Empirical Investigations Into The Causal Impact Of Healthcare Provider Behavior On Patient Care

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Doctor of Philosophy (PhD)
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Operations & Information Management
causal inference
empirical operations management
health care management
Health and Medical Administration
Operational Research
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This dissertation in operations management focuses on the study of healthcare operations management using large-scale empirical datasets and econometric methods. In chapter one, we utilize infrared location tracking data to study the impact of physical facility layout on how service workers organize their tasks. We focus on the hospital emergency department as a service setting where nurses (servers) have discretion over how they interact with their patients (customers) in a facility that introduces significant heterogeneity in necessary walking distance. Our findings show that even in services, the spatial organization of a facility can lead to servers with discretion over task timing using that discretion in ways that help the server but that lead to reduced customer quality. In chapter two, we examine the hospital intensive care unit (ICU) to investigate the impact of exogenous medication delays, introduced by shift changes, on granular patient health outcomes. The ICU is an ideal setting for this research because patients are often in critical condition and require medications to remain in healthy states (as measured by vital signs). Using patient vital sign data electronically archived every few minutes, merged with the electronic medical record and the medication order/delivery database, we are able to estimate the marginal impact of a minute of medication delay on patient vital status following the late medication. Beyond providing actionable, data-driven insight to managers and healthcare practitioners surrounding how we can better enable workers to maximize effectiveness and efficiency, the research in this dissertation utilizes novel large-scale datasets, unique econometric techniques, and innovative measurement of health outcomes.

Christian Terwiesch
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