On the tension between standardized and customized policies in health care: The case of length‐of‐stay reduction

Abstract

Hospitals increasingly adopt standardized policies as a way to improve the efficiency of health care delivery. One key policy has been to reduce a patient's length of stay, which is commonly perceived as an effective means of improving patient outcome, as well as reducing the cost per procedure. We put this notion to the empirical test by using a database of 183,712,784 medical records of patients in the English NHS between 1998 and 2012, studying the effects of the NHS's policy of decreasing length of stay for hernia patients. While we found it to be an effective way of reducing the cost per procedure, on aggregate, we also found that it increases the risk of readmission and of death for vulnerable and elderly patients, unduly increasing the long‐term failure costs of the operation for these patient groups. Based on our findings, we propose a differentiated policy to selectively decrease length of stay, which we estimate could save up to US$565 per nonemergency hernia procedure (19.97% reduction in the cost per procedure). We outline the implications of our findings for medical practice and discuss the wider theoretical contributions to the wider standardization‐customization debate in health care operations management.

Sustainable process improvements: Evidence from intervention‐based research

“…Since Hayes, Wheelwright, and Clark (1988) identified the power of using the knowledge of employees to improve operations, and Leonard- Barton (1992) introduced the idea of shop floors as learning laboratories, several researchers have applied organizational learning theory to study PI in manufacturing and product development (Choo, Linderman, & Schroeder, 2007;Jayaram et al, 2010;MacDuffie, 1997;Mukherjee et al, 1998). In healthcare operations, involving frontline employees who deliver the services in the redesign of processes is especially helpful to increase their confidence in those processes (Nembhard & Tucker, 2011;Tucker et al, 2007) and to facilitate their use of standardization and adaptation in customer-facing processes (Berry Jaeker & Tucker, 2020;Catena et al, 2020).…”

“…Overall, our intervention shows how the dual needs for standardization and adaptation encountered in high interaction service environments (Berry Jaeker & Tucker, 2020;Catena, Dopson, & Holweg, 2020) can be successfully delivered by building appropriate control and flexibility in service delivery processes. This involves giving employees guidance on protocols that should be strictly adhered to and adjustments that can be made based on customer requirements and needs (Nissinboim & Naveh, 2018;Sousa & da Silveira, 2019).…”

Editorial: Delivering effective healthcare at lower cost: Introduction to the special issue

“…Two papers (Catena, Dopson, & Holweg, 2020;Lee, Venkataraman, Heim, Roth, & Chilingerian, 2020) examine how operational policies set by a national health system affect the delivery of healthcare. The papers are presented in two broad groupsoperational and strategic-based on their level of investigation.…”

“…The paper "On the tension between standardized and customized policies in health care: The case of length-of-stay reduction" by Catena et al (2020) examines how the English National Health System policy to decrease the length of stay (LOS) of hernia patients affects patient outcomes by using almost two million patient medical records covering a fifteen-year timespan. As expected, all of these papers find that the policies used affect performance and outcomes.…”

“…National policies have a large and significant impact on both healthcare delivery and ultimate performance outcomes. The paper "On the tension between standardized and customized policies in health care: The case of length-of-stay reduction" by Catena et al (2020) examines how the English National Health System policy to decrease the length of stay (LOS) of hernia patients affects patient outcomes by using almost two million patient medical records covering a fifteen-year timespan. The results of the investigation indicate that the policy is effective at reaching its intended goal of lower LOS as well as reducing the relative cost per procedure.…”