Jillian Berry Jaeker is a doctoral candidate in the Technology and Operations Management unit with a focus on healthcare operations. Her work centers on resource utilization in hospitals and its effects on operational efficiency and quality of care. Specifically, she explores how state-specific factors, such as workload and resource availability affect productivity and patient outcomes in hospitals.
Prior to entering HBS, Jillian graduated from the Massachusetts Institute of Technology in 2008 with a Bachelor of Science in Management (concentration Finance). During that period she interned in a tissue engineering laboratory at Brigham and Women’s Hospital where she worked with adult stem cells to produce new bone tissue in vitro. She interned at the MIT Investment Management Company and was an editor for the MIT Tech.
Increased Speed Equals Increased Wait: The Impact of a Reduction in Emergency Department Ultrasound Order Processing Time
We exploit an exogenous process change at two emergency departments (EDs) within a health system to test the theory that increasing capacity in a discretionary work setting increases wait times due to additional services being provided to customers as a consequence of reduced marginal costs for a task. We find that an increase in physicians' capacity for ordering ultrasounds (U/S) resulted in an 11.5 percentage point increase in the probability of an U/S being ordered, confirming that resource availability induces demand. Furthermore, we find that the additional U/S demand increased the time to return other radiological tests due to the higher demand placed on radiologists from the additional U/S. Consequently, the average length of stay (LOS) for patients with an abdominal complaint increased by nearly 30 minutes, and the waiting time to enter the ED increased by 26 minutes. We do not find any indications of improved performance on clinical metrics, with no statistical change in the number of admissions to the hospital or readmissions to the ED within 72 hours. Our study highlights an important lesson for process improvement in interdependent service settings: increasing process capacity at one step in the process can increase demand at that step, as well as for a subsequent shared service, and both can result in an overall negative impact on performance.
Demand and Consumers;
Health Care and Treatment;
An Empirical Study of the Spillover Effects of Workload on Patient Length of Stay
We use two years of inpatient data from 243 California hospitals to quantify the relationship between hospital-level workload and patient length of stay (LOS), and its "spillover" effects across patient types. Patients are categorized as medical or surgical, and the effects of same type patient workload (occupancy) on LOS are analyzed. The analysis is repeated with workload replaced by other type patient occupancy, providing a "spillover" effect. We find that the effects of inpatient workload on LOS spillover across patient types, which we theorize results from most inpatients, regardless of type, utilizing the same shared resources (e.g. pharmacy and laboratory). These spillover effects remain even while we find that the effects of workload vary at different time points during a patient's stay: LOS increases as inpatient workload on the day of admission increases, while inpatient workload at the end of the stay has a U-shaped effect on LOS.
Health Care and Treatment;
Jillian has an interest in understanding the effect of high worker autonomy and uncertainty on operational metrics. Her research attempts to empirically explore the relationship between efficiency, resource utilization, and quality in hospital settings. Specifically, her primary focus is on how state-specific factors (e.g., patient workload and resource availability) affect resource use and patient outcomes at inpatient-unit and hospital-wide levels.
Jillian has developed a model of the spillover effects of patient workload on LOS in hospitals. Using patient-level data state of California, she is examining how different measures of workload affect LOS at more than 200 hospitals. Her findings show that workload effect spillover across inpatient units. These results indicate that, contrary to current behvior, optimal resource allocation and management decisions should not only be based on the information of a single inpatient unit. Related to this work, Jillian is exploring the interhospital differences in workload effect.
In addition, Jillian is working on a project with a two-site major academic medical institution examining the effect of a recent resource policy change. Specifically, at one site, ultrasound availability improved in the Emergency Department (ED) during the study period. She is attempting to quantify the increase ultrasound use that resulted from this policy change, as well as its impact on other resources (e.g., CT scans, length of stay) and patient outcomes (e.g. probability of readmission to the ED).
Teaching Fellow, Technology and Operations Management Core MBA course
Rating: 4.6/5 n=24 (Fall, 2012)
Teaching Fellow, Frances Frei's Technology and Operations Management Core MBA course
Teaching Fellow, Pre-MBA Program
First Year TOM Review Session Teaching Fellow
Led weekly review sessions for first year MBAs. Focus on process fundamentals in operations