Diwas KC

Professor of Information Systems & Operations Management Emory University, Goizueta Business School

  • Atlanta GA

See my website for up-to-date research information: https://diwaskc.com

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Biography

I teach and conduct research in areas of Data Analytics, Operations, and Healthcare. My research topics include workforce productivity, capacity management, technology adoption, policy formulation, and the design and organization of healthcare delivery.

My research has been published in leading journals including Management Science, Manufacturing and Service Operations Management, Operations Research, Marketing Science, and Production and Operations Management. I serve as Senior and Associate Editor at M&SOM and POMS.

I received my PhD in Applied Economics and Managerial Sciences from the Wharton School of Business, MS in Management Science and Engineering from Stanford University, and ScB in Electrical Engineering from Brown University. Prior to doctoral studies, I was a Principal Software Engineer for Oracle Corporation.

Education

The Wharton School, University of Pennsylvania

PhD

Managerial Sciences and Applied Economics

2008

Stanford University

MS

Management Science and Engineering

2003

Brown University

BS

Electrical Engineering

1999

Areas of Expertise

Workforce Productivity
Technology Adoption
Capacity Management
Quality Management
New Models of Care Delivery
Health Care Management
Policy Formulation

Publications

Are Patients Patient? The Role of Time to Appointment in Patient Flow

Production and Operations Management

2016

In this paper, we examine the effect of wait to appointment on patient flow, specifically on a patient's decision to schedule an appointment and to subsequently arrive to it...

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Does multitasking improve performance? Evidence from the emergency department

Manufacturing & Service Operations Management

2013

This paper examines the effect of multitasking on overall worker performance, as measured by processing time, throughput rate, and output quality using microlevel operational data from the field. Specifically, we study the multitasking behavior of physicians in a busy
hospital emergency department (ED)...

