Collaboration, Interruptions, and Changeover Times: Workflow Model and Empirical Study of Hospitalist Charting

• 成果类型: Article
• 署名作者: Gurvich, Itai; O'Leary, Kevin J.; Wang, Lu; Van Mieghem, Jan A.
• 署名单位: Cornell University; Northwestern University; Feinberg School of Medicine; Northwestern University
• 刊物名称: M&SOM-MANUFACTURING & SERVICE OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1523-4614
• DOI: 10.1287/msom.2019.0771
• 发表日期: 2020
• 页码: 754-774
• 关键词: Collaboration; COORDINATION; multitasking; DISCRETION; changeover time; empirical; interruptions

摘要

Problem definition: Collaboration is important in services but may lead to interruptions. Professionals exercise discretion on when to preempt individual tasks to switch to collaborative tasks. Academic/practical relevance: Discretionary task switching can introduce changeover times when resuming the preempted task and, thus, can increase total processing time. Methodology: We analyze and quantify how collaboration, through interruptions and discretionary changeovers, affects total processing time. We introduce an episodal workflow model that captures the interruption and discretionary changeover dynamics-each switch and the episode of work it preempts-present in settings in which collaboration and multitasking is paramount. A simulation study provides evidence that changeover times are properly identified and estimated without bias. We then deploy the model in a field study of hospital medicine physicians: hospitalists. The hospitalist workflow includes visiting patients, consulting with other caregivers to guide patient diagnosis and treatment, and documenting in the patient's medical chart. The empirical analysis uses a data set assembled from direct observation of hospitalist activity and pager-log data. Results: We estimate that a hospitalist incurs a total changeover time during documentation of five minutes per patient per day. Managerial implications: This estimate represents a significant 20% of the total processing time per patient caring for 14 patients per day, our model estimates that a hospitalist spends more than one hour each day on changeovers. This provides evidence that task switching can causally lead to longer documentation time.