Work after work: The impact of new service delivery models on work hours

• Author: Hessam Bavafa,Christian Terwiesch
• DOI: http://doi.org/10.1002/joom.1052
• Published date: 01 October 2019
• Date: 01 October 2019

RESEARCH ARTICLE

Work after work: The impact of new service delivery models on

work hours

Hessam Bavafa

1,2

| Christian Terwiesch

3,4

1

Wisconsin School of Business, University

of Wisconsin-Madison, Madison, Wisconsin

2

School of Medicine and Public Health,

University of Wisconsin-Madison, Madison,

Wisconsin

3

The Wharton School, University of

Pennsylvania, Philadelphia, Pennsylvania

4

Perelman School of Medicine, University

of Pennsylvania, Philadelphia, Pennsylvania

Correspondence

Hessam Bavafa, Wisconsin School of

Business, University of Wisconsin-Madison,

975 University Ave., Madison, WI 53706.

Email: hessam.bavafa@wisc.edu

Funding information

Wisconsin Alumni Research Foundation

Handling Editor: Anita Tucker

Abstract

In many professional service organizations (PSOs), a single server such as a physi-

cian or lawyer delivers services to customers across multiple channels. In these set-

tings, 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 physi-

cians providing care to patients following the introduction of a new service deliv-

ery channel, e-visits. Our data cover an 8.5-year timespan and include 3.3 million

patient encounters, including about one million e-visits. We find that e-visit adop-

tion nearly doubles the number of hours containing work (defined as office visits

or e-visits) each week. Of the additional hours containing such work, only 49% are

in weekday business hours; the rest are in weekday evenings or early mornings

(37%) and on weekends (14%). We also show that increases in office or e-visit

workloads lead to more post-workday activity in the e-visit channel. We conclude

the analysis by examining the impact of these workloads on e-visit work content,

as measured by the number of words and amount of time spent on each e-visit; we

estimate precise but practically small effects of workload on these work content

outcomes.

KEYWORDS

empirical, e-visits, healthcare operations, service operations, work-life balance

1|INTRODUCTION

Technology has changed the way that professionals

deliver services. Rather than interacting with their clients

only in the office, business people also engage with their

clients via phone calls, virtual meetings, and emails. Edu-

cators teach classes in-person and online, hold office

hours, and deal with emails. Moreover, physicians and

nurses see their patients in office visits but also provide

care through synchronous and asynchronous digital inter-

actions, via video and online channels. These types of

care fall under the broad umbrella of telemedicine, and its

use has risen rapidly since its introduction (Dorsey &

Topol, 2016). More specifically, they fall under the newer

model of multichannel care that has come to permeate

healthcare service delivery.

A common bind among these types of multichannel ser-

vices is that they are professional services warranting unique

operations management models (Lewis & Brown, 2012).

Professional services are defined in Harvey, Heineke, and

Lewis (2016) as services that include high levels of customer

contact, with significant face-to-face interactions and consul-

tations (a second part of the definition requires that profes-

sionals dictate both the outcome and means of the process at

stake, in part due to information asymmetry between the

server and client). A physician satisfies these conditions, for

example, because she has significant contact with her

patients and makes key decisions about both the care out-

come and its process.

Received: 18 July 2018 Revised: 11 June 2019 Accepted: 1 July 2019

DOI: 10.1002/joom.1052

636 © 2019 Association for Supply Chain Management, Inc. J Oper Manag. 2019;65:636–658.wileyonlinelibrary.com/journal/joom

Prior literature in operations management has focused on

various aspects of managing PSOs such as server collabora-

tion (Senot, Chandrasekaran, & Ward, 2016), the impact of

task variety on learning and productivity (Avgerinos &

Gokpinar, 2018), and compensation structures (Goodale,

Kuratko, & Hornsby, 2008). In this article, we detail the

unique challenges faced by professional primary care servers

(physicians) in a multichannel setting. We focus on the

introduction of e-visits, a technological channel enabling

secure messaging between patients and physicians. Our goal

is to investigate several hypotheses regarding the impact of

multichannel services on physicians' workflow, workload,

and work content.

Using technology to deliver services has many advan-

tages, including enhanced convenience for the customer.

