Boundaries of Focus and Volume: An Empirical Study in Neonatal Intensive Care

• 成果类型: Article
• 署名作者: Miedaner, Felix; Sulz, Sandra
• 署名单位: University of Cologne; Erasmus University Rotterdam - Excl Erasmus MC; Erasmus University Rotterdam
• 刊物名称: PRODUCTION AND OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1059-1478
• DOI: 10.1111/poms.13110
• 发表日期: 2020
• 页码: 298-308
• 关键词: VOLUME; focus; patient heterogeneity; neonatal intensive care

摘要

Our study contributes to the scholarly debate whether organizational units should have a narrow focus and admit a homogeneous patient cluster or whether they should admit a pool of patient clusters. We investigate whether the benefits of increased volume through pooling patients outweigh the disadvantages of increased heterogeneity and pursue our analysis in the context of neonatal care. Our empirical studies relies on 4020 patient episodes collected in 18 German neonatal intensive care units and we distinguish between two patient clusters that differ with respect to the inherent medical risk and operational heterogeneity. Cluster 1 consists of very-low birth weight (VLBW) infants with increased risk of complications but similar service trajectories and lower operational heterogeneity. Cluster 2 contains non-VLBW infants with lower risk of complications but more diversity in disease patterns and higher operational heterogeneity. Our analysis shows that cluster volume, that is, the unit's absolute patient volume in a cluster, is positively related to process outcomes as indicated by decreasing length of stay. This relationship is found for both clusters. Regarding focus, we do not find any evidence of positive effects. In fact, we even find that cluster focus, that is, the unit's relative volume of the cluster, is detrimentally related to process outcomes for non-VLBW patients with lower risk of complications and more operational heterogeneity. This indicates that organizational units providing services for complex patients should not have a narrow focus, but should rather provide services for related patient clusters in order to achieve higher volume levels within the unit.