IDEAS home Printed from https://ideas.repec.org/a/wly/emetrp/v86y2018i3p997-1030.html
   My bibliography  Save this article

The Efficiency of Slacking off: Evidence From the Emergency Department

Author

Listed:
  • David C. Chan

Abstract

Work schedules play an important role in utilizing labor in organizations. In this study of emergency department physicians in shift work, schedules induce two distortions: First, physicians “slack off†by accepting fewer patients near end of shift (EOS). Second, physicians distort patient care, incurring higher costs as they spend less time on patients assigned near EOS. Examining how these effects change with shift overlap reveals a tradeoff between the two. Within an hour after the normal time of work completion, physicians are willing to spend hospital resources more than six times their market wage to preserve their leisure. Accounting for overall costs, I find that physicians slack off at approximately second†best optimal levels.

Suggested Citation

  • David C. Chan, 2018. "The Efficiency of Slacking off: Evidence From the Emergency Department," Econometrica, Econometric Society, vol. 86(3), pages 997-1030, May.
    • Handle: RePEc:wly:emetrp:v:86:y:2018:i:3:p:997-1030
    DOI: 10.3982/ECTA13565
    as

    Download full text from publisher

    File URL: https://doi.org/10.3982/ECTA13565
    Download Restriction: no
    File URL: https://libkey.io/10.3982/ECTA13565?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. Oliver Hart & John Moore, 2008. "Contracts as Reference Points," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(1), pages 1-48.
    2. Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 151-184, February.
    3. Oriana Bandiera & Iwan Barankay & Imran Rasul, 2005. "Social Preferences and the Response to Incentives: Evidence from Personnel Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(3), pages 917-962.
    4. Paul Oyer, 1998. "Fiscal Year Ends and Nonlinear Incentive Contracts: The Effect on Business Seasonality," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 113(1), pages 149-185.
    5. Aghion, Philippe & Tirole, Jean, 1997. "Formal and Real Authority in Organizations," Journal of Political Economy, University of Chicago Press, vol. 105(1), pages 1-29, February.
    6. Mathias Dewatripont & Ian Jewitt & Jean Tirole, 1999. "The Economics of Career Concerns, Part II: Application to Missions and Accountability of Government Agencies," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 66(1), pages 199-217.
    7. 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.
    8. Che‐Lin Su & Kenneth L. Judd, 2012. "Constrained Optimization Approaches to Estimation of Structural Models," Econometrica, Econometric Society, vol. 80(5), pages 2213-2230, September.
    9. Oriana Bandiera & Iwan Barankay & Imran Rasul, 2009. "Social Connections and Incentives in the Workplace: Evidence From Personnel Data," Econometrica, Econometric Society, vol. 77(4), pages 1047-1094, July.
    10. Alexandre Mas & Amanda Pallais, 2017. "Valuing Alternative Work Arrangements," American Economic Review, American Economic Association, vol. 107(12), pages 3722-3759, December.
    11. Claudia Goldin, 2014. "A Grand Gender Convergence: Its Last Chapter," American Economic Review, American Economic Association, vol. 104(4), pages 1091-1119, April.
    12. repec:ner:ucllon:http://discovery.ucl.ac.uk/17678/ is not listed on IDEAS
    13. Jonathan T. Kolstad, 2013. "Information and Quality When Motivation Is Intrinsic: Evidence from Surgeon Report Cards," American Economic Review, American Economic Association, vol. 103(7), pages 2875-2910, December.
    14. Forrest Briscoe, 2007. "From Iron Cage to Iron Shield? How Bureaucracy Enables Temporal Flexibility for Professional Service Workers," Organization Science, INFORMS, vol. 18(2), pages 297-314, April.
    15. repec:mpr:mprres:3658 is not listed on IDEAS
    16. Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
    17. 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.
    18. Ernst Fehr & Oliver Hart & Christian Zehnder, 2011. "Contracts as Reference Points--Experimental Evidence," American Economic Review, American Economic Association, vol. 101(2), pages 493-525, April.
    19. Ernst Fehr & Oliver Hart & Christian Zehnder, 2008. "Contracts as reference points � experimental evidence," IEW - Working Papers 393, Institute for Empirical Research in Economics - University of Zurich.
    20. Linda Green, 1984. "A Multiple Dispatch Queueing Model of Police Patrol Operations," Management Science, INFORMS, vol. 30(6), pages 653-664, June.
    21. Roland Bénabou & Jean Tirole, 2003. "Intrinsic and Extrinsic Motivation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 70(3), pages 489-520.
    22. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
    23. Tirole, Jean, 1986. "Hierarchies and Bureaucracies: On the Role of Collusion in Organizations," The Journal of Law, Economics, and Organization, Oxford University Press, vol. 2(2), pages 181-214, Fall.
    24. Shapiro, Carl & Stiglitz, Joseph E, 1984. "Equilibrium Unemployment as a Worker Discipline Device," American Economic Review, American Economic Association, vol. 74(3), pages 433-444, June.
    25. Biyu He & Franklin Dexter & Alex Macario & Stefanos Zenios, 2012. "The Timing of Staffing Decisions in Hospital Operating Rooms: Incorporating Workload Heterogeneity into the Newsvendor Problem," Manufacturing & Service Operations Management, INFORMS, vol. 14(1), pages 99-114, January.
    26. Luis Garicano, 2000. "Hierarchies and the Organization of Knowledge in Production," Journal of Political Economy, University of Chicago Press, vol. 108(5), pages 874-904, October.
    27. Radner, Roy, 1993. "The Organization of Decentralized Information Processing," Econometrica, Econometric Society, vol. 61(5), pages 1109-1146, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Sam Watson’s journal round-up for 25th June 2018
      by Sam Watson in The Academic Health Economists' Blog on 2018-06-25 11:00:28