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Research Spotlight

6 min

Hiring More Nurses Generates Revenue for Hospitals

Underfunding is driving an acute shortage of trained nurses in hospitals and care facilities in the United States. It is the worst such shortage in more than four decades. One estimate from the American Hospital Association puts the deficit north of one million. Meanwhile, a recent survey by recruitment specialist AMN Healthcare suggests that 900,000 more nurses will drop out of the workforce by 2027. American nurses are quitting in droves, thanks to low pay and burnout as understaffing increases individual workload. This is bad news for patient outcomes. Nurses are estimated to have eight times more routine contact with patients than physicians. They shoulder the bulk of all responsibility in terms of diagnostic data collection, treatment plans, and clinical reporting. As a result, understaffing is linked to a slew of serious problems, among them increased wait times for patients in care, post-operative infections, readmission rates, and patient mortality—all of which are on the rise across the U.S. Tackling this crisis is challenging because of how nursing services are reimbursed. Most hospitals operate a payment system where services are paid for separately. Physician services are billed as separate line items, making them a revenue generator for the hospitals that employ them. But under Medicare, nursing services are charged as part of a fixed room and board fee, meaning that hospitals charge the same fee regardless of how many nurses are employed in the patient’s care. In this model, nurses end up on the other side of hospitals’ balance sheets: a labor expense rather than a source of income. For beleaguered administrators looking to sustain quality of care while minimizing costs (and maximizing profits), hiring and retaining nursing staff has arguably become something of a zero-sum game in the U.S. The Hidden Costs of Nurse Understaffing But might the balance sheet in fact be skewed in some way? Could there be potential financial losses attached to nurse understaffing that administrators should factor into their hiring and remuneration decisions? Research by Goizueta Professors Diwas KC and Donald Lee, as well as recent Goizueta PhD graduates Hao Ding 24PhD (Auburn University) and Sokol Tushe 23PhD (Muma College of Business), would suggest there are. Their new peer-reviewed publicationfinds that increasing a single nurse’s workload by just one patient creates a 17% service slowdown for all other patients under that nurse’s care. Looking at the data another way, having one additional nurse on duty during the busiest shift (typically between 7am and 7pm) speeds up emergency department work and frees up capacity to treat more patients such that hospitals could be looking at a major increase in revenue. The researchers calculate that this productivity gain could equate to a net increase of $470,000 per 10,000 patient visits—and savings to the tune of $160,000 in lost earnings for the same number of patients as wait times are reduced. “A lot of the debate around nursing in the U.S. has focused on the loss of quality in care, which is hugely important,” says Diwas KC. But looking at the crisis through a productivity lens means we’re also able to understand the very real economic value that nurses bring too: the revenue increases that come with capacity gains. Diwas KC, Goizueta Foundation Term Professor of Information Systems & Operations Management “Our findings challenge the predominant thinking around nursing as a cost,” adds Lee. “What we see is that investing in nursing staff more than pays for itself in downstream financial benefits for hospitals. It is effectively a win-win-win for patients, nurses, and healthcare providers.” Nurse Load: the Biggest Impact on Productivity To get to these findings, the researchers analyzed a high-resolution dataset on patient flow through a large U.S. teaching hospital. They looked at the real-time workloads of physicians and nurses working in the emergency department between April 2018 and March 2019, factoring in variables such as patient demographics and severity of complaint or illness. Tracking patients from admission to triage and on to treatment, the researchers were able to tease out the impact that the number of nurses and physicians on duty had on patient throughput. Using a novel machine learning technique developed at Goizueta by Lee, they were able to identify the effect of increasing or reducing the workforce. The contrast between physicians and nursing staff is stark, says Tushe. “When you have fewer nurses on duty, capacity and patient throughput drops by an order of magnitude—far, far more than when reducing the number of doctors. Our results show that for every additional patient the nurse is responsible for, service speed falls by 17%. That compares to just 1.4% if you add one patient to the workload of an attending physician. In other words, nurses’ impact on productivity in the emergency department is more than eight times greater.” Boosting Revenue Through Reduced Wait Times Adding an additional nurse to the workforce, on the other hand, increases capacity appreciably. And as more patients are treated faster, hospitals can expect a concomitant uptick in revenue, says KC. “It’s well documented that cutting down wait time equates to more patients treated and more income. Previous research shows that reducing service time by 15 minutes per 30,000 patient visits translates to $1.4 million in extra revenue for a hospital.” In our study, we calculate that staffing one additional nurse in the 7am to 7pm emergency department shift reduces wait time by 23 minutes, so hospitals could be looking at an increase of $2.33 million per year. Diwas KC This far eclipses the costs associated with hiring one additional nurse, says Lee. “According to 2022 U.S. Bureau of Labor Statistics, the average nursing salary in the U.S. is $83,000. Fringe benefits account for an additional 50% of the base salary. The total cost of adding one nurse during the 7am to 7pm shift is $310,000 (for 2.5 full-time employees). When you do the math, it is clear. The net hospital gain is $2 million for the hospital in our study. Or $470,000 per 10,000 patient visits.” Incontrovertible Benefits to Hiring More Nurses These findings should provide compelling food for thought both to healthcare administrators and U.S. policymakers. For too long, the latter have fixated on the upstream costs, without exploring the downstream benefits of nursing services, say the researchers. Their study, the first to quantify the economic value of nurses in the U.S., asks “better questions,” argues Tushe; exploiting newly available data and analytics to reveal incontrovertible financial benefits that attach to hiring—and compensating—more nurses in American hospitals. We know that a lot of nurses are leaving the profession not just because of cuts and burnout, but also because of lower pay. We would say to administrators struggling to hire talented nurses to review current wage offers, because our analysis suggests that the economic surplus from hiring more nurses could be readily applied to retention pay rises also. Sokol Tushe 23PhD, Muma College of Business The Case for Mandated Ratios For state-level decision makers, Lee has additional words of advice. “In 2004, California mandated minimum nurse-to-patient ratios in hospitals. Since then, six more states have added some form of minimum ratio requirement. The evidence is that this has been beneficial to patient outcomes and nurse job satisfaction. Our research now adds an economic dimension to the list of benefits as well. Ipso facto, policymakers ought to consider wider adoption of minimum nurse-to-patient ratios.” However, decision makers go about tackling the shortage of nurses in the U.S., they should go about it fast and soon, says KC. “This is a healthcare crisis that is only set to become more acute in the near future. As our demographics shift and our population starts again out, demand for quality will increase. So too must the supply of care capacity. But what we are seeing is the nursing staffing situation in the U.S. moving in the opposite direction. All of this is manifesting in the emergency department. That’s where wait times are getting longer, mistakes are being made, and overworked nurses are quitting. It is creating a vicious cycle that needs to be broken.” Diwas Diwas KC is a professor of information systems & operations management and Donald Lee is an associate professor of information systems & operations management. Both experts are available to speak about this important topic simply click on either icon now to arrange an interview today.

