It Takes Two to Make It Right: How Nurses’ Response to Sepsis Alerts Impacts Physicians’ Process Compliance

Problem definition : Standardized processes have improved operational performance across various sectors, including healthcare. A persistent gap, however, remains between evidence-based standards and actual clinical practice. Automated alert systems offer a solution by identifying situations where standards apply and prompting workers to act accordingly. In this study, we focus on sepsis, a life-threatening condition, for which timely performance of standard care actions—that is, compliance—is critical, and alert systems are employed to promote such compliance. We empirically examine how a clinical team—comprising two roles, nurse and physician, within a hierarchical structure—delivers care in compliance with standards using a sepsis alert system. This system introduces a workflow that reconfigures the traditional nurse-physician dynamic, enabling nurses to proactively engage in care delivery rather than passively awaiting physician instructions. Within this reconfigured team dynamic, we investigate how nurses’ timely response to sepsis alerts (acknowledging the alert and notifying physicians within a designated time frame) affects physicians’ compliance with sepsis care standards (performing diagnostic or treatment actions within a designated time frame). Methodology/results : Using multiple econometric specifications on data from a large U.S. hospital group with a sepsis alert system, we find that nurses’ timely response positively affects physicians’ compliance with care standards. This positive effect becomes stronger under heavy workloads and weaker as the number of false alerts increases. Furthermore, improved physician compliance, facilitated by nurses’ timely response, leads to shorter hospital stays and fewer intensive care admissions. Managerial implications : Contrary to the traditional view of nurses as subordinates executing physicians’ orders, our findings underscore nurses’ key role in improving physicians’ decision making and support recent initiatives to empower nurses in hospital operations. Our results also emphasize the importance of recognizing interprofessional complementarities as well as the nuances of workload and technology performance when designing workflows and allocating tasks to ensure high-quality care.