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dc.contributor.authorFreeman, Men
dc.contributor.authorSavva, Nen
dc.contributor.authorScholtes, Stefanen
dc.date.accessioned2016-02-26T12:51:38Z
dc.date.available2016-02-26T12:51:38Z
dc.date.issued2017-10en
dc.identifier.citationFreeman et al. Management Science (2016)en
dc.identifier.issn0025-1909
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/254040
dc.description.abstractWe use a detailed operational and clinical dataset from a maternity hospital to investigate how workload affects decisions in gatekeeper-provider systems, where the servers act as gatekeepers to specialists but may also attempt to serve customers themselves, albeit with a probability of success that is decreasing in the complexity of the customer's needs. We study the effect of workload during a service episode on gatekeepers' service configuration decisions and the rate at which gatekeepers refer customers to a specialist. We find that gatekeeper-providers (midwives in our context) make substantial use of two levers to manage their workload (measured as patients per midwife): They ration resource-intensive discretionary services (epidural analgesia) for customers with non-complex service needs (mothers with spontaneous onset of labor) and, at the same time, increase the rate of specialist referral (physician-led delivery) for customers with complex needs (mothers with pharmacologically induced labor). The workload effect in the study unit is surprisingly large and comparable in size to those for leading clinical risk factors: When workload increases from two standard deviations below to two standard deviations above the mean, non-complex cases are 28.8% less likely to receive an epidural, leading to a cost reduction of 8.7%, while complex cases are 14.2% more likely to be referred for a physician-led delivery, leading to a cost increase of 2.6%. These observations are consistent with overtreatment at both high and low workload levels, albeit for different types of patients, and suggest that smoothing gatekeeper workload would reduce variability in customer service experience.
dc.language.isoenen
dc.publisherInforms
dc.titleGatekeepers at work: an empirical analysis of a maternity uniten
dc.typeArticle
prism.endingPage3167
prism.issueIdentifier10en
prism.publicationDate2017en
prism.publicationNameManagement Scienceen
prism.startingPage3147
prism.volume63en
dcterms.dateAccepted2016-02-16en
rioxxterms.versionofrecord10.1287/mnsc.2016.2512en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2017-10en
dc.identifier.eissn1526-5501
rioxxterms.typeJournal Article/Reviewen
cam.issuedOnline2016-09-02en


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