Speediness Isn't The Same For All Physicians

How do high-performing organizations learn and adapt their routines and procedures? Do they look to constantly bring new information into their processes? Are they quick to adopt new ways of doing things at the individual and organizational levels?

Researchers at the University of Maryland’s Robert H. Smith School of Business sought to answer those questions, examining not only individuals within the organization, but also how the interplay between organizational and individual characteristics enhances or inhibits assimilation of newly available information.

Their study focused on the treatment of coronary arterial disease, examining how organizations and professionals would adapt amid new multi-level information diffusion. The information was the introduction of a landmark 2006 guideline for the use of coronary stents, issued by the American Heart Association and the American College of Cardiology, which recommended limiting stents for low severity heart disease patients.

The researchers empirically examined how individual physicians with different types of expertise — some general and some specialized — vary in the speed they adopt the new information.

They studied spillovers in learning as well, finding that organizations that responded swiftly to new information typically possessed expert physicians, and were also subject to intra-organizational externalities through peer effects. “Using quantitative and qualitative approaches, we find both individual and organizational expertise affects changes in practice,” they wrote.

The research reveals that experts who had deliberate practice tended to react faster to new information. Those with more general forms of expertise, such as tenure or elite education, meanwhile, didn’t exhibit such responses.

The researchers say their findings may have applications in other fields, such as education, law and consulting, where intensive knowledge work and complex technology play prominent roles. They caution, however, that the results should be interpreted cautiously, because of the potential influence of other outside factors.

“Theoretically, we believe this interplay between macro-level organizational factors that create an environment conducive for learning and adaptation, and micro-level human capital that enables individuals to respond positively within such organizational environments, is a more nuanced, and ultimately more precise, depiction of how learning takes place within fast-moving institutionalized fields.”

Ritu Agarwal, senior associate dean for research, and the Robert H. Smith Dean’s Chair of Information Systems at the Smith School, says the latest research could hold “significant implications” for the medical profession. Agarwal, who authored the paper with Smith School colleagues Rajshree Agarwal and Anandasivam Gopal, and the University of Minnesota’s Brad N. Greenwood, is also the the founder and director of the Smith School’s Center for Health Information and Decision Systems.

Adherence to guidelines significantly improves clinical care outcomes, so the researchers surmised that the appropriate reaction, from an economic perspective, should be “an immediate and sharp drop in the stenting rate.” The researchers concluded, therefore, that the fact that the response across agents of all levels of expertise was not immediate did present cause for concern.

In fact, they computed the economic burden of the relatively slow response. They assumed that the 3.5 percent stenting rate for low-severity SCAD patients in 2010 was stable, meaning that roughly 35,500 patients in the sample would have been subjected to unnecessary stenting procedures. At $17,000 per procedure, that would translate to an avoidable burden of roughly $603 million in the state of Florida. Given how pervasive SCAD and the practice of stenting are, the costs associated with the delay would be substantial, likely reaching into the tens of billions of dollars.

“While our study focused on changes in organizational routines in a single domain, examples of physician non-compliance or slow compliance with medical guidelines are pervasive,” the researchers say.

For example, fewer than 40 percent of women diagnosed with ovarian cancer in the U.S. receive care that complies with guidelines, which significantly increases their risk of death. And in fact, treatments for numerous medical conditions, from cholesterol to breast cancer, exhibit physician non-compliance with medical guidelines.

“A clear implication of our study is that deliberate practice is an enabler; the presence of such experts in organizations is instrumental in not only preventing needless spending, but also avoiding potential loss of health and even life associated with poor adherence to medical guidelines,” the researchers say.

The increase in the number of specialists in medicine at perhaps the expense of medical students selecting into general practice has been treated as a matter of some concern, the researchers note. “Our results provide some evidence for the benefits of increasing specialization and the role of experts as influencers,” they write. “Indeed, some physicians from our qualitative sample stated their hospitals now mandate that their physicians be board certified in their sub-specialty in order to have admitting privileges.”

Read more: The Role of Individual and Organizational Expertise in Adoption of New Practices is featured in Organization Science.