IDEAS home Printed from https://ideas.repec.org/a/inm/ormnsc/v63y2017i11p3531-3551.html
   My bibliography  Save this article

Early Task Initiation and Other Load-Adaptive Mechanisms in the Emergency Department

Author

Listed:
  • Robert J. Batt

    (Wisconsin School of Business, University of Wisconsin–Madison, Madison, Wisconsin 53706)

  • Christian Terwiesch

    (The Wharton School and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104)

Abstract

We study a multistage service process that adapts to system occupancy level. Using operational data from more than 140,000 patient visits to a hospital emergency department, we show that the system-level performance of the emergency department is an aggregation of several simultaneous server-level workload response mechanisms. We identify early task initiation as a between-stage adaptive response mechanism that occurs when an upstream stage initiates tasks that are normally handled by a downstream stage. We show that having some diagnostic tests ordered during the triage process reduces treatment time by 20 minutes, on average. However, ordering too many tests at triage can lead to an increase in the total number of tests performed on the patient. We also demonstrate the presence of other response mechanisms such as queuing delays for tasks such as medication delivery, and rushing as nurses spend less time with their patients when the queue length is high.

Suggested Citation

  • 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.
    • Handle: RePEc:inm:ormnsc:v:63:y:2017:i:11:p:3531-3551
    DOI: 10.1287/mnsc.2016.2516
    as

