Admission Control Biases in Hospital Unit Capacity Management: How Occupancy Information Hurdles and Decision Noise Impact Utilization

Management Science, Forthcoming

42 Pages Posted: 9 Aug 2018 Last revised: 27 Aug 2019

See all articles by Song-Hee Kim

Song-Hee Kim

University of Southern California - Marshall school of Business

Jordan Tong

University of Wisconsin - Madison - School of Business

Carol Peden

University of Southern California - Keck School of Medicine

Date Written: August 26, 2019

Abstract

Providing patients with timely care from the appropriate unit involves both correct clinical evaluation of patient needs and making admission decisions to effectively manage a unit with limited capacity in the face of stochastic patient arrivals and lengths of stay. We study human decision behavior in the latter operations management task. Using behavioral models and controlled experiments in which physicians and MTurk workers manage a simulated hospital unit, we identify cognitive and environmental factors that drive systematic admission decision bias.We report on two main findings. First, seemingly innocuous “occupancy information hurdles” (e.g., having to type a password to view current occupancy) can cause a chain of events that leads physicians to maintain systematically lower unit utilization. Specifically, these hurdles cause physicians to make most admission decisions without checking the current unit occupancy. Then – between the times that they do check – physicians underestimate the number of available beds when occupancy increases from admissions are more salient than occupancy decreases from discharges. Second, decision-related random error or “noise” leads to higher- or lower-than-optimal utilization of hospital units in predictable patterns, depending on the system parameters. We provide evidence that these patterns are due to some settings providing more opportunity for physicians to mistakenly admit patients, while other settings provide more opportunity to mistakenly reject patients. These findings help identify when and why clinicians are likely to make inefficient decisions due to human cognitive limitations and suggest mitigation strategies to help hospital units improve their capacity management.

Keywords: healthcare operations, behavioral operations, admission control, laboratory experiments, cognitive judgment bias, nudge, random error, information frictions

Suggested Citation

Kim, Song-Hee and Tong, Jordan and Peden, Carol, Admission Control Biases in Hospital Unit Capacity Management: How Occupancy Information Hurdles and Decision Noise Impact Utilization (August 26, 2019). Management Science, Forthcoming. Available at SSRN: https://ssrn.com/abstract=3219451 or http://dx.doi.org/10.2139/ssrn.3219451

Song-Hee Kim (Contact Author)

University of Southern California - Marshall school of Business ( email )

BRI 401, 3670 Trousdale Parkway
Los Angeles, CA 90089
United States

Jordan Tong

University of Wisconsin - Madison - School of Business ( email )

975 University Avenue
Madison, WI 53706
United States

Carol Peden

University of Southern California - Keck School of Medicine ( email )

Los Angeles, CA 90089
United States

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