    Citations

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


    Cited by:

    1. 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.
    2. 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.
    3. Agovino, Massimiliano & Musella, Gaetano & Scaletti, Alessandro, 2022. "Equilibrium and efficiency in the first aid services market: The case of the emergency department of Sorrento," Socio-Economic Planning Sciences, Elsevier, vol. 82(PB).
    4. Masoud Kamalahmadi & Qiuping Yu & Yong-Pin Zhou, 2021. "Call to Duty: Just-in-Time Scheduling in a Restaurant Chain," Management Science, INFORMS, vol. 67(11), pages 6751-6781, November.
    5. Gianni De Fraja & Jesse Matheson & James Rockey, 2020. "Zoomshock: The geography and local labour market consequences of working from home," Discussion Papers 20-31, Department of Economics, University of Birmingham.
    6. Moscelli, G.; & Sayli, M.; & Blanden, J.; & Mello, M.; & Castro-Pires, H.; & Bojke, C.;, 2023. "Non-monetary interventions, workforce retention and hospital quality: evidence from the English NHS," Health, Econometrics and Data Group (HEDG) Working Papers 23/13, HEDG, c/o Department of Economics, University of York.
    7. Maria R. Ibanez & Michael W. Toffel, 2020. "How Scheduling Can Bias Quality Assessment: Evidence from Food-Safety Inspections," Management Science, INFORMS, vol. 66(6), pages 2396-2416, June.
    8. Rachet-Jacquet, Laurie & Gutacker, Nils & Siciliani, Luigi, 2021. "Scale economies in the health sector: The effect of hospital volume on health gains from hip replacement surgery," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 704-729.
    9. David C Chan & Matthew Gentzkow & Chuan Yu, 2022. "Selection with Variation in Diagnostic Skill: Evidence from Radiologists [The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care]," The Quarterly Journal of Economics, Oxford University Press, vol. 137(2), pages 729-783.
    10. Moscelli, Giuseppe & Sayli, Melisa & Blanden, Jo & Mello, Marco & Castro-Pires, Henrique & Bojke, Chris, 2023. "Non-monetary Interventions, Workforce Retention and Hospital Quality: Evidence from the English NHS," IZA Discussion Papers 16379, Institute of Labor Economics (IZA).
    11. Lawrence Jin & Rui Tang & Han Ye & Junjian Yi & Songfa Zhong, 2020. "Time Dependency in Physician Decision-Making," AEA Papers and Proceedings, American Economic Association, vol. 110, pages 284-288, May.
    12. Saravanan Kesavan & Susan J. Lambert & Joan C. Williams & Pradeep K. Pendem, 2022. "Doing Well by Doing Good: Improving Retail Store Performance with Responsible Scheduling Practices at the Gap, Inc," Management Science, INFORMS, vol. 68(11), pages 7818-7836, November.
    13. 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.
    14. Freedman, Seth & Golberstein, Ezra & Huang, Tsan-Yao & Satin, David J. & Smith, Laura Barrie, 2021. "Docs with their eyes on the clock? The effect of time pressures on primary care productivity," Journal of Health Economics, Elsevier, vol. 77(C).
    15. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2020. "Capacity constraints and time allocation in public health clinics," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 324-336, March.
    16. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2019. "Capacity Constraints and the Provision of Public Services: The Case of Workers in Public Health Clinics," NBER Working Papers 25706, National Bureau of Economic Research, Inc.

