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• Working Paper | HBS Working Paper Series | 2020

  Can Shared Service Delivery Increase Customer Engagement? A Study of Shared Medical Appointments

  Ryan W. Buell, Kamalini Ramdas and Nazlı Sönmez

  Customers and providers alike often consider one-on-one service delivery to be ideal, assuming—perhaps unquestioningly—that devoting individualized attention maximizes customer engagement and improves outcomes. Alternatively, shared service delivery, in which customers are served in batch, may, through the dynamics of group interaction, lead to increased customer engagement. On the other hand, the loss of privacy and personal connection in shared delivery models may undermine engagement and performance. To explore this tradeoff, we conducted a randomized controlled trial with 1,000 patients who were undergoing glaucoma treatment over a three-year period at a large eye hospital. Using verbatim and behavioral transcripts from over 20,000 minutes of video recorded during our trial, we examine how shared medical appointments (SMAs)—in which groups of patients with similar conditions meet with a doctor simultaneously, and each receives one-on-one care in turn—impact patients' engagement during their appointments. Patients who experienced SMAs asked 37.2% more questions per minute, made 8.2% more comments per minute, answered 3.6% more questions per minute, and exhibited higher levels of non-verbal engagement across a wide-array of measures (attentiveness, positivity, head wobbling or ‘talai taḷḷāṭṭam’ in Tamil—a South Indian gesture to signal agreement or understanding, eye contact and end-of-appointment happiness), relative to patients who attended one-on-one appointments. We further find that patients in SMAs went on to report higher levels of satisfaction and exhibit greater levels of learning and medication compliance. These results shed light on the potential for shared service delivery models to increase customer engagement and enhance service performance.

  Keywords: Customer Engagement; shared service delivery; shared medical appointments; healthcare Operations; Service Delivery; Health Care and Treatment; Service Operations; Customers; Behavior;

  Citation:

  Buell, Ryan W., Kamalini Ramdas, and Nazlı Sönmez. "Can Shared Service Delivery Increase Customer Engagement? A Study of Shared Medical Appointments." Harvard Business School Working Paper, No. 21-001, July 2020.  View Details

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• Article | Annals of Emergency Medicine

  The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding

  Brian Franklin, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris and Eric Goralnick

  Delayed access to inpatient beds for admitted patients contributes significantly to emergency department (ED) boarding and crowding, which have been associated with deleterious patient safety effects. To expedite inpatient bed availability, some hospitals have implemented discharge lounges, allowing discharged patients to depart their inpatient rooms while awaiting completion of the discharge process or transportation. This conceptual article synthesizes the evidence related to discharge lounge implementation practices and outcomes. Using a conceptual synthesis approach, we reviewed the medical and gray literature related to discharge lounges by querying PubMed, Google Scholar, and Google and undertaking backward reference searching. We screened for articles either providing detailed accounts of discharge lounge implementations or offering conceptual analysis on the subject. Most of the evidence we identified was in the gray literature, with only three peer-reviewed articles focusing on discharge lounge implementations. Articles generally encompassed single-site descriptive case studies or expert opinions. Significant heterogeneity exists in discharge lounge objectives, features, and apparent influence on patient flow. Although common barriers to discharge lounge performance have been documented, including underuse and care team objections, limited generalizable solutions are offered. Overall, discharge lounges are widely endorsed as a mechanism to accelerate access to inpatient beds, yet the limited available evidence indicates wide variation in design and performance. Further rigorous investigation is required to identify the circumstances under which discharge lounges should be deployed as well as how discharge lounges should be designed to maximize their effect on hospitalwide patient flow, ED boarding and crowding, and other targeted outcomes.

  Keywords: health care delivery; emergency room; operations improvement; operations management; Health Care and Treatment; Service Delivery; Operations; Management; Performance Improvement; Service Operations;

  Citation:

  Franklin, Brian, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris, and Eric Goralnick. "The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding." Annals of Emergency Medicine 75, no. 6 (June 2020): 704–714.  View Details

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• Article | JAMA, the Journal of the American Medical Association

  The Business of Medicine in the Era of COVID-19

  David M. Cutler, Sayeh Nikpay and Robert S. Huckman

  This Viewpoint discusses the shifting landscape of health care financing, regulation, and delivery as a result of the coronavirus pandemic, and discusses regulatory and other changes that need to be in place if telehealth and physician practice and hospital mergers become the “new normal” once the pandemic is controlled.

  Keywords: health care; COVID-19; telemedicine; business; Health Pandemics; Health Care and Treatment; Change; Competition;

  Citation:

  Cutler, David M., Sayeh Nikpay, and Robert S. Huckman. "The Business of Medicine in the Era of COVID-19." JAMA, the Journal of the American Medical Association 323, no. 20 (May 26, 2020): 2003–2004.  View Details

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