The contribution of resident physicians to hospital productivity

Resident physicians play a double role in hospital activity. They participate in medical practices and thus, on the one hand, they should be considered as an input. Also, they are medical staff in training and, on the other hand, must be considered as an output. The net effect on hospital activities should therefore be empirically determined. Additionally, when considering their role as active physicians, a natural hypothesis is that resident physicians are not more productive than senior ones. This is a property that standard logarithmic production functions (including Cobb–Douglas and Translog functional forms) cannot verify for the whole technology set. Our main contribution is the development of a Translog modification, which implies the definition of the input “doctors” as a weighted sum of senior and resident physicians, where the weights are estimated from the empirical application. This modification of the standard Translog is able, under suitable parameter restrictions, to verify our main hypothesis across the whole technology set while determining if the net effect of resident physicians in hospitals’ production should be associated to an output or to an input. We estimate the resulting output distance function frontier with a sample of Spanish hospitals. Our findings show that the overall contribution of resident physicians to hospitals’ production allows considering them as an input in most cases. In particular, their average productivity is around 37% of that corresponding to senior physicians.

Violence against doctors in Iraq during the time of COVID-19

Objectives This study assessed patterns in reported violence against doctors working in 11 Baghdad hospitals providing care for patients with COVID-19 and explored characteristics of hospital violence and its impact on health workers. Methods Questionnaires were completed by 505 hospital doctors (38.6% male, 64.4% female) working in 11 Baghdad hospitals. No personal or identifying information was obtained. Findings Of 505 doctors, 446 (87.3%) had experienced hospital violence in the previous 6 months. Doctors reported that patients were responsible for 95 (21.3%) instances of violence, patient family or relatives for 322 (72.4%), police or military personnel for 19 (4.3%), and other sources for 9 (2%). The proportion of violent events reported did not differ between male and female doctors, although characteristics varied. There were 415 of the 505 doctors who reported that violence had increased since the beginning of the pandemic, and many felt the situation would only get worse. COVID-19 has heightened tensions in an already violent health workplace, further increasing risks to patients and health providers. Interpretation During the COVID-19 epidemic in Iraq an already violent hospital environment in Baghdad has only worsened. The physical and emotional toll on health workers is high which further threatens patient care and hospital productivity. While more security measures can be taken, reducing health workplace violence requires other measures such as improved communication, and addressing issues of patient care.

Hospital Productivity After Data Breaches: Difference-in-Differences Analysis

Background Data breaches are an inevitable risk to hospitals operating with information technology. The financial costs associated with data breaches are also growing. The costs associated with a data breach may divert resources away from patient care, thus negatively affecting hospital productivity. Objective After a data breach, the resulting regulatory enforcement and remediation are a shock to a hospital’s patient care delivery. Exploiting this shock, this study aimed to investigate the association between hospital data breaches and productivity by using a generalized difference-in-differences model with multiple prebreach and postbreach periods. Methods The study analyzed the hospital financial data of the California Office of Statewide Health Planning and Development from 2012 to 2016. The study sample was an unbalanced panel of hospitals with 2610 unique hospital-year observations, including general acute care hospitals. California hospital data were merged with breach data published by the US Department of Health and Human Services. The dependent variable was hospital productivity measured as value added. The difference-in-differences model was estimated using fixed effects regression. Results Hospital productivity did not significantly differ from the baseline for 3 years after a breach. Data breaches were not significantly associated with a reduction in hospital productivity. Before a breach, the productivity of hospitals that experienced a data breach maintained a parallel trend with control hospitals. Conclusions Hospital productivity was resilient against the shocks from a data breach. Nonetheless, data breaches continue to threaten hospitals; therefore, health care workers should be trained in cybersecurity to mitigate disruptions.

Hospital Productivity Shows Resilience After Data Breaches (Preprint)

BACKGROUND Data breaches are an inevitable risk to hospitals operating with information technology. The financial costs associated with data breaches are also growing. The costs associated with a data breach may divert resources away from patient care, therefore negatively affect hospital productivity. OBJECTIVE After a data breach, the resulting regulatory enforcement and remediation is a shock to a hospital’s patient care delivery. Exploiting this shock, the association between hospital data breaches and productivity was estimated using a generalized difference-in-differences model with multiple pre and post periods. METHODS The study analyzed the California Office of Statewide Health Planning and Development hospital financial data from 2012 to 2016. The study sample was an unbalanced panel of hospitals with 2,610 unique hospital-year observations, including general acute care hospitals. California hospital data was merged with breach data published by the Department of Health and Human Services. The dependent variable was hospital productivity measured as value-added. The difference-in-differences model was estimated using a fixed-effects regression. RESULTS Hospital productivity did not significantly differ from the baseline for three years after a breach. Data breaches were not significantly associated with a reduction in hospital productivity. Before a breach, the productivity of breached hospitals maintained a parallel trend with control hospitals. CONCLUSIONS Hospital productivity was resilient against the shocks from a data breach. Nonetheless, data breaches continue to threaten hospitals, therefore healthcare workers should be trained for cybersecurity to mitigate disruptions.