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We conduct an empirical investigation of the impact of two different queue management systems on throughput times. Using an Emergency Department’s (ED) patient-level data (N = 231,081) from 2007 to 2010, we find that patients’ lengths of stay (LOS) were longer when physicians were assigned patients under a pooled queuing system, compared to when each physician operated under a dedicated queuing system. The dedicated queuing system resulted in a 10 percent decrease in LOS—a 32-minute reduction in LOS for an average patient of medium severity in this ED. We propose that the dedicated queuing system yielded shorter throughput times because it provided physicians with greater ability and incentive to manage their patients’ flow through the ED from arrival to discharge. Consistent with social loafing theory, our analysis shows that patients were treated and discharged at a faster rate in the dedicated queuing system than in the pooled queuing system. We conduct additional analyses to rule out alternate explanations, such as stinting on care and decreased quality of care. Our paper has implications for health care organizations and others seeking to reduce throughput time, resource utilization, and costs.

The performance gap between hospital spending and outcomes is indicative of inefficient care delivery. Operational failures—breakdowns in internal supply chains that prevent work from being completed—contribute to inefficiency by consuming 10% of nurses’ time (Hendrich et al. 2008, Tucker 2004). This paper seeks to identify organizational factors associated with operational failures, with a goal of providing insight into effective strategies for removal. We observed nurses on medical/ surgical units at two hospitals, shadowed support staff who provided materials, and interviewed employees about their internal supply chain’s performance. These activities created a database of 120 operational failures and the organizational factors that contributed to them. We found that employees believed their department’s performance was satisfactory, but poorly trained employees in other departments caused the failures. However, only 14% of the operational failures arose from errors or training. They stemmed instead from multiple organizationally-driven factors: insufficient workspace (29%), poor process design (23%), and a lack of integration in the internal supply chains (23%). Our findings thus suggest that employees are unlikely to discern the role that their department’s routines play in operational failures, which hinders solution efforts. Furthermore, in contrast to the “Pareto Principle” which advocates addressing “large” problems that contribute a disproportionate share of the cumulative negative impact of problems, the failures and causes were dispersed over a wide range of factors. Thus, removing failures will require deliberate cross-functional efforts to redesign workspaces and processes so they are better integrated with patients’ needs.

A potential avenue for organizational learning is frontline employees’ experience with internal supply chain problems. However, extensive research has established that employees rarely speak up to managers about problems. They tend to work around problems without additional effort to create organizational learning. This paper tests the premise that managerial action, via work design, can alter this dynamic. We use laboratory experiments to test the impact of three work design variables on proactive, improvement-oriented behaviors, workarounds, and errors. We find that two out of the three work design variables were effective at inducing proactive improvement-oriented behavior. Our results suggest that small changes in job design can reduce employee silence about organizational problems. Furthermore, we test the impact of the variables on risky workarounds and errors to account for unanticipated negative effects of work design to facilitate speaking up.

The report discusses employment in the health care system in Poland based on analysis and projections of the demand and supply of medical workforce. The impact of the financial situation and policy on relativelly low employment level of medical personel was accounted for in the analysis while projections were driven by demographic changes in the following two decades. Results of different demographic variants of projections used in Neujobs project and additional scenarios show that while ageing is an important factor that may stimulate demand for provision of medical personnel, changes might be mitigated by further increase in efficiency of care. At the same time the supply of care will be affected by ageing too. The results indicate that more detailed monitoring of employment in the future will be needed in order to assure adequacy of provision of medical professionals, especially of nurses (critical gap), some medical specialists, physiotherapists and medical technical personnel. [ABSTRACT FROM AUTHOR]