Collaboration, Interruptions and Changeover Times: Model and Empirical Study of Hospitalist Processing Times
Collaboration is important in services, but may lead to interruptions. Professionals exercise discretion on when to preempt individual tasks to switch to collaborative tasks. Discretionary task switching can introduce changeover times when resuming the preempted task and thus can increase total processing time. 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 changeovers dynamics — each switch and the episode of work it preempts — present in settings where 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.” A hospitalist’s patient-care routine includes visiting patients and consulting with other caregivers to guide patient diagnosis and treatment. A rigorous empirical analysis is presented using a dataset assembled from direct observation of physician activity and pager-log data. We estimate that a hospitalist incurs a total changeover time of 5mins per patient per day, which represents a significant 20% of total processing time per patient: caring for 14 patients per day, a hospitalist spends more than one hour each day on changeovers. Task switching causally lead to longer documentation time.
Itai Gurvich, Jan A. Van Mieghem
Gurvich, Itai, and Jan A. Van Mieghem. 2017. Collaboration, Interruptions and Changeover Times: Model and Empirical Study of Hospitalist Processing Times.