Mixing It Up: Operational Impact of Hospitalist Workload

50 Pages Posted: 13 Oct 2019 Last revised: 23 Oct 2019

See all articles by Masoud Kamalahmadi

Masoud Kamalahmadi

Indiana University, Kelley School of Business, Department of Operation & Decision Technologies, Students

Kurt Bretthauer

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies

Jonathan Helm

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies

Alex Mills

Baruch College Zicklin School of Business

Edwin Coe

affiliation not provided to SSRN

Alisa Judy-Malcolm

affiliation not provided to SSRN

Areeba Kara

affiliation not provided to SSRN

Julian Pan

Lean Care Solutions Corporation Pte. Ltd

Date Written: September 19, 2019

Abstract

Hospitalists are physicians that specialize in the care of hospital inpatients, a job that until recently belonged to primary care physicians. We develop an operational model of hospitalist-patient interaction with rounding and responding service modes, optimizing hospitalist case-mix and workload to achieve the maximal reduction in patient length of stay (LOS). We show that hospitalists are effective at reducing LOS for patients with complex conditions, matching clinician intuition. However, we show that the optimal hospitalist case-mix also includes "simple" patients with few interventions and short LOS, as they can effectively reduce discharge delays. This actionable insight is particularly salient for small community hospitals with simple, short-stay patients, where hospitalists may be undervalued due to the prevailing belief that they are primarily effective for complex patients. We conduct a comparative case study of a small community hospital and a large academic hospital, drawing a stark contrast between the two in terms of ideal workload and patient coverage. Despite the fact that the academic hospital treats higher complexity patients, hospitalists at the community hospital should actually have a lower workload than hospitalists at the academic hospital due to shorter stays in the community hospital. Both hospitals are understaffed but for different reasons: the academic hospital needs to staff more hospitalists to reduce the current workload of its hospitalists, whereas the community hospital needs to staff more hospitalists to expand its hospitalist coverage to more patients. We estimate that these hospitals can save $1.5 million annually by implementing the optimal staffing policies.

Keywords: healthcare operations management; hospitalist workload; case-mix; length of stay

Suggested Citation

Kamalahmadi, Masoud and Bretthauer, Kurt and Helm, Jonathan and Mills, Alex and Coe, Edwin and Judy-Malcolm, Alisa and Kara, Areeba and Pan, Julian, Mixing It Up: Operational Impact of Hospitalist Workload (September 19, 2019). Baruch College Zicklin School of Business Research Paper No. 2019-10-02. Available at SSRN: https://ssrn.com/abstract=3456882 or http://dx.doi.org/10.2139/ssrn.3456882

Masoud Kamalahmadi (Contact Author)

Indiana University, Kelley School of Business, Department of Operation & Decision Technologies, Students ( email )

Business 670
1309 E. Tenth Street
Bloomington, IL 47401
United States

Kurt Bretthauer

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies ( email )

Business 670
1309 E. Tenth Street
Bloomington, IN 47401
United States

Jonathan Helm

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies ( email )

Business 670
1309 E. Tenth Street
Bloomington, IN 47401
United States

Alex Mills

Baruch College Zicklin School of Business ( email )

55 Lexington Ave
New York, NY 10010
United States

Edwin Coe

affiliation not provided to SSRN

Alisa Judy-Malcolm

affiliation not provided to SSRN

Areeba Kara

affiliation not provided to SSRN

Julian Pan

Lean Care Solutions Corporation Pte. Ltd ( email )

Singapore

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