Research

Working Papers

• Impact of Travel Nurse Participation in Surgical Operations with Eric Johnson and Vikram Tiwari.
  • Under review at M&SOM

  Problem definition: Under financial pressures and persistent nursing shortages, US hospitals increasingly rely on flexible labor (e.g., travel nurses) to meet demand for care. While nursing has been an active focus of researchers, little is known about the operational impact of travel nurse participation on operating room (OR) performance. We examine whether, when, and where travel scrub nurses impact surgical throughput and process flow. The results can guide hospital managers in making staffing decisions, scheduling shifts, and designing orientation materials that protect efficiency while preserving the benefits of workforce flexibility. Methodology/Results: Using OR case-level data from 264,000 surgeries linked to unique workforce documentation from a large academic medical center, we analyze the impact of travel nurse participation on surgical performance. To address endogeneity from non-random scheduling, we instrument travel nurse participation using exogenous variation in the labor supply, measured by state nurse licensing approvals. Travel scrub nurse participation increases surgical case lengths by 7-8%, adding about 10 minutes to a two-hour surgery. We find that slowdowns are concentrated in instrument-intensive specialties and elective care settings that exhibit more standardization. The performance gap between staff and travel nurses narrows with institutional familiarity: the effect declines after three months of active tenure but remains sizable after six months. As extensions, we also examine travel scrub nurses’ operational effects on surgical process flow: between-surgery transitions take 3% longer, and first-scheduled cases of the day are 2-6% less likely to start on schedule. Managerial implications: Managers should consider prioritizing procedure-specific orientation for newly hired nurses, longer contracts, and staffing travel nurses into settings that exhibit less standardization. Scheduling also matters: sequencing cases to preserve scrub continuity across consecutive surgeries substantially mitigates setup inefficiencies, and scheduling travel nurses on cases later in the day can reduce schedule spillovers while maintaining OR capacity.

• How Recreational Cannabis Legalization Affects Hospital Operations with Maria R. Ibanez.
  • Under second-round review, 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.