Abstract
We conduct an empirical investigation of the impact of queue management on patients’ average wait time and length of stay (LOS). Using an emergency department’s (ED) patient-level data from 2007 to 2010, we find that patients’ average wait time and LOS are longer when physicians are assigned patients under a pooled queuing system with a fairness constraint compared to a dedicated queuing system with the same fairness constraint. Using a difference-in-differences approach, we find the dedicated queuing system is associated with a 17% decrease in average LOS and a 9% decrease in average wait time relative to the control group—a 39-minute reduction in LOS and a four-minute reduction in wait time for an average patient of medium severity in this ED. Interviews and observations of physicians suggest that the improved performance stems from the physicians’ increased ownership over patients and resources that is afforded by a dedicated queuing system, which enables physicians to more actively manage the flow of patients into and out of ED beds. Our findings suggest that the benefits from improved flow management in a dedicated queuing system can be large enough to overcome the longer wait time predicted to arise from nonpooled queues. We conduct additional analyses to rule out alternate explanations for the reduced average wait time and LOS in the dedicated system, such as stinting and decreased quality of care. Our paper has implications for healthcare organizations and others seeking to reduce patient wait time and LOS without increasing costs. This paper was accepted by Serguei Netessine, operations management.
Highlights
Improving efficiency and customer experience are key objectives for managers of service organizations
The coefficient on Physician Assignment System (PAS) is not statistically significant at conventional levels ( 1 = -0.03, p ≈ 0.10), suggesting that there was no significant change in patients’ lengths of stay in the Rapid Care Area (RCA). These results offer strong support for our main hypothesis, which predicted that, in our setting, pooled queuing systems are associated with longer throughput times compared to dedicated queuing systems
Using 3.5 years of data from a hospital’s emergency department (ED), we found that patients experienced shorter lengths of stay when physicians were working in a dedicated queuing system as opposed to a pooled queuing system
Summary
Improving efficiency and customer experience are key objectives for managers of service organizations. To our knowledge, there has been limited field-based empirical study of the impact of differences in queue management systems on the speed of service This is an important area for further investigation because without understanding both the human and system factors that impact the effectiveness of different queuing systems, operations management theory will be underdeveloped, leading to limited impact on practice. To address this gap, we empirically test the impact of the structure of the queuing system on the throughput time of patients in an emergency department (ED) that switched from having a pooled queuing system to a dedicated queuing system. This paper makes a contribution to the literature on queue pooling because prior research has emphasized customer behaviors (e.g., jockeying) that reduce the process losses of dedicated queues, but fewer papers have empirically tested the impact of server behaviors on the performance of different types of queuing systems (Boudreau et al 2003, Hopp et al 2007, Jouini et al 2008)
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