    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. David C. Chan, Jr., 2015. "The Efficiency of Slacking Off: Evidence from the Emergency Department," NBER Working Papers 21002, National Bureau of Economic Research, Inc.
    2. Committee, Nobel Prize, 2016. "Oliver Hart and Bengt Holmström: Contract Theory," Nobel Prize in Economics documents 2016-1, Nobel Prize Committee.
    3. Oliver Hart, 2011. "Thinking about the Firm: A Review of Daniel Spulber's The Theory of the Firm," Journal of Economic Literature, American Economic Association, vol. 49(1), pages 101-113, March.
    4. Eduard Marinov, 2016. "The 2016 Nobel Prize in Economics," Economic Thought journal, Bulgarian Academy of Sciences - Economic Research Institute, issue 6, pages 97-149.
    5. Luis Garicano & Luis Rayo, 2016. "Why Organizations Fail: Models and Cases," Journal of Economic Literature, American Economic Association, vol. 54(1), pages 137-192, March.
    6. Bejarano, Hernán & Corgnet, Brice & Gómez-Miñambres, Joaquín, 2021. "Economic stability promotes gift-exchange in the workplace," Journal of Economic Behavior & Organization, Elsevier, vol. 187(C), pages 374-398.
    7. Bloom, Nicholas & Van Reenen, John, 2011. "Human Resource Management and Productivity," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 19, pages 1697-1767, Elsevier.
    8. Albanese, Marina & Navarra, Cecilia & Tortia, Ermanno C., 2015. "Employer moral hazard and wage rigidity. The case of worker owned and investor owned firms," International Review of Law and Economics, Elsevier, vol. 43(C), pages 227-237.
    9. Oriana Bandiera & Iwan Barankay & Imran Rasul, 2011. "Field Experiments with Firms," Journal of Economic Perspectives, American Economic Association, vol. 25(3), pages 63-82, Summer.
    10. Nicholas Bloom & Raffaella Sadun & John Van Reenen, 2010. "Recent Advances in the Empirics of Organizational Economics," Annual Review of Economics, Annual Reviews, vol. 2(1), pages 105-137, September.
    11. Gregor Matvos, 2014. "Renegotiation Design: Evidence from National Football League Roster Bonuses," Journal of Law and Economics, University of Chicago Press, vol. 57(2), pages 387-430.
    12. Schmitz, Patrick W., 2021. "On the optimality of outsourcing when vertical integration can mitigate information asymmetries," Economics Letters, Elsevier, vol. 202(C).
    13. Edward P. Lazear, 1995. "Personnel Economics," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262121883, December.
    14. Schinkel, M.P. & Tóth, L. & Tuinstra, J., 2014. "Discretionary Authority and Prioritizing in Government Agencies," CeNDEF Working Papers 14-15, Universiteit van Amsterdam, Center for Nonlinear Dynamics in Economics and Finance.
    15. Christian Koch, 2021. "Can reference points explain wage rigidity? Experimental evidence," Journal for Labour Market Research, Springer;Institute for Employment Research/ Institut für Arbeitsmarkt- und Berufsforschung (IAB), vol. 55(1), pages 1-17, December.
    16. Hernán Bejarano & Brice Corgnet & Joaquín Gómez-Miñambres, 2019. "Labor Contracts, Gift-Exchange and Reference Wages: Your Gift Need Not Be Mine!," Working Papers 19-26, Chapman University, Economic Science Institute.
    17. Guido Friebel & Matthias Heinz & Mitchell Hoffman & Nick Zubanov, 2023. "What Do Employee Referral Programs Do? Measuring the Direct and Overall Effects of a Management Practice," Journal of Political Economy, University of Chicago Press, vol. 131(3), pages 633-686.
    18. Simona Grassi & Ching-to Albert Ma, 2016. "Information acquisition, referral, and organization," RAND Journal of Economics, RAND Corporation, vol. 47(4), pages 935-960, November.
    19. Albert H. Choi & George Triantis, 2021. "Contract Design When Relationship-Specific Investment Produces Asymmetric Information," The Journal of Legal Studies, University of Chicago Press, vol. 50(2), pages 219-260.
    20. Fahn, Matthias, 2019. "Reciprocity in Dynamic Employment Relationships," Rationality and Competition Discussion Paper Series 198, CRC TRR 190 Rationality and Competition.

    More about this item

    Lists

    This item is featured on the following reading lists, Wikipedia, or ReplicationWiki pages:
    1. The Efficiency of Slacking Off: Evidence from the Emergency Department (ECTA 2018) in ReplicationWiki

    Statistics

    Access and download statistics

    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:wly:emetrp:v:86:y:2018:i:3:p:997-1030. 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: Wiley Content Delivery (email available below). General contact details of provider: https://edirc.repec.org/data/essssea.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.