Christian Terwiesch

University of Pennsylvania | UP · The Wharton School

Connected healthcare is a form of health delivery that connects patients and providers through connected health devices, allowing providers to monitor patient behavior and proactively intervene before an adverse event occurs. Unlike the costs, the benefits of connected healthcare in improving patient behavior and health outcomes are usually difficu...

More and more firms use connected technologies to reshape fundamentally the way in which they interact with their customers. Rather than having few episodic interactions, companies are trying to create a continuous relationship with their customers that reduces friction and allows companies to anticipate the needs of their customers. In this chapte...

We estimated the harm related to medication delivery delays across 12,474 medication administration instances in an intensive care unit using retrospective data in a large urban academic medical center between 2012 and 2015. We leveraged an instrumental variables (IV) approach that addresses unobserved confounds in this setting. We focused on nurse...

We study capacity rationing by servers facing differentiated customer classes using data from the Veterans Health Administration, which is the largest integrated healthcare system in the U.S. Using more than 11 million health encounters over two years in which the system was capacity constrained, our study provides a comprehensive analysis of the i...

Technologies that enable “e‐visits” ‐ remote interactions between patients and physicians ‐ are touted as a way to improve and expand primary care. We study a setting in which a physician can divert some of the patient demand away from the office visits and into the e‐visits, which utilize less of the physician's service capacity while maintaining...

Introduction Mental health follow-up after an emergency department (ED) visit for suicide ideation/attempt is a critical component of suicide prevention for young people. Methods We analyzed 2009-2012 Medicaid Analytic Extract for 62,139 treat-and-release ED visits and 30,312 ED-to-hospital admissions for suicide ideation/attempt among patients ag...

Problem definition: We study the impact of service facility layout on how service workers organize their tasks. We focus on the hospital emergency department (ED) as a service setting in which nurses (servers) have discretion over how they interact with patients (customers) in a facility that introduces significant heterogeneity in necessary walkin...

Due to the global shortage of PPE caused by increasing number of COVID-19 patients in recent months, many hospitals have had difficulty procuring adequate PPE for the clinicians who care for these patients. Faced with a shortage, hospitals have had to implement new PPE conservation policies. In this paper, we describe a tool to help hospitals bette...

Connected healthcare is a form of health delivery that connects patients and providers through connected health devices, allowing providers to monitor patient behavior and proactively intervene before an adverse event occurs. Unlike the costs, the benefits of connected healthcare in improving patient behavior and health outcomes are usually difficu...

We study capacity rationing by servers facing differentiated customer classes using data from the Veterans Health Administration, which is the largest integrated healthcare system in the US. Using over 11 million health encounters over two years in which the system was capacity constrained, our study provides a comprehensive analysis of the impacts...

We examine the published empirical literature in healthcare operations management over the last 20 years. We note several unique characteristics of the research in healthcare operations, including a focus on operational and organizational variables, an interest in the underlying mechanisms that explain operational causal pathways, and an interest i...

In many professional service organizations (PSOs), a single server such as a physician or lawyer delivers services to customers across multiple channels. In these settings, there exists a risk that work obligations encroach on the personal lives of the servers. We empirically examine this concern in the primary care setting of physicians providing...

We develop a database of all empirical research related to operations management in the journals Management Science, Manufacturing and Service Operations Management (M&SOM), and Production and Operations Management (POM) from the beginning of 1999 to the end of 2016. This database includes 236 empirical papers. We analyze the set of empirical paper...

The amount of empirical research in operations management that has been published in this journal and in Management Science has recently witnessed a significant increase. Beyond this increase in numbers, research questions and empirical methodologies have also changed substantially. Whereas empirical research in the 1990s was primarily carried out...

In recent years, the drive to contain health care costs has increased scrutiny of the traditional mode of delivering primary care where a patient is treated only by his primary care physician. In particular, greater reliance on non‐physician providers has been suggested as a lower‐cost alternative to the traditional set‐up. In this paper, we consid...

We invoke the insights from the auction literature to study trade in services using data from an online market for programming support. We find that the observed clustering of trade between countries can be rationalized through a model featuring endogenous sorting of sellers who are heterogeneous in both quality and costs across projects offered by...

Secure messaging, or “e-visits,” between patients and providers has sharply increased in recent years, and many hope they will help improve healthcare quality, while increasing provider capacity. Using a panel data set from a large healthcare system in the United States, we find that e-visits trigger about 6% more office visits, with mixed results...

Importance: Adherence to medications prescribed after acute myocardial infarction (AMI) is low. Wireless technology and behavioral economic approaches have shown promise in improving health behaviors. Objective: To determine whether a system of medication reminders using financial incentives and social support delays subsequent vascular events i...

