3 ms·

It is unprofitable to provide "perfect service", because in order to provide perfect service you need people on hand that aren't doing anything that can spring

It is unprofitable to provide "perfect service", because in order to provide perfect service you need people on hand that aren't doing anything that can spring into action during surge events. Someone's going to stand around when there's an imbalance between demand and labor supply. At our local grocery store, they overhire high school kids to stand around waiting to check people out. I've never waited in line for more than 3 minutes there. If they cut costs by firing the extra labor, I'd have to stand around and wait for the "optimized" labor force to attend to me.

solidsnack9000 2y ago
Is it so unprofitable to provide perfect service? Consider your grocery store example... The incentives of hospitals are much more complex than those of grocery stores, because of how different their business is. One of their major customers, for all patients, is the government -- which rewards some things and not others. Unlike the grocery store, then, the hospitals have to be quite attentive not only to the experience of people coming the door but the metagame of quality measures -- what the government thinks the experience of those people is. The article hints at a reasonable solution, which is for the government to include surplus capacity as part of their incentive structure.
- LorenPechtel 2y ago
  The basic problem is that demand is unpredictable. From a patient care perspective you overprovision so that pretty much any surge doesn't exceed capacity. But note that the cost to the hospital is pretty much based on what they provision for, not what they actually do. You're not paying the hospital the big bucks for actually doing, you're paying for the capacity to do it. From a profit perspective you overprovision only to the point where the marginal value drops to zero, a point far below the peak of a surge. Unless mandated otherwise no business provisions to the biggest surges.
  - solidsnack9000 2y ago
    Then it should be mandated; but that's not really a public versus private issue. It would have to be mandated in the public context, as well.
    - LorenPechtel 2y ago
      Agreed, it needs to be mandated. The healthcare companies fight tooth and nail against any such mandates, though, and usually get no more than a slap on the wrist even if there are rules. I think public is worse than private in this regard, it's a lot easier to change the definition of acceptable than it is to fund what really should be done.
janalsncm 2y ago
I have walked out of stores when the wait time is too long. If it didn’t hurt sales what would stop an entire Home Depot from operating off of only one employee? I am really hoping more people will be aware of the time they’re wasting and at least understand there’s a reason things are slow. Understaffing is a deliberate choice, and time is an extra tax that people apparently don’t consider. If you price your time at zero, the store will too.
- FireBeyond 2y ago
  John Oliver (I know, entertainment, but still) did a segment on this, although around the low end stores, like Dollar General. And they do exactly this. "Ever wonder why it's chaotic? Because many a time DG will literally schedule only two, or even one, employee to the shift. And they're on the register, so shelf stocking, cleaning is not on their agenda."
bruce511 2y ago
It's not polite yo say so, but perhaps it's worth considering that a for-profit Healthcare system is not necessarily aligned with a "optimal outcomes" system. In other words you can have a system which prioritizes profit, or you can have a system that prioritizes care. But you can't prioritize both.
- solidsnack9000 2y ago
  These hospitals are actually subject to regulation, though, and the regulation does not actually condition funding on spare capacity. That's just going to lead to broken results. A completely publicly funded healthcare system without spare capacity requirements would falter in the same way.
- cmrdporcupine 2y ago
  Our hospitals are not for-profit here in Canada, but they still have clusterfucked emergency rooms. (In some places, probably worse.) There's always some kind of rationing of the limited resource. There it's based in large part on you or your insurance's ability to pay. Here it's based on how much the government/taxpayer is willing to shell out.
  - quacked 2y ago
    Canada has also experienced record rates of recent population growth, so even at historically normal building levels (which are artificially suppressed) there would be a lag time between demand and availability.
    - cmrdporcupine 2y ago
      Nah, this is a problem going back to the early 90s, when governments got the neo-liberal austerity thing going. Especially the huge mid-90s cuts to federal health and social transfers to the provinces, by the federal Liberal gov't under Jean Chretien. Health care is the biggest portion of every provincial gov't budget, and always a point of contention.

solidsnack9000 2y ago

Is it so unprofitable to provide perfect service? Consider your grocery store example... The incentives of hospitals are much more complex than those of grocery stores, because of how different their business is. One of their major customers, for all patients, is the government -- which rewards some things and not others. Unlike the grocery store, then, the hospitals have to be quite attentive not only to the experience of people coming the door but the metagame of quality measures -- what the government thinks the experience of those people is. The article hints at a reasonable solution, which is for the government to include surplus capacity as part of their incentive structure.

LorenPechtel 2y ago
The basic problem is that demand is unpredictable. From a patient care perspective you overprovision so that pretty much any surge doesn't exceed capacity. But note that the cost to the hospital is pretty much based on what they provision for, not what they actually do. You're not paying the hospital the big bucks for actually doing, you're paying for the capacity to do it. From a profit perspective you overprovision only to the point where the marginal value drops to zero, a point far below the peak of a surge. Unless mandated otherwise no business provisions to the biggest surges.
- solidsnack9000 2y ago
  Then it should be mandated; but that's not really a public versus private issue. It would have to be mandated in the public context, as well.
  - LorenPechtel 2y ago
    Agreed, it needs to be mandated. The healthcare companies fight tooth and nail against any such mandates, though, and usually get no more than a slap on the wrist even if there are rules. I think public is worse than private in this regard, it's a lot easier to change the definition of acceptable than it is to fund what really should be done.

janalsncm 2y ago

I have walked out of stores when the wait time is too long. If it didn’t hurt sales what would stop an entire Home Depot from operating off of only one employee? I am really hoping more people will be aware of the time they’re wasting and at least understand there’s a reason things are slow. Understaffing is a deliberate choice, and time is an extra tax that people apparently don’t consider. If you price your time at zero, the store will too.

FireBeyond 2y ago
John Oliver (I know, entertainment, but still) did a segment on this, although around the low end stores, like Dollar General. And they do exactly this. "Ever wonder why it's chaotic? Because many a time DG will literally schedule only two, or even one, employee to the shift. And they're on the register, so shelf stocking, cleaning is not on their agenda."

bruce511 2y ago

It's not polite yo say so, but perhaps it's worth considering that a for-profit Healthcare system is not necessarily aligned with a "optimal outcomes" system. In other words you can have a system which prioritizes profit, or you can have a system that prioritizes care. But you can't prioritize both.

solidsnack9000 2y ago
These hospitals are actually subject to regulation, though, and the regulation does not actually condition funding on spare capacity. That's just going to lead to broken results. A completely publicly funded healthcare system without spare capacity requirements would falter in the same way.
cmrdporcupine 2y ago
Our hospitals are not for-profit here in Canada, but they still have clusterfucked emergency rooms. (In some places, probably worse.) There's always some kind of rationing of the limited resource. There it's based in large part on you or your insurance's ability to pay. Here it's based on how much the government/taxpayer is willing to shell out.
- quacked 2y ago
  Canada has also experienced record rates of recent population growth, so even at historically normal building levels (which are artificially suppressed) there would be a lag time between demand and availability.
  - cmrdporcupine 2y ago
    Nah, this is a problem going back to the early 90s, when governments got the neo-liberal austerity thing going. Especially the huge mid-90s cuts to federal health and social transfers to the provinces, by the federal Liberal gov't under Jean Chretien. Health care is the biggest portion of every provincial gov't budget, and always a point of contention.