DEPARTMENT OF MANAGEMENT’S
FALL 2013 RESEARCH COLLOQUIUM
BEYOND THE CHECKLIST:
It is not WHAT to do but HOW to do it
PRESENTED BY OUR FALL 2013
Raymond E. Miles Distinguished Scholar
RACHNA SHAH, PH.D.
• Associate Professor, University of Minnesota
• Associate Editor, Production And Operation
Management
• 2007 Wickham Skinner Early Career Research
Accomplishments Award
• 2004 Shingo Award for Excellence in Research
Friday, October 11, 2013
9:30am – 12:00pm
(Continental Breakfast: 9:00am / Presentation 9:30am)
BLB Seminar Rooms 281/285
Please RSVP to Virginia.Jones@unt.edu (x2072)
By October 1, 2013
Beyond The Checklist: It is not WHAT to do but HOW to do it
Rachna Shah, Associate Professor
Supply Chain and Operations Department
Carslon School of Management, University of Minnesota
Email: shahx024@umn.edu
Abstract
Checklists have gained immense popularity in recent years; they are associated with standardizing a
process by reducing variation. The relationship between standardization and performance has been
extensively studied and results show that increasing standardization improves performance at the
process and organization level. However, most of the previous research is conducted in
manufacturing settings, where the work is performed mostly within one organization, and variation
is measured at the process level rather than the constituent task level. In the current study, we
examine the relationship between task variability and process outcomes in a healthcare setting for a
process devised to treat patients suffering from STEMI, the most serious type of heart attacks.
Treatment for STEMI includes angioplasty (aka ballooning) to open the clogged arteries and is
available mostly in large metro areas. The treatment protocol we study is recognized as best in
class, is highly standardized and is extremely time sensitive. It consists of 9 major tasks performed
by workers in at least three independent organizations which are physically separated: rural
community hospital where the patient first arrives with chest pains, transporters, and Minneapolis
Heart Institute, where angioplasty in conducted. Using patient level data collected over a five year
period, we study whether task variability has an impact on process performance and which type of
task variability impacts process performance. Using task completion time and variability in task
completion time as our independent variables, we find that they have a statistically significant and
negative impact on patient length of stay and patient mortality. Our second finding is that not all
variability has a similar impact; specifically, variability in tasks involving handoffs (i.e. interorganizational tasks) has a significantly bigger impact than intra-organizational tasks.
Our study makes several contributions. First, our results highlight the advantages of
standardizing work in professional service organizations. Physicians have long argued that
standardizing patient care is not possible or advisable because each patient is unique. We show that
a critical condition like heart attack can be treated with a standard treatment protocol. These results
can have critical implications for health care policy and expenditure debate. Second, our results
guide the practicing managers deciding where and how to allocate their efforts in improving a
process. We show that in a process spanning multiple organizations, managers must first tend to
intra-organizational tasks and then put their efforts into improving inter-organizational tasks.
Finally, the current focus on using a checklist to ensure that correct tasks are done detracts from the
importance of personnel training in how those tasks should be done. We find that even in our best in
class process, different organizations vary greatly in the time they take to do the same task,
suggesting that simply knowing what to do does not ensure that it will be done that way every time.
BIO:
RACHNA SHAH, PhD, is an Associate Professor in the Supply Chain and Operations
Management Department at the University of Minnesota’s Carlson School of Management. She
received her PhD from the Fisher College of Business at The Ohio State University in 2002. Prior to
her PhD, she worked in the healthcare practice of a management-consulting firm for over four
years, where she was on the fast-track to partnership.
Professor Shah is globally recognized for her research in lean operations both in manufacturing and
service industries, and is widely published. In 2004, she received the prestigious “Shingo Award for
Excellence in Research” for her paper “Lean manufacturing: Context, Practice bundles and
Performance” published in the Journal of Operations Management (JOM). This and one other paper
are among the Top 10 Most Downloaded Papers since their publication online. In 2007, she
received the “Wickham Skinner Early Career Research Accomplishments Award” from the
Production and Operations Management Society. The award is given to a junior faculty member for
conducting research with a strong potential to impact theory and practice, and for overall research
productivity. She has published articles in the Journal of Operations Management, POMS
Chronicle, Decision Science, and IEEE Transactions on Engineering Management.
Professor Shah is a co-investigator on a research grant from the Medical Industry Leadership
Institute to study one of the most effective heart attack treatment programs in the U.S. She has
received grants from The McKnight Foundation and is a Research Fellow at The Ohio State
University Center for Operational Excellence. Professor Shah has taught operations management,
lean management and statistics courses at the undergrad, graduate and the PhD level, in the degree
and executive programs, at Carlson and other schools including INSEAD (France), IESE (Spain),
and Ohio State.
Professor Shah is very actively involved in performing service in and outside the Carlson School.
She is an Associate Editor at the Journal of Operations Management and Decision Sciences Journal,
and is a Senior Editor at Production and Operations Management. In 2009, she was selected to cochair the Annual National Decision Science Institute Conference held in San Diego in November
2010. She has chaired the Lean/Process improvement track at the Production and Operations
Management Society Conference since 2005, in addition to other responsibilities she has held.