 66(10), pages 4397-4416, October.
    12. Tianxiang Wang & Peiwen Yu & Jianqiang Hu, 2022. "Admission Control Game with Capacity Borrowing," Production and Operations Management, Production and Operations Management Society, vol. 31(2), pages 547-560, February.
    13. Jillian A. Berry Jaeker & Anita L. Tucker, 2017. "Past the Point of Speeding Up: The Negative Effects of Workload Saturation on Efficiency and Patient Severity," Management Science, INFORMS, vol. 63(4), pages 1042-1062, April.
    14. Jose A. Guajardo & Morris A. Cohen, 2018. "Service Differentiation and Operating Segments: A Framework and an Application to After-Sales Services," Manufacturing & Service Operations Management, INFORMS, vol. 20(3), pages 440-454, July.
    15. Dongyuan Zhan & Amy R. Ward, 2019. "Staffing, Routing, and Payment to Trade off Speed and Quality in Large Service Systems," Operations Research, INFORMS, vol. 67(6), pages 1738-1751, November.
    16. Xiaofang Wang & Laurens G. Debo & Alan Scheller‐Wolf & Stephen F. Smith, 2012. "Service design at diagnostic service centers," Naval Research Logistics (NRL), John Wiley & Sons, vol. 59(8), pages 613-628, December.
    17. Saied Samiedaluie & Vedat Verter, 2019. "The impact of specialization of hospitals on patient access to care; a queuing analysis with an application to a neurological hospital," Health Care Management Science, Springer, vol. 22(4), pages 709-726, December.
    18. Robert J. Batt & Christian Terwiesch, 2017. "Early Task Initiation and Other Load-Adaptive Mechanisms in the Emergency Department," Management Science, INFORMS, vol. 63(11), pages 3531-3551, November.
    19. Krishnan S. Anand & M. Faz{i}l Paç & Senthil Veeraraghavan, 2011. "Quality-Speed Conundrum: Trade-offs in Customer-Intensive Services," Management Science, INFORMS, vol. 57(1), pages 40-56, January.
    20. Noa Zychlinski, 2023. "Applications of fluid models in service operations management," Queueing Systems: Theory and Applications, Springer, vol. 103(1), pages 161-185, February.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:inm:ormnsc:v:61:y:2015:i:12:p:3032-3053. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Chris Asher (email available below). General contact details of provider: https://edirc.repec.org/data/inforea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.