The Wharton School, U. of Pennsylvania, United States
HCM Division Best Paper Based on a Dissertation
Health care delivery often relies on the coordination of fluid teams with members spanning different roles and specialties. Work on familiarity and expertise in health care has found that both team familiarity and expertise individually improve performance, but less work has investigated how the two interact to affect performance. This paper seeks to answer how familiarity and expertise influence performance in concert with one another using patient and provider data from a large hospital system’s emergency department. We look at the effects of familiarity and performance on two aspects of ED performance: time to disposition decision and 72-hour returns. Overall, we replicate the literature's existing findings that both team familiarity and expertise have positive effects on performance individually. In addition, we find that the two interact as substitutes, with team familiarity having a stronger effect on performance when teams contain non-expert members. Finally, we find that for efficiency outcomes, the familiarity of residents is relatively more important to a team's performance than attendings' or nurses' familiarity. However, for quality measures, the opposite is true, and the relative familiarity of attendings and nurses is more important to performance than that of residents.