The Effects of Multi-Siting on Productivity and Quality

Abstract

In the modern workplace, it is increasingly common for workers to concurrently attend to tasks across multiple physical locations. However, frequent site switching can lead to increased setup and overhead costs. Specifically, workers expend significant time and cognitive effort getting reoriented with personnel, operating processes, tools, and resources whenever they switch sites. In this paper, we look at the productivity and quality implications of multi-site work. To estimate the effect of multi-site operations on performance, we turn to a setting where multi-site worker assignment is common - that of physicians who have admitting privileges at multiple hospitals. We collected detailed data on individual physicians practicing in 83 hospitals between 1999 and 2010. Our extensive data set includes detailed operational and clinical factors associated with over 950,000 patient encounters. Our empirical analysis takes the form of a panel, where we follow a given physician over time, and link short-term multi-siting to patient level outcomes. We find that multi-siting negatively impact productivity. Specifically, for each additional site at which a physician works, we observe a 2% increase in patient length of stay. For each site served, the likelihood of a patient developing a complication increases by 3%. Greater travel distance between sites, and lack of focus at a given site explain the performance declines due to multi-siting. In addition, we find that the performance declines due to multi-site operation are reduced among low-complexity patients, and among highly-experienced physicians.

Keywords: multi-site operations, operational familiarity, productivity, hospital operations

JEL Classification: I11, M11, M54, C12