    Download full text from publisher

    File URL: https://doi.org/10.1287/mnsc.2016.2516
    Download Restriction: no
    File URL: https://libkey.io/10.1287/mnsc.2016.2516?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. 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.
    3. David C. Chan, 2016. "Teamwork and Moral Hazard: Evidence from the Emergency Department," Journal of Political Economy, University of Chicago Press, vol. 124(3), pages 734-770.
    4. 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.
    5. Saed Alizamir & Francis de Véricourt & Peng Sun, 2013. "Diagnostic Accuracy Under Congestion," Management Science, INFORMS, vol. 59(1), pages 157-171, December.
    6. Massimiliano Bratti & Alfonso Miranda, 2011. "Endogenous treatment effects for count data models with endogenous participation or sample selection," Health Economics, John Wiley & Sons, Ltd., vol. 20(9), pages 1090-1109, September.
    7. Richard C. Larson, 1987. "OR Forum—Perspectives on Queues: Social Justice and the Psychology of Queueing," Operations Research, INFORMS, vol. 35(6), pages 895-905, December.
    8. Jo Thori Lind & Halvor Mehlum, 2010. "With or Without U? The Appropriate Test for a U‐Shaped Relationship," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 72(1), pages 109-118, February.
    9. Jennifer M. George & J. Michael Harrison, 2001. "Dynamic Control of a Queue with Adjustable Service Rate," Operations Research, INFORMS, vol. 49(5), pages 720-731, October.
    10. 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.
    11. Diwas S. Kc & Christian Terwiesch, 2009. "Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations," Management Science, INFORMS, vol. 55(9), pages 1486-1498, September.
    12. Durbin, J, 1970. "Testing for Serial Correlation in Least-Squares Regression When Some of the Regressors are Lagged Dependent Variables," Econometrica, Econometric Society, vol. 38(3), pages 410-421, May.
    13. Van de Ven, Wynand P. M. M. & Van Praag, Bernard M. S., 1981. "The demand for deductibles in private health insurance : A probit model with sample selection," Journal of Econometrics, Elsevier, vol. 17(2), pages 229-252, November.
    14. 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.
    15. Askin, Ronald G. & Chen, Jiaqiong, 2006. "Dynamic task assignment for throughput maximization with worksharing," European Journal of Operational Research, Elsevier, vol. 168(3), pages 853-869, February.
    16. Genji Yamazaki & Hirotaka Sakasegawa, 1987. "An Optimal Design Problem for Limited Processor Sharing Systems," Management Science, INFORMS, vol. 33(8), pages 1010-1019, August.
    17. Michael Anderson & Carlos Dobkin & Tal Gross, 2012. "The Effect of Health Insurance Coverage on the Use of Medical Services," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 1-27, February.
    18. Bradley R. Staats & Francesca Gino, 2012. "Specialization and Variety in Repetitive Tasks: Evidence from a Japanese Bank," Management Science, INFORMS, vol. 58(6), pages 1141-1159, June.
    19. 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.
    20. Ludwig Kuntz & Roman Mennicken & Stefan Scholtes, 2015. "Stress on the Ward: Evidence of Safety Tipping Points in Hospitals," Management Science, INFORMS, vol. 61(4), pages 754-771, April.
    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. Diwas Singh KC & Christian Terwiesch, 2012. "An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit," Manufacturing & Service Operations Management, INFORMS, vol. 14(1), pages 50-65, January.
    23. Thomas B. Crabill, 1972. "Optimal Control of a Service Facility with Variable Exponential Service Times and Constant Arrival Rate," Management Science, INFORMS, vol. 18(9), pages 560-566, May.
    24. Robert J. Batt & Christian Terwiesch, 2015. "Waiting Patiently: An Empirical Study of Queue Abandonment in an Emergency Department," Management Science, INFORMS, vol. 61(1), pages 39-59, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Carri W. Chan & Linda V. Green & Suparerk Lekwijit & Lijian Lu & Gabriel Escobar, 2019. "Assessing the Impact of Service Level When Customer Needs Are Uncertain: An Empirical Investigation of Hospital Step-Down Units," Management Science, INFORMS, vol. 65(2), pages 751-775, February.
    2. 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.
    3. Büşra Ergün‐Şahin & Evrim Didem Güneş & Ayşe Kocabıyıkoğlu & Ahmet Keskin, 2022. "How does workload affect test ordering behavior of physicians? An empirical investigation," Production and Operations Management, Production and Operations Management Society, vol. 31(6), pages 2664-2680, June.
    4. Lee, Seung-Yup & Chinnam, Ratna Babu & Dalkiran, Evrim & Krupp, Seth & Nauss, Michael, 2021. "Proactive coordination of inpatient bed management to reduce emergency department patient boarding," International Journal of Production Economics, Elsevier, vol. 231(C).
    5. Hessam Bavafa & Lorin M. Hitt & Christian Terwiesch, 2018. "The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care," Management Science, INFORMS, vol. 64(12), pages 5461-5480, December.
    6. Tinglong Dai & Sridhar Tayur, 2020. "OM Forum—Healthcare Operations Management: A Snapshot of Emerging Research," Manufacturing & Service Operations Management, INFORMS, vol. 22(5), pages 869-887, September.
    7. Gautam Gowrisankaran & Keith Joiner & Pierre Thomas Léger, 2023. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," Management Science, INFORMS, vol. 69(6), pages 3202-3219, June.
    8. Yingchao Lan & Deepa Goradia & Aravind Chandrasekaran, 2022. "Ancillary Cost Implications of Physicians Multisiting and Inter‐Organizational Collaboration During Healthcare Delivery," Production and Operations Management, Production and Operations Management Society, vol. 31(2), pages 561-582, February.
    9. Ahmad M. Ashkanani & Benjamin B. Dunford & Kevin J. Mumford, 2022. "Impact of Motivation and Workload on Service Time Components: An Empirical Analysis of Call Center Operations," Management Science, INFORMS, vol. 68(9), pages 6697-6715, September.
    10. Cildoz, Marta & Ibarra, Amaia & Mallor, Fermin, 2020. "Coping with stress in emergency department physicians through improved patient-flow management," Socio-Economic Planning Sciences, Elsevier, vol. 71(C).
    11. Hummy Song & Anita L. Tucker & Karen L. Murrell & David R. Vinsonc, 2018. "Closing the Productivity Gap: Improving Worker Productivity Through Public Relative Performance Feedback and Validation of Best Practices," Management Science, INFORMS, vol. 64(6), pages 2628-2649, June.
    12. Farzad Zaerpour & Marco Bijvank & Huiyin Ouyang & Zhankun Sun, 2022. "Scheduling of Physicians with Time‐Varying Productivity Levels in Emergency Departments," Production and Operations Management, Production and Operations Management Society, vol. 31(2), pages 645-667, February.
    13. Matthias Thürer & Mark Stevenson & James Aitken & Cristovao Silva, 2020. "State-dependent service rates in make-to-order shops: an assessment by simulation," Operations Management Research, Springer, vol. 13(1), pages 70-84, June.
    14. Saghafian, Soroush & Imanirad, Raha & Traub, Stephen J., 2019. "Do Physicians Influence Each Other’s Performance? Evidence from the Emergency Department," Working Paper Series rwp19-018, Harvard University, John F. Kennedy School of Government.

