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April 5, 2023
David Burda
Economics Outcomes System Dynamics

Staff Turnover Means Same Quality But Worse Service. Are We Talking About Hospitals or Restaurants?

What do you think when you go into a store, a bank or a restaurant that you frequent, and each time you go in, you see different people behind the register, desk or hostess stand?

I think high turnover and poor service. High turnover because the businesses don’t pay their employees enough. Poor service because the businesses don’t have time to properly train their staff.

If you need proof, go to the Party City, Old Second National Bank or Buttermilks in Wheaton, Ill., at least twice. Never the same people. And they never fail to disappoint.

But what if you’re a customer of a hospital and your doctor has admitted you as an inpatient on a general medical-surgical floor? Does medical resident turnover at the end of a clinical rotation lead to poor care or poor service?

That’s what researchers from the University of Toronto wanted to find out, and they recently published their study findings in JAMA Network Open. They looked at how end-of-rotation changes in medical residents affected four outcomes:

  • Length of stay
  • Transfers to critical care within seven days of admission
  • Inpatient death within seven days of admission
  • Discharge rate per 100 patients

The study pool was about 95,000 patients admitted to four teaching hospitals — all affiliated with the University of Toronto — over a 10-year period, July 1, 2010, through June 30, 2019. Twenty-four percent of the patients experienced a physician rotation change during their stays. Seventy-six percent did not.

To make a long explanation and statistical analysis short, here’s what the researchers found when they compared the two pools of patients after controlling for variables like age, sex and diagnoses:

  • The average length of stay was slightly longer for patients with a rotation change (6.7 days compared with 6.5 days).
  • The percentage of patients transferred to critical care within seven days of admission was the same for both groups (5.5 percent compared with 5.5 percent).
  • The percentage of patients who died within seven days of admission was slightly lower with a rotation change (2.4 percent compared with 2.5 percent).
  • And the rate of discharges per 100 patients was slightly lower with a rotation change (10.9 per 100 compared with 11.6 percent).

In terms of clinical outcomes — transfers to critical care and death — it basically was a tie. In terms of length of stay and discharges, it was a little worse as rotation changes likely slowed things down a bit.

The results of the study again show that hospitals are a business and behave like any other business in any other industry.

If we think in terms of Party City, Old Second National Bank and Buttermilks, it would mean you’d get your party plates, napkins and balloons in the right size and color; you’d get your money deposited in the right account; and you’d get your Mountain House skillet made with the right ingredients. In each case, you’d get what you wanted, but it would take a little longer because the constant newbies on staff don’t have it together.

If you convert everything in healthcare to your retail experiences, what happens in healthcare all makes sense. That means, applying what works in retail to healthcare makes sense, doesn’t it? It makes sense to me.

To learn more about this topic, please read “The Secret to Being a Good Healthcare Consumer Is Food” on 4sighthealth.com.

Thanks for reading.


About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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