Air Pollution and Doctors’ Work Performance: Evidence from Extubation Failure in the Intensive Care Unit

Abstract

When it comes to the impacts of air pollution on the healthcare system, previous studies mostly focus on the increased patient demand due to air pollution-related health deterioration, taking a demand-side perspective. We extend this stream of literature from a provider-side perspective by studying how air pollution can affect doctors’ work performance, which is an ignored effect on the healthcare system. Using a unique data set that records all extubation events from a cardiothoracic intensive care unit in Singapore over 80 months, we address our research question in doctors’ extubation work. We find a negative relationship between air pollution exposure and doctors’ extubation performance. Specifically, a one-standard-deviation increase in Pollutant Standards Index is associated with a 11.71% increase in the probability of 48-hour reintubation. We also show that the negative psychological effect of air pollution on doctors could be an important mechanism. Additionally, according to the mediating effect of extubation protocol adherence and the non-linear moderating effect of workload observed in the mechanism discussion, healthcare managers could enhance doctors’ protocol adherence or adjust workload level to mitigate the impact of air pollution. Our research highlights that ambient air pollution is an unexplored environmental risk to doctors’ work performance and provides practical insights to fight against air pollution.

Note:
Funding Information: This research is supported by the National Natural Science Foundation of China (grant numbers 71921001, 71771202) and by the Ministry of Education, Singapore, under its Academic Research Fund (AcRF) Tier 2 (grant number MOE2019-T2-1-185).

Conflict of Interests: There are no conflicts of interest to declare.

Ethical Approval: This study was granted access to the IT Systems in National University Health System, complying with the NUHS Acceptable Use Policy (NUHS-CAP-CIO-002) and the MOHH Group Policy on Data Protection and Data Security. Data used in this study were obtained from the IT Systems and anonymized. This study did not involve human subjects and animal use.

Keywords: Air Pollution; Work Performance; Extubation Failure; Protocol Adherence; Workload

JEL Classification: I1, J2, Q5