Research Roundtable in Health Sector Improvement

Host

The Sandra Rotman Centre for Health Sector Strategy is a research, education and policy centre aimed at generating insights for governments, organizations and other key stakeholders facing complex healthcare challenges. 

Event synopsis

Any potential improvement to a healthcare system is complex, as services rely on an ecosystem of workflows, products, and people. Join us for a series of presentations by faculty at the Rotman School of Management, who discuss their research and key findings focused on health sector improvement – topics range from triage errors, double-booking, workflows, to the introduction of artificial intelligence. 

Agenda

About

On Dedicated versus Pooled Service in the Presence of Triage Errors

Opher Baron, Distinguished Professor of Operations Management, Professor of Operations Management; and Yonit Barron, Lecturer, Industrial Engineering and Management, Ariel University

Synopsis: Many service systems, such as emergency departments (EDs), differentiate among customer's types to meet specific service level (SL) targets. To meet these targets, some EDs serve customers using dedicated resources (e.g., in different zones) while others use pooled ones. We study this choice using stylized queueing models with two customer's types where the decision maker minimizes capacity while meeting SL targets. We compare the performances of two dedicated single-server systems with these of a pooled server that prioritizing the high priority customers or serving all customers in a first- come-first-serve (FCFS) fashion. We consider the servers', customers', and system's perspectives. We explain how the optimal system design depends on the system's parameters, including SL targets and workloads. Moreover, when a service system cannot observe customer's types, it triages customers to service classes. However, in many settings, this triage process is prone to errors. We highlight that triage errors change the pattern of workload arriving to servers and the pattern of service to customers. We show that such errors significantly impact the optimal dedicated systems, slightly impact the optimal priority system, and have no impact on the FCFS system. Finally, while, as expected, triage errors typically harm performance, we demonstrate that errors may improve performance (in comparison to the no error case) from all three perspectives simultaneously: servers may face a lower utilization (even though one capacity increases), customers are served faster (one type is strictly faster), and costs are lower.

Keywords: Service Level, Triage errors, Queueing, Healthcare, Service Operations

When does scientific research get used in new products?

Kevin Bryan, Associate Professor, Strategic Management Area

Synopsis: Ideas are, famously, in the air. This means that identifying how many ideas, and which ideas, are used in innovative products like new medicines is quite difficult - intellectual influence does not generally leave a paper trail. We pursue modern techniques in machine learning alongside a large-scale survey of inventors, largely drawn from the biomedical industry, to understand what types of ideas inventors are most likely to draw on. This work is joint with Yasin Ozcan and Bhaven Sampat.

Product liability litigation and medical device innovation

Alberto Galasso, Rotman Chair in Life Sciences Commercialization, Professor of Strategic Management

Synopsis: We examine the relationship between product liability litigation and the development of new medical technologies constructing a new dataset that links more than 200,000 product liability cases to medical technologies and the firms commercializing them. We show that product liability litigation exhibits a high degree of concentration within a limited set of technology areas. Litigation is associated with a sharp decline in the commercialization of new medical devices in the product category by the targeted firm. Results are robust to exploiting variation in litigation risk generated by: (i) differences in the rate of public reporting of device malfunctioning by the FDA and, (ii) the Supreme Court's decision in Riegel v. Medtronic which immunized certain medical device technologies from specific types of liability claims.  We show that litigation induces firms to re-direct their innovation toward safer technologies. Finally, we examine the spill-over effects that litigation has on firms operating in the technology area but not involved in the cases.

Artificial intelligence in healthcare: Challenges and opportunities

Avi Goldfarb, Rotman Chair in Artificial Intelligence and Healthcare and a professor of marketing

Synopsis: Artificial intelligence presents an extraordinary opportunity and an extraordinary threat. But not in the way that might be expected. Today’s AI is best understood as prediction technology rather than a machine that can do everything humans do. Prediction technology can nevertheless transform the healthcare industry. It does this by decoupling prediction from the other aspects of decision making, thereby creating new ways of delivering value. Unleashing this potential requires the invention of new ways of operating, many of which remain undiscovered. Today, we sit in a striking phase in the development of this technology, The Between Times after witnessing AI’s potential, but before its widespread impact. On the other side of The Between Times, when this process of invention is complete, the changes in decisions will mean changes in power. For healthcare, this might mean a democratization of access and care. It might also mean disruption to those who benefit from the way the system works today.

