Research

Working Papers

• Catalyst or Outsider? Impact of Travel Nurses on Surgical Operations with Eric Johnson and Vikram Tiwari.

  We explore how the rise of flexible labor marketplaces, such as travel nurse staffing, may influence the efficiency of healthcare operations, particularly in the context of operating rooms. Using rich surgery and HR administrative data from a large academic medical center covering nearly 300,000 surgeries between 2018 and 2024, we examine how temporary scrub nurse participation impacts surgical case duration. While travel nurses provide essential flexibility during staffing shortages, their integration into surgical teams may present challenges: coordination gaps, reduced team familiarity, or mismatches in workflow routines could all affect operating room performance. Our analysis using an instrumental variable method suggests that surgical cases involving travel nurses take significantly more time on average, with variation across surgical specialties and settings. This pattern may reflect the inherent difficulty of incorporating temporary staff into tightly coupled, high-skill environments where coordination and timing are critical. As temporary and platform-based work models continue to expand across service industries and healthcare in particular, our study contributes to a deeper understanding of how these evolving labor arrangements can influence operational efficiency in complex, high-stakes settings.

• How Recreational Cannabis Legalization Affects Hospital Operations with Maria R. Ibanez.
  • Invited for Major Revision at Management Science

  Problem definition: Cannabis is the most common federally illegal drug in the United States. The federal stance contrasts with the growing trend of recreational cannabis legalization (RCL) across states. A vital implementation question is how legalization affects hospitals. We propose that as cannabis spreads throughout society, its effects permeate healthcare systems, reaching inpatient wards. Cannabis peculiar symptoms—including aggravated chronic conditions, psychosis, agitation, and intractable vomiting—will increase workload complexity, restrict staff time and hospital capital resources available to other patients, and cause disturbance. Methodology/results: Using a difference-in-differences approach, we find that hospitals speed up care, with legalization shortening inpatient lengths of stay by 2.6%. Second, patient satisfaction with hospital noise levels at night, staff helpfulness, and information received about home recovery decrease by 5-10%, with potential reputational and financial damages for hospitals. Third, disciplinary actions against doctors, physician assistants, and nurses increase by 34%. Managerial implications: These findings underscore the need for policymakers to consider the broader implications of RCL, including its impact on hospital operations, amidst shifting societal norms. Strategies to mitigate the adverse effects of RCL should be explored, focusing on maintaining quality care. By understanding and addressing the challenges posed by RCL, healthcare providers can adapt their practices to ensure optimal patient care in an evolving regulatory landscape.

• Racial Disparity in Maternal Care and Moderating Factors: Role of Specialization, Exposure, and Ownership in Eliminating the Gap with Maria R. Ibanez. Manuscript available upon request.

  Problem definition: Annually, approximately 60,000 U.S. women experience severe maternal morbidity (SMM)—unexpected labor or delivery outcomes with serious short- or long-term health impacts. Many of these outcomes are preventable with appropriate care choices and applications. However, demographic and socioeconomic disparities in obstetric care and outcomes persist, and Black mothers consistently experience higher odds of labor complications. In this paper, we examine how hospital- and physician-level operational factors influence the racial disparity for Black mothers relative to other mothers in the likelihood of (1) riskier delivery procedures (e.g., first-time unscheduled Cesarean Section) and (2) resulting 90-day readmission rates following these procedures. Methodology/Results: Using cross-sectional data of all labor and delivery admissions across six U.S. states, we confirm that Black mothers receive C-sections disproportionately more frequently than other mothers with comparable health conditions and face higher readmission rates after a first-time unscheduled C-section. Encouragingly, we uncover operational factors mitigating these disparities: stronger hospital- and physician-level C-section specialization reduces the gap, as does greater exposure to treating patients from underserved groups. Managerial implications: These findings highlight the importance of more efficient patient-provider matching, more detailed quality information disclosure, and more rigorous provider evaluations by regulators. Such measures are crucial to promoting unbiased decision-making and advancing equitable health outcomes.

Work in Progress

• Algorithmic Identification of Patient Complaint Matter for Improving Provider Compliance and Patient Outcomes with Eric Johnson and William Cooper.
• Impact of Interhospital Transfers on Inpatient Care Quality with Carri Chan, Jangwon Park, Vahid Sarhangian.
• Note-Worthy Encounters: Physician Adoption of AI Tools and Patient Visit Documentation Quality with Eric Johnson.