Diwas KCDonald Lee

5 min

Expert Research: Mandated Restrictions on Opioid Prescriptions Have Unintended—and Deadly—Consequences

New research from Goizueta’s Diwas KC unpacks the dual impact of Prescription Drug Monitoring Programs on opioid prescriptions and heroin overdose deaths. More than two million individuals in the US are experiencing Opioid Use Disorder (OUD). The CDC defines OUD as “a problematic pattern of opioid use that causes significant impairment or distress.” Around 130 people die of opioid overdoses every day. Perhaps more startlingly, four million people over the age of 12 have reported using pain medication recreationally, including opioids. Prescription opioids are a highly-regulated class of drug. They interact with the opioid receptors on nerve cells throughout the body, as well as the brain, which reduces the intensity of pain signals to the body. For many, they are a necessary prescription to get through the pain of surgery or injury, as the body heals itself. Unfortunately, the function of opioids in the body—releasing endorphins and boosting feelings of pleasure, as well as reducing pain—also make them highly addictive. PDMP: A Successful Federal Mandate The United States continues to see increases in deaths from opioid overdoses. So, federal and state governments have been working in enact policies that are designed to decrease those fatalities. One of the methods states are using to prevent common abuse patterns like “doctor shopping,” which is the pattern of visiting multiple physicians to obtain prescriptions, is the Prescription Drug Monitoring Program (PDMP), designed to be used in conjunction with Health Information Technology (HIT) programs. PDMP serve two purposes: identifying drug-seeking behaviors in patients, and identifying physicians with patterns of inappropriate prescribing. Nearly all 50 states have enacted PDMPs of some degree. Some programs require physicians to check the PDMP before prescribing restricted pharmaceuticals, but in others it’s only suggested. Intrastate communication between PDMPs is not always possible, however. The Unintended Consequences The use of PDMPs has been shown to reduce the number of opioid prescriptions, the intended outcome of the program. Enter a recently published study by Diwas KC, Goizueta Foundation Term Professor of Information Systems & Operations Management. The research shows that during time the research was conducted, prescriptions for opioids declined by 6.1%. However, the research also brought to light a very serious and unintended consequence of the implementation of PDMPs. The study concluded that while the implementation of PDMPs did reduce opioid prescriptions, it did not reduce overall numbers of prescription opioid deaths. In fact, it may have contributed to a 50% increase in heroin overdose fatalities. “The heroin increase was definitely something we were not expecting, it was a total surprise,” says KC. "It was something that we had hypothesized. You’ve got a bunch of individuals who have used prescription opiates and had presumably been dependent. Now with the passage of this PDMP law, it has become more difficult to obtain prescription opiates. Therefore, some people might be forced to turn to the street version of it." Diwas KC “We didn’t expect the effect size it to be as significant as it is,” says KC. Heroin and commonly prescribed opioids like oxycodone and hydrocodone are very similar on a biochemical level. What’s more, they generate a similar sensation in the body, according to KC. That’s why he and his team had the initial hypothesis that some addicted individuals, when unable to get prescription medication, might turn to street drugs, which are much more dangerous on many levels. “There are many aspects to this. One has to do with the potency and the toxicity of the things you get on the streets. There are very little checks and balances on those. There’s no control in quality for sure,” KC says. He also notes the lack of checks and balances on the frequency of usage. “So the frequency of usage, the quality of the substances you’re putting inside your body, and possibly the circumstances of acquiring it might also be very risky too.” A Dual Impact The research concludes that mandating PDMP use is an example of a successful use of policy for intervention. It does, in fact, decrease the number of opioid prescriptions available to patients. That’s critical information for policy makers and physicians to take in. And it’s a solid reason to keep using and expanding PDMP usage, according to KC. "I should point out very clearly that the policy did have the intended effect of reducing prescriptions. So, it definitely benefited people who might otherwise have become addicted." Diwas KC “By reducing unnecessary prescriptions it might have limited the number of people who would have gotten hooked on the drugs in the first place. So there’s definitely the benefit of that,” says KC. “It’s just that when the policy was implemented, there was also this side effect because of people who were already using it. So, when those people were forced to look for alternatives, that’s when things got bad.” Research papers like this one show an important side of using data to mark successes and failures of government policies. Taken on the surface, data can show a policy’s impact for the greater good. But a deeper dive into the surrounding data—like the increase in heroin use after the implementation of PDMPs—gives everyone a better idea of the full impact of this mandate. "Policies have intended as well as unintended consequences. In this case of PDMP it had the desired effect of reducing prescriptions. That probably helped a lot of people not get addicted to opiates in the first place." Diwas KC “But sometimes policies also have unintended consequences,” says KC. “Like in the case of people who were already addicted to painkillers suddenly stopping it, causing them to take drastic actions, and that’s what happened for some of the people in the study. Policies need to consider the possibility of unintended consequences and take actions to also mitigate those unintended consequences.” Interested in knowing more? Diwas KC is the Goizueta Foundation Term Professor of Information Systems & Operations Management. He is available to talk about this important topic simply click on his icon now to arrange an interview today

Diwas KC

3 min

Is hospital advertising actually good for our health?