In this study, we examine the hospital's ability to admit patients from its emergency department. From a medical perspective, the number of patients being admitted should depend solely on the patients’ clinical conditions. Using a large scale econometric study that includes detailed operational and clinical data on all cardiac patient encounters fr...

We study a multistage service process that adapts to system occupancy level. Using operational data from more than 140,000 patient visits to a hospital emergency department, we show that the system-level performance of the emergency department is an aggregation of several simultaneous server-level workload response mechanisms. We identify early tas...

Using a detailed data set from the U.S. automotive industry, we enrich the existing literature on product line breadth with new results that highlight previously unexplored operational aspects of its benefits and costs. We find that expanding product line breadth has a significant effect on increasing mismatch costs arising from the increased deman...

We study a multi-stage service process that adapts to system occupancy level. Using operational data from over 140,000 patient visits to a hospital emergency department, we show that the system-level performance of the emergency department is an aggregation of several simultaneous server-level workload response mechanisms. We identify early task in...

Office visits represent the core component of primary care practice, but little is known about what percentage of primary care provider (PCP) visit time could be suitable for reassignment to another medical home team member or to a non-face-to-face modality (e.g. secure messaging) in order to optimize face-to-face PCP visit time. We videotaped 121...

Medical home models seek to increase efficiency and maximize the use of resources by ensuring that all care team members work at the top of their licenses. We sought to break down primary care office visits into measurable activities to better understand how primary care providers (PCPs) currently spend visit time and to provide insight into potent...

We study queue abandonment from a hospital emergency department. We show that abandonment is influenced by the queue length and the observable queue flows during the waiting exposure, even after controlling for wait time. For example, observing an additional person in the queue or an additional arrival to the queue leads to an increase in abandonme...

We use a detailed data set from the U.S. auto industry spanning from 2002 to 2009 and a variety of econometric methods to characterize the relationship between the availability of production mix flexibility and firms’ use of responsive pricing. We find that production mix flexibility is associated with reductions in observed manufacturer discount...

Online service marketplaces allow service buyers to post their project requests and service providers to bid for them. To reduce the transactional risks, marketplaces typically track and publish previous seller performance. By analyzing a detailed transactional data set with more than 1,800,000 bids corresponding to 270,000 projects posted between...

Rather than seek solutions to health care's problems in facile recommendations from management gurus with experience in unrelated industries, we'd do better to find a solution process to use from within. And the process for high-impact innovation can in fact be learned. Many health care professionals find it irritating when management gurus recomme...

Patient access to primary care is often noted to be poor. Improving access may reduce emergency room (ER) visits. To examine the relationship between primary care access and ER use and to test whether this relationship is moderated by having a continuous relationship with a Primary Care Provider (PCP) (or if the PCP is the near-sole provider of car...

This report examines the emergence of the Massively Open Online Course (MOOC) and its impact on business schools. Business schools provide a bundle of benefits to students, only one of which is learning specific academic subjects. The focal technology relevant to business schools is not the MOOC but rather a technology embedded within the MOOC — ch...

We propose a new innovation model designed to accelerate the rate of learning from provider payment reform initiatives. Drawing on themes from operations research, we describe a new approach that balances speed and rigor to more quickly build evidence on what works in delivery system redesign. While randomized controlled trials provide "gold standa...

Using a detailed dataset from the U.S. automotive industry, we empirically study the benefits and costs of maintaining a broader product line. Consistently with theoretical predictions, we find a positive association between product line breadth and both market share and unit production costs. We enrich the existing literature with new results that...

Faced with the need to improve quality, health care enterprises have used principles from highly reliable industries to make tactical progress. As the health care system faces growing challenges to transform itself, we propose business model innovation as a strategic framework for improving the delivery of health care. We believe that this approach...

In recent years, the drive to contain health care costs in the US has increased scrutiny of the traditional mode of delivering primary care where a patient is treated by his primary care physician during a face-to-face visit. In particular, two approaches, the use of "e-visits" and greater reliance on non-physician providers, have been suggested as...

Interest in innovative health care delivery models has increased due to measures such as the Affordable Care Act, which is designed to expand insurance coverage and contain health care costs. The goal of these innovations is to increase physician productivity without sacrificing quality of care. One innovation that has been forwarded as a low-cost...

This paper explores the rationing of bed capacity in a cardiac intensive care unit (ICU). We find that the length of stay for patients admitted to the ICU is influenced by the occupancy level of the ICU. In particular, a patient is likely to be discharged early when the occupancy in the ICU is high. This in turn leads to an increased likelihood of...

Online service marketplaces allow service buyers to post their project requests and service providers to bid for them. In order to reduce the transactional risks, marketplaces typically track and publish previous seller performance as a numerical reputation score. By analyzing a detailed transactional dataset with more than 1,800,000 bids correspon...

