Productivity Losses due to Coordination: An Empirical Study of Generalists in a Hospital

Professional work often involves generalists who act as hubs, discussing and consulting with specialists to gather information and make decisions. Coordination is critical when tasks, like consultations, require the simultaneous collaboration of multiple people. Professionals typically have their individual tasks that may be preempted to switch to collaborative tasks. Task switching can introduce setup times, often mental and unobservable, when resuming the preempted task and reduce a generalist's labor productivity.

We analyze the productivity loss from coordination in a field study of hospital medicine general physicians -- "hospitalists" -- at Northwestern Memorial Hospital in Chicago. A hospitalist's patient-care routine includes visiting patients and consulting with specialized care professionals to guide patient diagnosis and treatment. We introduce an episodal workflow model that captures the coordination dynamics -- each switch and the episode of work it preempts. A rigorous empirical analysis is presented using a data set assembled from direct observation of physician activity and pager-log data. We show that more switches between documentation and communication causally lead to longer documenting time, and that the cause of the switch matters: when the switch is triggered by the hospitalist the setup impact is smaller. We estimate that a hospitalist incurs a total setup time of 5 min per patient per day. This is substantial: Caring for 14 patients per day, a hospitalist spends more than one hour each day on mental setups, which translates to about 20% productivity loss.

In contrast to a static snapshot of collaboration, our episodal workflow model could be deployed in other professional settings where resource coordination is paramount.