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Boundaries of Focus and Volume: An Empirical Study in Neonatal Intensive Care

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  • Felix Miedaner
  • Sandra Sülz

Abstract

Our study contributes to the scholarly debate whether organizational units should have a narrow focus and admit a homogeneous patient cluster or whether they should admit a pool of patient clusters. We investigate whether the benefits of increased volume through pooling patients outweigh the disadvantages of increased heterogeneity and pursue our analysis in the context of neonatal care. Our empirical studies relies on 4020 patient episodes collected in 18 German neonatal intensive care units and we distinguish between two patient clusters that differ with respect to the inherent medical risk and operational heterogeneity. Cluster 1 consists of very‐low birth weight (VLBW) infants with increased risk of complications but similar service trajectories and lower operational heterogeneity. Cluster 2 contains non‐VLBW infants with lower risk of complications but more diversity in disease patterns and higher operational heterogeneity. Our analysis shows that cluster volume, that is, the unit's absolute patient volume in a cluster, is positively related to process outcomes as indicated by decreasing length of stay. This relationship is found for both clusters. Regarding focus, we do not find any evidence of positive effects. In fact, we even find that cluster focus, that is, the unit's relative volume of the cluster, is detrimentally related to process outcomes for non‐VLBW patients with lower risk of complications and more operational heterogeneity. This indicates that organizational units providing services for complex patients should not have a narrow focus, but should rather provide services for related patient clusters in order to achieve higher volume levels within the unit.

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  • Felix Miedaner & Sandra Sülz, 2020. "Boundaries of Focus and Volume: An Empirical Study in Neonatal Intensive Care," Production and Operations Management, Production and Operations Management Society, vol. 29(2), pages 298-308, February.
    • Handle: RePEc:bla:popmgt:v:29:y:2020:i:2:p:298-308
    DOI: 10.1111/poms.13110
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    1. Wai Fong Boh & Sandra A. Slaughter & J. Alberto Espinosa, 2007. "Learning from Experience in Software Development: A Multilevel Analysis," Management Science, INFORMS, vol. 53(8), pages 1315-1331, August.
    2. Nicole DeHoratius & Ananth Raman, 2008. "Inventory Record Inaccuracy: An Empirical Analysis," Management Science, INFORMS, vol. 54(4), pages 627-641, April.
    3. Linda V. Green, 2012. "OM Forum--The Vital Role of Operations Analysis in Improving Healthcare Delivery," Manufacturing & Service Operations Management, INFORMS, vol. 14(4), pages 488-494, October.
    4. Soon Ang & Sandra Slaughter & Kok Yee Ng, 2002. "Human Capital and Institutional Determinants of Information Technology Compensation: Modeling Multilevel and Cross-Level Interactions," Management Science, INFORMS, vol. 48(11), pages 1427-1445, November.
    5. Robert S. Huckman & Bradley R. Staats & David M. Upton, 2009. "Team Familiarity, Role Experience, and Performance: Evidence from Indian Software Services," Management Science, INFORMS, vol. 55(1), pages 85-100, January.
    6. Robert S. Huckman & Darren E. Zinner, 2008. "Does focus improve operational performance? Lessons from the management of clinical trials," Strategic Management Journal, Wiley Blackwell, vol. 29(2), pages 173-193, February.
    7. Robert S. Huckman & Bradley R. Staats, 2011. "Fluid Tasks and Fluid Teams: The Impact of Diversity in Experience and Team Familiarity on Team Performance," Manufacturing & Service Operations Management, INFORMS, vol. 13(3), pages 310-328, July.
    8. Bradley R. Staats & Francesca Gino, 2012. "Specialization and Variety in Repetitive Tasks: Evidence from a Japanese Bank," Management Science, INFORMS, vol. 58(6), pages 1141-1159, June.
    9. Martin Gaynor & Harald Seider & William B. Vogt, 2005. "The Volume–Outcome Effect, Scale Economies, and Learning-by-Doing," American Economic Review, American Economic Association, vol. 95(2), pages 243-247, May.
    10. Sriram Narayanan & Sridhar Balasubramanian & Jayashankar M. Swaminathan, 2009. "A Matter of Balance: Specialization, Task Variety, and Individual Learning in a Software Maintenance Environment," Management Science, INFORMS, vol. 55(11), pages 1861-1876, November.
    11. Kamalini Ramdas & Khaled Saleh & Steven Stern & Haiyan Liu, 2018. "Variety and Experience: Learning and Forgetting in the Use of Surgical Devices," Management Science, INFORMS, vol. 64(6), pages 2590-2608, June.
    12. Melissa A. Schilling & Patricia Vidal & Robert E. Ployhart & Alexandre Marangoni, 2003. "Learning by Doing Something Else: Variation, Relatedness, and the Learning Curve," Management Science, INFORMS, vol. 49(1), pages 39-56, January.
    13. Ray Reagans & Linda Argote & Daria Brooks, 2005. "Individual Experience and Experience Working Together: Predicting Learning Rates from Knowing Who Knows What and Knowing How to Work Together," Management Science, INFORMS, vol. 51(6), pages 869-881, June.
    14. Ludwig Kuntz & Roman Mennicken & Stefan Scholtes, 2015. "Stress on the Ward: Evidence of Safety Tipping Points in Hospitals," Management Science, INFORMS, vol. 61(4), pages 754-771, April.
    15. Jonathan R. Clark & Robert S. Huckman, 2012. "Broadening Focus: Spillovers, Complementarities, and Specialization in the Hospital Industry," Management Science, INFORMS, vol. 58(4), pages 708-722, April.
    16. Diwas Singh KC & Christian Terwiesch, 2012. "An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit," Manufacturing & Service Operations Management, INFORMS, vol. 14(1), pages 50-65, January.
    17. Ludwig Kuntz & Stefan Scholtes & Sandra Sülz, 2019. "Separate and Concentrate: Accounting for Patient Complexity in General Hospitals," Management Science, INFORMS, vol. 67(6), pages 2482-2501, June.
    18. Thomas J. Best & Burhaneddin Sandıkçı & Donald D. Eisenstein & David O. Meltzer, 2015. "Managing Hospital Inpatient Bed Capacity Through Partitioning Care into Focused Wings," Manufacturing & Service Operations Management, INFORMS, vol. 17(2), pages 157-176, May.
    19. Diwas Singh KC & Christian Terwiesch, 2011. "The Effects of Focus on Performance: Evidence from California Hospitals," Management Science, INFORMS, vol. 57(11), pages 1897-1912, November.
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