Travel time is saved when clients do not have to drive to

legal offices, students can gain clarity by emailing their

teachers over the weekend, and patients benefit from receiv-

ing care from the comfort of their homes (Dorsey et al.,

2013). From an operational perspective, the lack of coordi-

nation on time and place needed between servers and clients

for technologically provided services is appealing (Berry,

2006). The ability to use one resource for multiple work-

streams is also attractive as it minimizes slack during the

day. In theory, a lawyer could switch to answering emails on

days with few in-person meetings, and a physician can use

the time gained from a canceled appointment to conduct

e-visits. If such slack time is not adequate, however, the pro-

fessional will need to carve out time from her leisure hours

to accommodate the new service needs. The workload and

workflow implications are a priori not obvious, and thus

these new channels of service raise concerns.

In this article, we hypothesize and empirically investigate

three concerns regarding the introduction of a technological

channel of service delivery in the PSO setting of primary

care. Each of the concerns, we investigate is related to one

of three streams of literature within operations management

on which we build. These concerns (and associated hypothe-

ses) are the following. First, do physicians experience “work

creep”or “work after work”

1

(Kossek, 2016; Schieman &

Glavin, 2008) upon the introduction of a technological ser-

vice channel? Specifically, this question arises because ser-

vice channels using technology can frequently be delivered

online and thus at home. Second, how do the daily work-

loads in the office visit and e-visit channels interact to affect

work creep? For example, a day with many office visits or e-

visits leaves less time for the physician to respond to e-visits

during the day; this will increase the likelihood of the physi-

cian working late. Third, how do these workloads affect

work content? For example, if physicians conduct e-visits

after a long workday, they may be tired and more prone to

cutting corners. The objective of our research is to

empirically test for the presence of these concerns and mea-

sure the sizes of their associated effects.

We next outline the streams of literature on which we

build. First, as mentioned, we build on the PSO literature by

examining how a new service channel using technology

affects the server's workload, workflow, and work content.

The professional setting is important because it implies that

the professional must herself deliver service via the new

channel instead of offloading it to another server. This idea

of a single server dealing with multiple channels as they

become introduced is new and contrasts with much of the

current literature, which has focused more on how new ser-

vice channels affect “non-professional”servers such as those

in retail (Bell, Gallino, & Moreno, 2014; Gallino & Moreno,

2014; Gao & Su, 2016). The professional setting is also

unique because such servers typically have control over

much of their workflow (Harvey, 1990), forcing them to

individually reoptimize their workflow when a new service

delivery channel is introduced. Additionally, the PSO

setting—and particularly the physician setting—implies that

we should not anticipate large reductions in work content

even when workload is high, because professionals have

strong norms to prioritize their clients' needs above their

own (Harvey et al., 2016).

Second, because of this paper's focus on the impact of

technology on the physician's work-life balance, this

research is connected to an already developed and growing

body of work on “techno-stress”(Ayyagari, Grover, &

Purvis, 2011; Ragu-Nathan, Tarafdar, Ragu-Nathan, & Tu,

2008). This term signifies the stress created as a result of

information and computer technology use. Recent studies

document the “work–home interference”caused by commu-

nication technologies (Derks, van Duin, Tims, & Bakker,

2015), and the relationship between email load and work-

load stress (Barley, Meyerson, & Grodal, 2011; Stich,

Tarafdar, Stacey, & Cooper, 2019). In particular, this

research is about connectivity broadly and not only about

the number of hours spent on technology, motivating our

key outcome of hours containing work (not hours of work).

To this literature, we contribute new evidence using

timestamp data from a group of professionals deeply vulner-

able to techno-stress. This paper thus complements the broad

array of survey-based studies more prevalent in the litera-

ture, for example, Mano & Mesch, 2010 and Tarafdar,

Pullins, & Ragu-Nathan, 2015. In our particular setting of

healthcare, there are growing concerns about physician burn-

out due to the digitization of healthcare (New York Times,

2018; The New Yorker, 2018).

Third, this paper is connected to the literature on work-

load and how it impacts work patterns and work content

(Hopp, Iravani, & Yuen, 2007; Ibanez, Clark, Huckman, &

Staats, 2017). We review this literature in more detail as we

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