Haste or Waste? Peer Pressure and Productivity in the Emergency Department

Abstract

Motivated by wide cross-sectional variations in intensity of care that are unrelated to quality of care, researchers and policymakers commonly claim that healthcare providers waste considerable resources, engaging in so-called “flat-of-the-curve” medicine. A key yet elusive prediction of this hypothesis is that providers ought to be able to cut back on care without sacrificing quality. This article examines the effects of a particular form of provider cutbacks – those generated by physicians working in high-pressure peer group environments. Using expansive, time-stamped discharge data from 137 hospital-based emergency departments, I document that physicians systematically alter their pace and intensity of care across frequently shuffled peer groups. Peer groups that induce a physician to work faster also induce her to order fewer tests and spend less money. Contrary to the flat-of-the-curve hypothesis, these cutbacks lead to large reductions in quality of care. This evidence, paired with the fact that slower physicians do not produce better average outcomes, suggests that cross-physician differences in resource utilization reflect substantial differences in physician productivity within a hospital.

Modeling of 3R (Reduce, Reuse and Recycle) for Sustainable Construction Waste Reduction: A Partial Least Squares Structural Equation Modeling (PLS-SEM)

“…We sought an idea from a professional with at least 20 years of working experience in construction management and who has participated in many construction projects in which he experienced construction first-hand information. [37,38] Time pressure [39,40] Difficulties for delivery vehicles accessing construction sites [41,42] 2 Transportation problem [43,44] Lack of supervision [45] Inefficient method of unloading [46,47] 3 Incorrect Procurement [48,49] Lack of on-site waste management plans [50,51] Insufficient protections during unloading [50,52] 4 Lack of design standards for reducing construction waste [53,54] Use of incorrect material requiring replacement [54,55] Waste resulting from cutting uneconomical shapes [56,57] 5 Low cost for construction waste disposal [58,59] Poor craftsmanship [60,61] Damage to materials on-site [62] 6…”

Peers and Motivation at Work

“…A large literature provides compelling evidence that a worker's own performance depends on her peers and social interactions (Herbst and Mas 2015). Several studies show that worker effort is sensitive to the social pressure that arises when there are externalities from effort due to joint production and team compensation (Mas and Moretti 2009;Gould and Winter 2009;Bandiera, Barankay, and Rasul 2013;Babcock et al 2015;Arcidiacono, Kinsler, and Price 2016;Battisti 2017;Cornelissen, Dustmann, and Schonberg 2017;Jiang 2020;Amodio and Martinez-Carrasco 2018;Silver 2019). For example, Mas and Moretti (2009) find that retail workers in teams appear to engage in monitoring and free-riding behavior that affects productivity.…”

“…When we use the maximum of peer ability as the measure of peer influence, we find statistically significant and positive impacts that are somewhat smaller than estimates based on Equation 1. We find statistically insignificant and positive estimates when we use the minimum of peer ability as the measure.27 An alternative model of peer effects is discussed inSilver (2019). This work innovates relative to the literature on workplace peer effects by focusing on group match effects that capture the influence of working with a particular co-worker group.…”

“…This work innovates relative to the literature on workplace peer effects by focusing on group match effects that capture the influence of working with a particular co-worker group. As an exploratory exercise, we have implemented an approach based onSilver (2019) and found there are important worker-by-peer group match effects in our setting. Specifically, workers are 24.3 percent more productive when working in a two-standard deviation faster peer group environment.…”

Peers and Motivation at Work: Evidence from a Firm Experiment in Malawi

“…A large literature provides compelling evidence that a worker's own performance depends on her peers and social interactions (Herbst and Mas 2015). Several studies show that worker effort is sensitive to the social pressure that arises when there are externalities from effort due to joint production and team compensation (Mas and Moretti 2009;Gould and Winter 2009;Bandiera, Barankay, and Rasul 2013;Babcock et al 2015;Arcidiacono, Kinsler, and Price 2016;Battisti 2017;Cornelissen, Dustmann, and Schonberg 2017;Jiang 2020;Amodio and Martinez-Carrasco 2018;Silver 2019). For example, Mas and Moretti (2009) find that retail workers in teams appear to engage in monitoring and free-riding behavior that affects productivity.…”