Examining the Role of Single versus Dual Decision-Making Approach for Patient Care

Abstract

Decisions related to patient treatment during their hospital stay are done by two key decision-makers: The attending physician (AP) and the operating physician (OP). Under the single decision-making approach (S-DMA), the AP and OP are the same, whereas, under the dual decision-making approach (D-DMA), the AP and OP are different. In recent years, hospitals have seen an increasing trend towards D-DMA over S-DMA approach to accommodate physician schedules. While research outside healthcare operations management has argued for benefits from both S-DMA and D-DMA approaches, very little knowledge exists on what is effective during healthcare delivery. In this study, we address this gap by investigating the DMA within a hospital through physicians effectively improves patient care outcomes. Using detailed data from the state of Florida on cardiology patients over three years, we find that a S-DMA is associated with reduced patient length of stay, treatment cost, and mortality. This runs counter to some of the trends observed in practice. Further, we find that the effect is more significant for patients with greater disease complexity. A follow-up post-hoc analyses also reveal interesting insights: (1) S-DMA is more beneficial for community hospitals than teaching and academic hospitals (2) S-DMA is more critical than physician specialization. Our results are robust to alternate explanations and demonstrate the role that physicians can play in effective care treatment during a hospital stay.