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we're here today with Wharton operation information and decisions professor huh
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me song to talk to her about some of her latest research how many thanks for being with us oh thanks for having me so
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first can you give us a short summary of this research so so my work is in healthcare operations and what I'm
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focusing on is thinking about how we can design systems and processes that will enable physicians to work more
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productively this particular paper I'm focusing on queue management systems thinking about how can we better design
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this queue management system to enable physicians to be more productive so first what do I mean by queue management
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so this is thinking about the kinds of you know think about a line that you waited in this morning let's say we
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encounter these things all over the place and we're trying to think about different ways of structuring them so in
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this particular case it's a queue structure thinking about what kinds of implications that has for productivity
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outcomes that were interested in in this kind of a healthcare setting we're thinking about the length of stay of the
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patients the waiting times of the patients and as we'll get to talk about this particular paper we're thinking
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about in an emergency department setting so these are patients in the waiting room of an emergency department thinking
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about how you should design those cues as they wait to be seen by a physician so you can naturally think of two
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different ways of structuring these queues one is what we'll call a pooled Q
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so this is a case where you have essentially a single line where the patients are waiting to be seen by one
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of the many physicians who are working there they're not pre assigned to particular physicians Q the other kind
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of cue structure that we consider is a dedicated queue and this dedicated Q is essentially as soon as they arrive and
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get registered they're getting assigned to a specific physicians dedicated queue
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right so from the beginning you're waiting in the line that belongs to a particular physician so ultimately we're
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asking given these type type two types of Q structures which one of these might lead to more efficient or productive
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outcomes which is a good question for any of us who've ever been ill I at the
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ER you know it can be a very frustrating experience so when you look at these two
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types of queues what it what were your key takeaways what did you find sure so what we find is surprisingly because
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this is actually counter to what tradition queuing theory would predict we find that having the dedicated queues
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actually led to faster throughput time so in this case shorter lengths of stays and shorter waiting times for the
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patients we found this to be interesting because like i said it's counterintuitive in a way and what we're
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finding is that it's it's not just that you know with pooled cues you are able
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to buffer against the variability that you might see in these kinds of cues but in this case with the dedicated cues
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given that the physicians are people who they're people first of all and they
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have a lot of discretion in terms of how they organize their work when they have
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these dedicated cues they start feeling a greater sense of ownership and responsibility over those queues of
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patients in this case and they're trying to actively think of ways to get people
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into the beds quicker which means that they have to think about how can i get the patients who are in the beds out
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faster so they're doing things differently like pulling for the test results if they ordered tests they're
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proactively you know calling up to see what kinds you know what are the results rather than just waiting for those
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results to be pushed to them and we can validate a lot of these hypotheses that we generated from our interviews and
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observations with the physicians through the data that we collect from the electronic medical records of the
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particular emergency department that we worked with for this project so looking at some of the practical implications of
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this research I guess with I'm an emergency department how could I I mean it seems like this is indicating that I
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would want to implement this sort of Q and I guess first of all is that in fact the case and if it is I guess how would
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I go about doing that I mean are there things you would say how do hospitals take this and really apply it sure so
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that's a great question and since this paper we've actually spoken with different emergency departments that
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have started implementing this because let me just backtrack just a little bit and say a little more about our findings
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and why it was so significant we find that you know this change that I told you about the reduction in the length of
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stay in the reduction in the waiting times they're actually quite significant
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so we're finding a seventeen percent decrease in the length of stay of the patients and a nine percent decrease in
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the waiting times when you translate that into numbers minutes for an average patient
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who's coming to this particular ed that's about 40 45 minute reduction in
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that total time so that's huge and if you think about given the fact that they're about 200 patients who are
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showing up to this emergency department per day that's a large amount of time if
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you add that up for all 200 such that they're able to see about 30 more patients per day with the same amount of
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resources that's exactly why practically speaking these other emergency departments that tend to have pooled
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queuing systems most EDS or emergency departments in the US still have pooled queuing systems that's why they're so
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interested in thinking about oh how can we make this transition to a dedicated queuing system given that that might
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mean that we're able to see much more in terms of kind of a patient load per day
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without adding more resources so the kinds of things that they're doing differently so a lot of times so this
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will defer by emergency department so each place we speak with is slightly different but in this case you can think
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of you know if there's a computer assignment system in terms of how you assign patients to physicians you can
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make that assignment happen just essentially at the beginning of when they get registered rather than when
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they get into a bed typically what is done with these pooled queuing systems is that they wait until the patient has
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an available bed to get into to assign the physician so in the again in the waiting room they're really waiting in
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this cold queue and when we think even beyond emergency departments thinking about how might we apply these kinds of
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things it's very much a case-by-case basis but what I would say is the key thing to think about is you know are
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these workers in this case it was physicians but in other cases it could be all sorts of other service sector
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workers are they people who have lots of discretion over how they work if they don't I i would say pooled queues are
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still probably more efficient but if they have that capacity to really change the way they structure their workflow
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and use their discretion to make those real-time decisions you might start thinking about these dedicated cues as a
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way to try to improve productivity and efficiency in ways you wouldn't have thought of before because it sounds like
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one of the keys here is that not only are you switching the way you do the queue but you're also the
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doctors know is that they have their given ownership over this list of people and so instead of just waiting what
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comes next they see what's next and how do what they can think about what they
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can do about it that's a really interesting point you mentioned about seeing it there's actually a separate
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study not mine that's recently come out and I've seen it in the press actually
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even just yesterday in the New York Times we're having visibility into the length of your queue is really important
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so if you design this queue where the physicians in this case might not actually be able to see how many
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patients are waiting in their queue it might not actually make much of a difference because what's important is
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you know you can actually see oh wow I've got 12 patients waiting for me like
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I should really get to them they belong to me if you don't have that kind of
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information maybe it won't change your behavior now what's next for this
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research or what are you going to what are you studying next yeah sure so most directly related to this project so with
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any kind of operations management question it's really important to think about trade-offs and thinking about the
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boundary condition so with this particular paper we looked at things like quality of care and look what it
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means for utilization those kinds of things but I want to take it a step further and think about less so in an
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empirical setting like this paper was but more so in kind of a jet more generalizable modeling setting so I'm
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working with some other colleagues writing a modeling paper trying to see what are the conditions under which this
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might be the case we're dedicated queues outperformed pulled queues given different types of work a version that
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you know servers might have so we consider things like whether they're averse to having high levels of workload
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or just have it or just being busy at all and then they would prefer idle time so we're trying to understand what is
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the threshold or what are the conditions under which this would be the case so that's most directly related to this
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particular queuing paper but more broadly I'm very interested in thinking about different levers that we might be
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able to use to try to think about ways to improve efficiency and productivity in these healthcare settings not just
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the emergency department but also thinking about impatient settings or outpatient settings more broadly so I've
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been looking into things like different ways of leveraging performance feedback that you might provide to physicians
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different ways we might thinking about matching the supply and demand of hospital beds because there are all
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sorts of different patients who show up in different types of beds that are available at different times and
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especially given the enormous amount of data that are being collected these days
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electronically in hospital settings how can we better leverage that to make predictions that we can act on in real
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time so those are the kinds of things I've been really interested in great thank you so much for being here thank
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you you