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

Abstract

When examining the impact of air pollution on the healthcare system, previous studies mostly focus on the increased patient demand for healthcare services 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. To address this research question, we draw on the strength model of self-control in psychological literature and develop three hypotheses. Using a unique data set that records all extubation events from a cardiothoracic intensive care unit in Singapore over 80 months, we test our hypotheses in doctors’ extubation work. Results suggest that exposure to air pollution lowers doctors’ extubation performance (as measured by increased extubation failure probability). Additionally, in the mediation analysis, we find that doctors are less likely to follow the extubation protocol on polluted days, thus partially leading to poor performance in extubation work. We also identify a non-linear moderating effect of workload on the relationship between air pollution and extubation performance. More specifically, as workload increases, the negative effect of air pollution on extubation performance becomes weaker first, and then stronger. These findings highlight that ambient air pollution is an unexplored environmental risk to doctors’ work performance and provide insights into how healthcare managers can adjust management activities 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