The pediatric intensive care unit (PICU), with limited number of beds and resource-intensive services, is a key component of patient flow. Because the PICU is a crossroads for many patients, transfer or discharge delays can negatively impact a patient's clinical status and efficiency. The objective of this study was to describe, using direct observ...

To examine the degree to which fast track (FT) treatment time varies among providers. A retrospective cohort study that included 105,783 FT visits at 3 emergency departments (EDs) during a 3-year period. We calculated the median treatment time for 80 primary providers (physicians and physician extenders) and 109 nurses (2 sites only). We used a hie...

ACADEMIC EMERGENCY MEDICINE 2011; 18:1262–1268 © 2011 by the Society for Academic Emergency Medicine Operations management (OM) is the science of understanding and improving business processes. For the emergency department (ED), OM principles can be used to reduce and alleviate the effects of crowding. A fundamental principle of OM is the waiting t...

In our prior work on product diffusions in presence of a capacity constraint, we postulated that a firm operating in such an environment should always attempt to fulfill as much of the present demand as is possible with the capacity constraint. In other words, the firm would never have demand backlogged while accumulating inventory. In this note, w...

As your hospital's ICU director, you are approached by the hospital's administration to help solve ongoing problems with ICU bed availability. The ICU seems to be constantly full, and trauma patients in the emergency department sometimes wait up to 24 hours before receiving a bed. Additionally, the cardiac surgeons were forced to cancel several ele...

Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED. We quantified the revenue effect of reducing boarding-the balance of h...

We use hospital-level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization—at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outc...

This paper explores the rationing of bed capacity in a cardiac intensive care unit (ICU). We find that the length of stay for patients admitted to the ICU is influenced by the occupancy level of the ICU. In particular, a patient is likely to be discharged early when the occupancy in the ICU is high. This in turn leads to an increased likelihood of...

As your hospital's ICU director, you are approached by the hospital's administration to help solve ongoing problems with ICU bed availability. The ICU seems to be constantly full, and trauma patients in the emergency department sometimes wait up to 24 hours before receiving a bed. Additionally, the cardiac surgeons were forced to cancel several ele...

We develop a structural demand model that captures the effect of out-of-stocks on customer choice. Our estimation method uses store-level data on sales and partial information on product availability. Our model allows for flexible substitution patterns which are based on utility maximization principles and can accommodate categorical and continuous...

Only a select few innovations ever see the light of day. Most end up as ‘also rans’. But how do we choose? And how do we know we’re not throwing out potential blockbusters along the way? Time to enter the innovation tournament.

In a wide variety of organizational settings, teams generate a number of possible solutions to a problem, and then select a few for further investigation. We examine the effectiveness of two creative problem solving processes for such tasks - one, where the group works together as a team (the team process), and the other where individuals first wor...

In this paper, we study the practice of forecast sharing and supply chain coordination with a game-theoretical model. We find that in a one-shot version of the game, forecasts are not shared truthfully by the customer. The supplier will rationally discount the forecast information in her capacity allocation. This results in Pareto suboptimality for...

Much of prior work in the area of service operations management has assumed service rates to be exogenous to the level of load on the system. Using operational data from patient transport services and cardiothoracic surgery--two vastly different health-care delivery services--we show that the processing speed of service workers is influenced by the...

Business processes have become more simultaneous and collaborative in the recent past. In simultaneous processes, multiple parties must adapt to one another in real time as decisions evolve. For example, New Product Development (NPD) requires collaboration in the context of Concurrent Engineering, and Supply Chain Management (SCM) in the context of...

In 2000, Dreamweaver, Macromedia's banner software product, had reached a market share of 80% among professional Web developers in the United States. With the American market approaching saturation, Macromedia decided to reach for a larger share of the international market. Macromedia decision makers wrestled with several choices. Should they add m...

In an innovation contest, a firm (the seeker) facing an innovation-related problem (e.g., a technical R& D problem) posts this problem to a population of independent agents (the solvers) and then provides an award to the agent that generated the best solution. In this paper, we analyze the interaction between a seeker and a set of solvers. Prior re...

Portfolio planning involves five basic tasks: identifying current as well as future gaps in the portfolio relative to the firm's overall business strategy, striking a balance between strengthening the firm's current strategic position and the exploration of new markets or technologies, creating a portfolio with the highest potential financial value...

This paper studies the effects of consumer search and firm entry on multiproduct firms' pricing and product line breadth decisions in a competitive market. We consider three search models: costless search, costly parallel search and costly sequential search. Conventional economic intuition suggests that firm entry leads to more competition which le...

