Ravi Aron

The Impact of Automation of Systems on Medical Errors: Evidence from Field Research

We use panel data from multiple wards from two hospitals spanning a three-year period to investigate the impact of automation of the core error prevention functions in hospitals on medical error rates. Although there are studies based on anecdotal evidence and self-reported data on how automation impacts medical errors, no systematic studies exist that are based on actual error rates from hospitals. Further, there is no systematic evidence on how incremental automation over time and across multiple wards impacts the rate of medical errors. The primary objective of our study is to fill this gap in the literature by empirically examining how the automation of core error prevention functions affects two types of medical errors. We draw on the medical informatics literature and principal-agency theory and use a unique panel data set of actual documented medical errors from two major hospitals to analyze the interplay between automation and medical errors. We hypothesize that the automation of the sensing function (recording and observing agent actions) will have the greatest impact on reducing error rates. We show that there are significant complementarities between quality management training imparted to hospital staff and the automation of control systems in reducing interpretative medical errors. We also offer insights to practitioners and theoreticians alike on how the automation of error prevention functions can be combined with training in quality management to yield better outcomes. Our results suggest an optimal implementation path for the automation of error prevention functions in hospitals.

Intelligent agents in electronic markets for information goods: customization, preference revelation and pricing

Electronic commerce has enabled the use of intelligent agent technologies that can evaluate buyers, customize products, and price in real-time. Our model of an electronic market with customizable products analyzes the pricing, profitability and welfare implications of agent-based technologies that price dynamically based on product preference information revealed by consumers. We find that in making the trade-off between better prices and better customization, consumers invariably choose less-than-ideal products. Furthermore, this trade-off has a higher impact on buyers on the higher end of the market and causes a transfer of consumer surplus towards buyers with a lower willingness to pay. As buyers adjust their product choices in response to better demand agent technologies, seller revenues decrease since the gains from better buyer information are dominated by the lowering of the total value created from the transactions. We study the strategic and welfare implications of these findings, and discuss managerial and technology development guidelines.

Just Right Outsourcing: Understanding and Managing Risk

The risks associated with outsourcing have been the principal limitation on the growth of business process outsourcing, especially cross border outsourcing. Technological improvements in risk management have lead to the dramatic increase in outsourcing in India. Further progress now comes from redesigning work flows and dividing work among multiple vendors, increasing the range of tasks that are now appropriate candidates for outsourcing.

Determinants of Operational Risk in Global Sourcing of Financial Services: Evidence from Field Research

The practice of global business process outsourcing (BPO) has gone beyond call centers to expertise-intensive functions such as tax accounting, equity research, cash flow forecasting, fixed income asset pricing research, transaction processing, supply chain coordination, and even research and development (R&D).1 Worldwide BPO is projected to reach

A model of market power and efficiency in private electronic exchanges

133.7 billion in 2005, an 8 per cent increase from 2004 revenue of

Online distribution: a taxonomy of channel structures, determinants of outcome, and determinants of strategy

123.8 billion, according to the Wharton Gartner Research Forecast (2003).2 The production of business processes is different from the production of physical goods in some important ways. First, the production of business processes involves no movement of physical goods, raw materials, inventories, or shipping and delivery costs. Here, inputs, output, and work-in-process are all information. Second, there is often minimal latency between the production of a process by a service center and its being bundled into a service for the end cus tomer. An offshore service provider (a BPO firm) may process all the savings and checking account-related transactions of customers, and these customers may well make decisions based on their account balances a few minutes after the

Applying JIT Principles to Resident Education to Reduce Patient Delays: A Pilot Study in an Academic Medical Center Pain Clinic

We investigate how private electronic markets (PEMs) can be used as a strategic tool by a large producer to compete against a consortium of smaller producers. We model the competition between a Large Producer and Consortium of producers in a two-tier supply chain as a game and characterize the resulting Subgame Perfect Nash Equilibrium. Our results demonstrate that as the costs of inputs to production increase, there are greater returns to ownership of a private exchange. Further, we demonstrate strong welfare enhancing effects of the PEM as the production efficiency of upstream suppliers declines. Finally, from a policy standpoint we show that when upstream suppliers are highly efficient, the creation of a private electronic exchange by the Large Producer will result in significant welfare loss.

Using process analysis to assess the impact of medical education on the delivery of pain services: A natural experiment

We have created a taxonomy of e-commerce channel structures and analyzed the strategic implications of these structures. We have identified the drivers of market outcomes in each channel structure and analyzed several business models that have failed because of channel conflict and the notable few that have survived and succeeded. Finally, we recommend strategies that can be successfully pursued in each channel context.

Information markets for product attributes: A game theoretic, dual pricing mechanism

OBJECTIVES This study investigated the effect on patient waiting times, patient/doctor contact times, flow times, and session completion times of having medical trainees and attending physicians review cases before the clinic session. The major hypothesis was that review of cases prior to clinic hours would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time. DESIGN Prospective quality improvement. SETTING Specialty pain clinic within Johns Hopkins Outpatient Center, Baltimore, MD, United States. PARTICIPANTS Two attending physicians participated in the intervention. Processing times for 504 patient visits are involved over a total of 4 months. INTERVENTION Trainees were assigned to cases the day before the patient visit. Trainees reviewed each case and discussed it with attending physicians before each clinic session. PRIMARY AND SECONDARY OUTCOME MEASURES Primary measures were activity times before and after the intervention. These were compared and also used as inputs to a discrete event simulation to eliminate differences in the arrival process as a confounding factor. RESULTS The average time that attending physicians spent teaching trainees while the patient waited was reduced, but patient/doctor contact time was not significantly affected. These changes reduced patient waiting times, flow times, and clinic session times. CONCLUSIONS Moving some educational activities ahead of clinic time improves patient flows through the clinic and decreases congestion without reducing the times that trainees or patients interact with physicians.

Impact of Internet-based distributed monitoring systems on offshore sourcing of services

Background: The medical, social, and economic effects of the teaching mission on delivery of care at an academic medical center (AMC) are not fully understood. When a free-standing private practice ambulatory clinic with no teaching mission was merged into an AMC, a natural experiment was created. The authors compared process measures across the two settings to observe the differences in system performance introduced by the added steps and resources of the AMCs teaching mission. Methods: After creating process maps based on activity times realized in both settings, the authors developed discrete-event simulations of the two environments. The two settings were comparable in the levels of key resources, but the AMC process flow included three residents/fellows. Simulation enabled the authors to consider an identical schedule across the two settings. Results: Under identical schedules, the average accumulated processing time per patient was higher in the AMC. However, the use of residents allowed simultaneous processing of multiple patients. Consequently, the AMC had higher throughput (3.5 vs. 2.7 patients per hour), higher room utilization (82.2% vs. 75.5%), reduced utilization of the attending physician (79.0% vs. 93.4%), and a shorter average waiting time (30.0 vs. 83.9 min). In addition, the average completion time for the final patient scheduled was 97.9 min less, and the average number of patients treated before incurring overtime was 37.9% greater. Conclusions: Although the teaching mission of the AMC adds processing steps and costs, the use of trainees within the process serves to increase throughput while decreasing waiting times and the use of overtime.