Recovering from Critical Incidents: Evidence from Paramedic Performance

Abstract

In service operations settings where the difficulty of jobs is unpredictable, workers can encounter critical incidents (CIs)-jobs which are sufficiently disturbing to challenge workers' coping mechanisms. We examine the impact of encountering CIs on subsequent operational performance of workers.Academic / Practical Relevance: Prior work has examined the effects of CIs on the long-term psychological health of workers. We demonstrate that encountering CIs has a practically meaningful impact on operational performance. We also examine the time-dependency and process-dependency of the effect, and analyze whether it is mitigated by individual characteristics such as age or experience.Methodology: We use data on 902,002 ambulance activations conducted by paramedics at the London Ambulance Service (LAS). We define CIs as incidents where patients have a high probability of dying at the scene, and examine the impact of such events on the paramedics' performance for the remainder of their shifts. Our outcomes are the completion time of the ambulance activation and each of its five sub-processes.The exogenous assignment of CIs to paramedic crews allows a clean identification of our effect using a shift-level difference-in-differences specification.Results: Crews who have encountered one prior CI (two prior CIs) spend on average 2.6% (7.5%) more time completing each remaining ambulance activation in the shift. The impact is strongest for the jobs immediately following a CI but persists throughout the shift. The largest effects come from the sub-processes which are least standardized and where paramedics cannot rely on standard operating procedures. The duration effect is larger for teams of older paramedics, but is simultaneously mitigated by experience.Managerial Implications: Our results show that CIs increase subsequent job duration and that more than one CIs have a compounding, negative effect on operational performance. As a result, managers in settings where performance consistency is key would be advised not to assign new jobs to teams with recent CI experiences.

Business analytics in service operations—Lessons from healthcare operations

“…Another interesting finding was reported by Bavafa (2020). They found that ambulance teams who treated disturbing cases, for example, with death, slowed down their work during the rest of the shift as a method of coping.…”

Consecutive surgeries with complications: the impact of scheduling decisions

“…Our research suggests that the occurrence of a complication may lead to a higher probability of substandard outcomes in subsequent procedures, either through the experience of harmful emotions or a lack of situational awareness. Further, recent work indicates that practitioners make different operational decisions after experiencing critical events, and this has performance implications (Bavafa and J onasson, 2021;Jin et al, 2022). Thus, it may not be appropriate to assume that a requisite level of quality can be achieved independently from decisions on how to perform tasks efficiently.…”

“…One possible explanation for this occurrence is that the event introduces availability bias in healthcare providers causing them to be more cautious or act pre-emptively for other patients in the ward. Bavafa and J onasson, 2021 demonstrate that critical incidents experienced by paramedics in the field (emergency calls where a patient has a high probability of dying) can negatively affect their future performance in the short-term.…”

Service Quality Implications of Long Periods of Consecutive Working Days: An Empirical Study of Neonatal Intensive Care Nursing Teams

“…As a consequence, staffing targets have rightly become an important quality control tool in hospitals (NICE 2018). Recent research in operations management also analysed other relevant short-term factors like emotions (Altman et al 2021) and the occurrence of critical incidents (Bavafa and Jónasson 2021a). However, longer-term factors that relate to the ability of staff to cope with high workload have received comparatively less attention.…”