Sit it out or dance: Representative bureaucracy contagion effects in health care

Abstract

The study of representative bureaucracy traces out multiple organizational and individual-level pathways through which identity-based representation contributes to improvements in bureaucratic processes, outcomes, and legitimacy. Leveraging a multi-level dataset of Florida emergency room visits, we simultaneously model aggregate (indirect) and individual (direct) forms of representation to shed light on what we term "contagion effects" in representative bureaucracy. Our theory of contagion argues that the presence of underrepresented bureaucrats (in the aggregate) can change the behavior of other existing bureaucrats. An empirical test of physician-patient sex matching in heart attack outcomes finds that male physicians get better results for female patients when they work alongside more female physicians in their unit, that contagion effects are indicative of men changing their behavior to be more receptive to women's symptoms, and that the quality of medical school is related to men's susceptibility to contagion influences.

Representative Bureaucracy and Social Equity: Bias, Perceived Fairness and Efficacy

“…Li (2022) finds that white highway patrol officers who work with Latinx officers are associated with less racial profiling of Latinx drivers (she finds null results for whites who work with African Americans). Meier and McCrea (2022) show that male emergency room physicians who work with female physicians have improved outcomes for women suffering heart attacks and that this occurs in cases of atypical symptoms that are more frequently recognized by female physicians. find that male math teachers in China who have more female math teachers as colleagues are associated with higher math grades for female students.…”

Bureaucratic Representation and Gender Mainstreaming in International Organizations: Evidence from the World Bank

“…As the literature demonstrates, a greater number of women can (under certain conditions) change the dynamics of deliberations on gender issues (Dietrich, Hayes, and O'Brien 2019;Karim and Beardsley 2016;Mendelberg, Karpowitz, and Goedert 2014). Specifically, the increased representation of women can shift the salience of certain issue areas (Meier and McCrea 2022), alter "masculine" subcultures (Kennedy, Bishu, and Heckler 2020), and encourage discussion on hitherto neglected policy issues (Chattopadhyay and Duflo 2004;Dietrich, Hayes, and O'Brien 2019).…”