    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. 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.
    2. Mirko Kremer & Francis de Véricourt, 2022. "Mismanaging diagnostic accuracy under congestion," ESMT Research Working Papers ESMT-22-01, ESMT European School of Management and Technology.
    3. 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.
    4. 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.
    5. 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.
    6. Büşra Ergün‐Şahin & Evrim Didem Güneş & Ayşe Kocabıyıkoğlu & Ahmet Keskin, 2022. "How does workload affect test ordering behavior of physicians? An empirical investigation," Production and Operations Management, Production and Operations Management Society, vol. 31(6), pages 2664-2680, June.
    7. Mohammad Delasay & Armann Ingolfsson & Bora Kolfal, 2016. "Modeling Load and Overwork Effects in Queueing Systems with Adaptive Service Rates," Operations Research, INFORMS, vol. 64(4), pages 867-885, August.
    8. Michael Freeman & Susan Robinson & Stefan Scholtes, 2021. "Gatekeeping, Fast and Slow: An Empirical Study of Referral Errors in the Emergency Department," Management Science, INFORMS, vol. 67(7), pages 4209-4232, July.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. Zeynep Akşin & Sarang Deo & Jónas Oddur Jónasson & Kamalini Ramdas, 2021. "Learning from Many: Partner Exposure and Team Familiarity in Fluid Teams," Management Science, INFORMS, vol. 67(2), pages 854-874, February.
    14. Yuqian Xu & Tom Fangyun Tan & Serguei Netessine, 2022. "The Impact of Workload on Operational Risk: Evidence from a Commercial Bank," Management Science, INFORMS, vol. 68(4), pages 2668-2693, April.
    15. Ludwig Kuntz & Roman Mennicken & Stefan Scholtes, 2015. "Stress on the Ward: Evidence of Safety Tipping Points in Hospitals," Management Science, INFORMS, vol. 61(4), pages 754-771, April.
    16. Carri W. Chan & Linda V. Green & Suparerk Lekwijit & Lijian Lu & Gabriel Escobar, 2019. "Assessing the Impact of Service Level When Customer Needs Are Uncertain: An Empirical Investigation of Hospital Step-Down Units," Management Science, INFORMS, vol. 65(2), pages 751-775, February.
    17. Noa Zychlinski, 2023. "Applications of fluid models in service operations management," Queueing Systems: Theory and Applications, Springer, vol. 103(1), pages 161-185, February.
    18. Tinglong Dai & Sridhar Tayur, 2020. "OM Forum—Healthcare Operations Management: A Snapshot of Emerging Research," Manufacturing & Service Operations Management, INFORMS, vol. 22(5), pages 869-887, September.
    19. Jim G. Dai & Pengyi Shi, 2021. "Recent Modeling and Analytical Advances in Hospital Inpatient Flow Management," Production and Operations Management, Production and Operations Management Society, vol. 30(6), pages 1838-1862, June.
    20. Teck-Hua Ho & Noah Lim & Sadat Reza & Xiaoyu Xia, 2017. "OM Forum—Causal Inference Models in Operations Management," Manufacturing & Service Operations Management, INFORMS, vol. 19(4), pages 509-525, October.

    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:63:y:2017:i:11:p:3531-3551. 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.