Arseniy Gorbushin, 5th-year PhD Candidate, Operations Management with Olga Bountali, Assistant Professor, OM & Statistics Area (CCIT & UTM)

Synopsis: During the COVID-19 vaccination process, a significant mass of patients booked double (or multiple) appointments for their vaccines with the hope of receiving treatment faster. This led to many unfulfilled appointments (a.k.a. no-shows) worldwide, left capacity under-utilized, and hindered the efficiency of the vaccination process during a very crucial period. We introduce a queuing model with strategic patients to capture the single- vs. double-booking decisions and examine their impact of system performance and patient outcomes. We use a benchmark representative of transparency, where a central mechanism allows patients to only single book, and quantify the corresponding loss/gain induced by double-booking. We further explore potential interventions for central planners and policy makers to mitigate the negative effects of double-booking.

Remaking the Multiple Meanings of Pediatric Hospital Wards in Sierra Leone

Ryann Manning, Assistant Professor of Organizational Behaviour

Synopsis: Hospitals are not just physical sites for the delivery of healthcare, but places with specific meanings, geographic locations, and materiality that powerfully shape and are shaped by the people who occupy them. In Sierra Leone, poor perceptions of hospitals as places where people go to die contribute to delayed care seeking and premature withdrawal from care, which in turn contribute to some of the world’s highest infant and child mortality rates. In this qualitative study, based on in-depth observations and interviews with nurses at two publicly funded referral and teaching hospitals in Sierra Leone, I examine the multiple, often contradictory meanings that characterize these hospitals. I show how nurses remake the hospitals through their daily practices, by resisting, repurposing, and reshaping the meanings they hold for nurses, patients, and the broader public. Such practices have implications not only for how the hospitals are seen and experienced, but for the lives of sick children who pass through their wards.

Patient Abandonment Behavior in the Emergency Department

Yaniv Ravid, PhD Student in Operations Management and Statistics with Philipp Afèche, Professor of Operations Management and Statistics

Synopsis: Patient abandonment from hospital emergency departments (ED), also known as leaving without being seen by a physician (LWBS) pose a significant challenge. To provide evidence-based guidelines on how to effectively reduce this LWBS behavior requires “good” models of its underlying drivers. Theoretical and empirical models of abandonment in the literature fail to capture two key features of LWBS in ED waiting rooms: (1) patients can observe and/or infer queue-related information during their wait, and (2) their propensity to abandon may depend on this dynamically changing information. Using patient-level data from a major hospital ED, we develop statistical models that aim to shed light on the relationships between various aspects of queue-related information and patients’ abandonment behavior.

Negative externality on service level across priority classes: Evidence from a radiology workflow platform

Gonzalo Romero, Associate Professor, Operations Management and Statistics

Synopsis: The advent of new radiology workflow platforms that aggregate images from multiple hospitals, where independent radiologists choose which emergency and non-emergency images to read, creates novel operational challenges that we address in this paper. We find that independent radiologists process non-emergency images with high bang-for-the-buck first. This preference exerts a negative externality on images with high operational priority, resulting in longer turnaround times and a higher frequency of delay. The delayed processing leads to bed-blocking and patient dissatisfaction cost on hospitals. Radiology workflow platforms should use their information systems to hide non-emergency high bang-for-the-buck images until higher priority images are processed.

Increasing Engagement in a Self-Guided Digital Health Treatment for Mood Disorders

Renante Rondina, Behavioural Scientist in the Office of Chief Human Resources Officer, Treasury Board of Canada Secretariat

Synopsis: Accessible and effective approaches to mental health treatment are important because of common barriers such as cost, stigma, and provider shortage. Self-guided treatment for depression and anxiety has established evidence of efficacy, and use has intensified because of the COVID-19 pandemic. Although self-guided treatment is effective for many patients, engagement remains important as dose-response relationships have been observed. We hypothesized that the use of behavioural economic principles would increase engagement in a self-guided digital health treatment for mood disorders. Results from a three-armed randomized controlled trial showed that users engaged with behavioural nudges and prompts, and that the addition of Tips and a To-Do Checklists increased completion of course components. To our knowledge, this is the first randomized controlled trial designed to test the implementation of behavioural economic interventions in an online self-guided course for mood disorders.