Hospitals and healthcare organizations in the U.S. spend $1.5 billion on advertising every year. It’s a topic that provokes lively debate and a certain amount of controversy. Medical bodies, policy makers, and scholars alike question the ethics and efficacy of using (constrained) budgets to promote hospitals to patients. Diwas KC, professor of information systems & operations management at Emory University’s Goizueta Business School, and Tongil Kim, an assistant professor of management at Naveen Jindal School of Management in Texas, conducted a large-scale study of hospitals and patients in the state of Massachusetts to better understand the impact of hospital advertising. What they found is striking: Not only does television advertising work, it significantly drives demand, attracting patients living far from the hospital and beyond its regular area. And that’s not all. KC and Kim discovered that limiting hospital advertising or imposing an outright ban, as some groups have called for, might actually have serious negative effects on patient healthcare. “There has been a lot of discussion about banning advertising over recent years because of uncertainties around wasting money and resources,” KC said. In the paper “Impact of hospital advertising on patient demand and outcomes,” KC shows that there is a correlation between the amount spent on TV advertising and the quality of the hospital in question. Healthcare facilities that invest more in advertising tend to be “better” hospitals, he adds; they offer higher caliber care and services and, as such, they see much lower patient readmission rates—a key quality metric in healthcare. To get to these insights, KC and Kim looked at more than 220,000 individual patient visits to hospitals in the state of Massachusetts over a 24-month period. Among the data they collected were things like hospital type, location, and dollars spent on advertising. Patients were documented in terms of medical conditions, insurance, zip codes (to determine residence), and median household income. They were able to contrast those hospitals that invested in television advertising and those that did not. With the former, they uncovered a significant uptick in patient visits, with people coming from far further afield. This was particularly true of wealthier patients. Then there’s the question of patient outcomes. Here the data showed unequivocally that it’s the high-quality, low-readmission hospitals that advertise more—something that KC attributes to the natural tendency to get “more bang for the advertising buck when the quality of your product or service is better.” As for banning advertising, this would negatively impact these hospitals, he argues, limiting their ability to attract patients. It could also lead to an increase in population-level readmission rates. “Patient readmission rates are one of the key metrics along with mortality rates that tell us how well a healthcare facility is working,” said KC. “If a patient gets discharged but has to come back to a hospital in, say, 30 days, unless it’s a chronic condition or ongoing treatment, it’s a good indication that the patient didn’t get the level of care they should have the first time.” Indeed, “when we looked at all of the data, we found that the hospitals where there were fewest revisit rates were those that advertised more,” he said. KC finds that a blanket ban on hospital advertising could lead to an extra 1.2 readmissions for every 100 patients discharged. It’s a significant and “surprising” finding. And one that should inform the debate around healthcare advertising spend in the U.S. “There’s also the idea that this is a zero-sum game because if a patient doesn’t go to hospital A, they’re just going to go to hospital B—the one that advertises more—splitting the pie in different ways but not increasing that pie,” KC said. “What our study finds is that yes, advertising does draw patients away from one facility and towards another, but that the latter generally delivers better patient outcomes,” he said. “So, there is a social welfare benefit right there that suggests that you should not ban hospital advertising. There are real health benefits in allowing [advertising] to happen.” If you are a journalist looking to cover this topic then let our experts help. Diwas KC is a Professor of Information Systems & Operations Management at Emory University’s Goizueta Business School. He is an expert in the areas of  Data Analytics, Operations, and Healthcare. If you are interesting in arranging an interview simply click on his icon to set up a time today.

Diwas KC
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In the News

Your Desire to Get Things Done Can Undermine Your Effectiveness

Harvard Business Review  online

2016-03-22

In unpublished research with Emory University’s Diwas KC and Northwestern University’s Maryam Kouchaki, we examined the completion bias of physicians in the emergency department (ED) of a busy hospital, where patients arrive unscheduled...

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