Collaboration, interruptions, and changeover times: Workflow model and empirical study of hospitalist charting

Problem definition: Collaboration is important in services but may lead to interruptions. Professionals exercise discretion on when to preempt individual tasks to switch to collaborative tasks. Academic/practical relevance: Discretionary task switching can introduce changeover times when resuming the preempted task and, thus, can increase total processing time. Methodology: 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 changeover dynamics-each switch and the episode of work it preempts-present in settings in which 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.” The hospitalist workflow includes visiting patients, consulting with other caregivers to guide patient diagnosis and treatment, and documenting in the patient's medical chart. The empirical analysis uses a data set assembled from direct observation of hospitalist activity and pager-log data. Results: We estimate that a hospitalist incurs a total changeover time during documentation of five minutes per patient per day. Managerial implications: This estimate represents a significant 20% of the total processing time per patient: caring for 14 patients per day, our model estimates that a hospitalist spends more than one hour each day on changeovers. This provides evidence that task switching can causally lead to longer documentation time.