Speakers

	Opher Baron, Distinguished Professor of Operations Management Opher has a PhD in Operations Management from the Sloan School of Management at the Massachusetts Institute of Technology, and an MBA and BSc in Industrial Engineering and Management from The Technion. On the teaching front, Opher is especially proud of the modeling and analytics courses he introduced and teaches at Rotman. On the application front he is proud of launching the Covidppehelp.ca platform with his colleagues. This platform has facilitated the flow of millions of PPE items to end-user customers during the global Covid19 pandemic. His research interests include queueing, business analytics, service operations (such as healthcare), autonomous vehicles, and revenue management. Opher's work is published in leading journals such as Operations Research, and Manufacturing & Service Operations Management, and he has won several research and teaching awards and grants, including the 1000 Talents Plan Scholar from the Shanghai Municipal Government, 2017 and the Rotman 2023 Distinguished Scholarly Contribution Award. Opher is active in the operations research and operations management community.
	Kevin Bryan, Associate Professor, Strategic Management Area Kevin’s work primarily consists of applied theoretical and empirical analyses of innovation and entrepreneurship. Since arriving at Rotman in 2014, he has also served as Lab Economist and moderator for the Creative Destruction Lab, the world's largest science-based entrepreneurship program, taught as a visiting professor at Duke Fuqua in Durham, North Carolina and at Université Cheikh Anta Diop in Dakar, Senegal, and served as Associate Editor for Management Science.
	Alberto Galasso, Rotman Chair in Life Sciences Commercialization, Professor of Strategic Management Alberto Galasso is a Professor of Strategic Management at the University of Toronto, where he holds the Rotman Chair in Life Sciences Commercialization. He is Research Associate at the National Bureau of Economic Research (NBER) and Research Fellow at the Centre for Economic Policy Research (CEPR). He serves as co-editor for the Journal of Economics and Management Strategy, as associate editor for the Journal of Industrial Economics and the International Journal of Industrial Organization, and as member of the editorial board for the Strategic Management Journal. His research agenda focuses on the determinants of innovative activity, the management of innovation and the functioning of markets for technology.
	Avi Goldfarb, Rotman Chair in Artificial Intelligence and Healthcare and a professor of marketing Avi is also Chief Data Scientist at the Creative Destruction Lab, a faculty affiliate at the Vector Institute and the Schwartz-Reisman Institute for Technology and Society, and a Research Associate at the National Bureau of Economic Research. Avi’s research focuses on the opportunities and challenges of the digital economy. Along with Ajay Agrawal and Joshua Gans, Avi is the author of the Globe & Mail bestselling book Prediction Machines: The Simple Economics of Artificial Intelligence. He has published academic articles in marketing, statistics, law, management, medicine, political science, refugee studies, physics, computing, and economics. Avi is a former Senior Editor at Marketing Science. His work on online advertising won the INFORMS Society of Marketing Science Long Term Impact Award, and he testified before the U.S. Senate Judiciary Committee on related work in competition and privacy in digital advertising. His work has been referenced in White House reports, European Commission documents, the New York Times, the Economist, and elsewhere.
	Arseniy Gorbushin, 5th-year PhD Candidate, Operations Management, Rotman School of Management Arseniy's research interests include the sharing economy and smart city operations. Prior to joining Rotman, Arseniy worked in strategy consulting. Arseniy holds a master's degree from the New Economic School and a bachelor's degree from the Lomonosov Moscow State University, Faculty of Mechanics and Mathematics.
	Ryann Manning, Assistant Professor of Organizational Behaviour Ryann received a PhD in Organizational Behavior and Sociology from Harvard University. Her research uses in-depth fieldwork to examine culture, emotion, and morality in organizational life, and to understand how organizations with a social mission, and people organizing to meet societal needs, grapple with challenges posed by acute and ongoing crises. Her recent research projects have examined online and offline organizing by volunteers responding to the 2014-2015 Ebola crisis in West Africa, the COVID-19 pandemic in the United States, and the crisis in Afghanistan starting in 2021. As an experienced manager, global health practitioner, and social entrepreneur, she is particularly interested in healthcare organizations, public sector organizations, and organizations in the developing world.
	Yaniv Ravid, PhD student in Operations Management and Statistics Yaniv’s research focuses on using behavioral models and data-driven techniques to solve operational problems. Prior to his PhD studies, Yaniv worked with tech and healthcare startups on developing data security and analysis tools. He holds a bachelor's degree in Engineering Physics (2017) and a master's degree in Operations Research and Information Engineering (2020) from Cornell University.
	Gonzalo Romero, Associate Professor, Operations Management and Statistics Gonzalo’s main research interests include operations management in developing countries, sustainable operations, operations and analytics in healthcare, supply chain management, and revenue management. Gonzalo's work has been accepted/published in premier journals such as Management Science, Manufacturing & Service Operations Management, Operations Research, Production and Operations Management and the Journal of Operations Management. His recent work focuses on using mathematical modeling and analytics to address sustainability and efficiency issues in supply chains in emerging markets.
	Renante Rondina, Behavioural Scientist in the Office of Chief Human Resources Officer, Treasury Board of Canada Secretariat Renante has led projects on hybrid work experimentation and digital skills strategy transformation. Previously, he was a postdoctoral fellow at BEAR and Western University, where he studied the ethics of choice architecture, the application of behavioural insights in mental health initiatives, and the cost-effectiveness of financial health incentives in a smart phone application. He completed his PhD in cognitive neuroscience at UofT and the Rotman Research Institute where he used eye-tracking and MEG to study how memory changes with healthy aging.