Abstract We develop a structural demand model that captures the eect,of out-of-stocks on customer behavior that can be estimated,using data commonly,and easily available to a store manager. Our model allows for flexible substitution patterns which are based on utility maximization,principles and can accommodate categorical and continuous product ch...

The Newsvendor model captures the trade-off faced by a decision maker that needs to place a firm bet prior to the occurence of a random event. Previous research in Operations Management has mostly focused on deriving the decision that minimizes the expected mismatch costs. In contrast, we present two methods that estimate the unobservable cost para...

Understanding the value of a product development project is central to a firm’s choice of project portfolio. The value of a project to a firm depends not only on the project’s properties but also on the other projects being developed by the firm. This is due to interactions with other projects in the portfolio that address the same consumer need an...

This paper examines the importance and relevance of using operational variables to predict future earnings. We develop a general framework that helps to identify a set of operational variables useful for earnings prediction. Using our framework, we show that these operational variables significantly increase the out-of-sample predictive power of ea...

User design offers tantalizing potential benefits to manufacturers and consumers, including a closer match of products to user preferences, which should result in a higher willingness to pay for goods and services. There are two fundamental approaches that can be taken to user design: parameter-based systems and needs-based systems. With parameter-...

If searching for a better price becomes easier for consumers, conventional wisdom suggests that pricing pressure will increase on firms, thereby low-ering prices in the market. There is indeed evidence that recent search facilitating technologies, such as the Internet, have in some markets reduced prices. But there is also evidence that firms have...

Forecast sharing in a supply chain using linear price contracts often leads to inefficiencies as the buyer has an incentive to inflate demand forecasts to ensure sufficient supply. Recent research in supply chain contracting has focused on one-shot relationships, and has identified various contracts that align incentives in the supply chain and ind...

Consumers often know what kind of product they wish to purchase, but do not know which specific variant best fits their needs. As a result, a consumer may find an acceptable product in one retailer but nevertheless purchase nothing, opting to search other retailers for an even better product. We study several models of retail assortment planning, s...

Product customization uses a flexible production system to deliver a product to order that matches the needs of an individual customer or user. User design is a particular form of product customization that allows the user to specify the properties of that product. User design has emerged as a mechanism to build brand loyalty, to fit products to th...

We present a formal model of haggling between a name-your-own-price retailer and a set of individual buyers. Rather than posting a price, the retailer waits for potential buyers to submit offers for a given product and then chooses to either accept or reject them. Consumers whose offers have been rejected can invest in additional haggling effort an...

We present a model describing the demand dynamics of two new products competing for a limited target market. The demand trajectories of the two products are driven by a market saturation effect and an imitation effect reflecting the product experience of previous adopters. In this general setting, we provide analytical results for the sales traject...

We study the demand forecast-sharing process between a buyer of customized production equipment and a set of equipment suppliers. Based on a large data collection we undertook in the semiconductor equipment supply chain, we empirically investigate the relationship between the buyer's forecasting behavior and the supplier's delivery performance. The...

Production ramp-up is the period of time during which a manufacturing process is scaled up from a small laboratory-like environment to high-volume production. During this scale-up, the firm needs to overcome the numerous discrepancies between how the process is specified to operate as written in the process recipe and how it actually is operated at...

A major challenge in the creation of custom-designed products lies in the elicitation of customer needs. As customers are frequently unable to accurately articulate their needs, designers typically create one or several prototypes, which they then present to the customer. This process, which we call collaborative prototyping, allows both parties to...

Despite the importance of the Newsvendor model, little attention has been paid to its robustness with respect to the estimation of one of its inputs, the salvage value. This oversight is inappropriate because we show that the performance of the Newsvendor model is quite sensitive to the particular method chosen to estimate the salvage value. We hig...

We consider the order-fulfillment process of a supplier producing a customized capital good, such as production equipment, commercial aircraft, medical devices, or defense systems. As is common in these industries, prior to receiving a firm purchase order from the customer, the supplier receives a series of shared forecasts, which are called "soft...

e studythe offers submitted byconsumers to a large Name-Your-Own-Price (NYOP) online retailer. A distinctive feature of this retailer is that it allows consumers to repeatedlysubmit offers on one and the same product. While consumers could identifythe threshold price (the minimum price for which the retailer is willing to sell) byincrementing their...

Successful application of concurrent development processes (concurrent engineering) requires tight coordination. To speed development, tasks often proceed in parallel by relying on preliminary information from other tasks, information that has not yet been finalized. This frequently causes substantial rework using as much as 50% of total engineerin...

The Bass diffusion model is a well-known parametric approach to estimating new product demand trajectory over time. This paper generalizes the Bass model by allowing for a supply constraint. In the presence of a supply constraint, potential customers who are not able to obtain the new product join the waiting queue, generating backorders and potent...