Finding Your Match … at the Hospital

Jillian Chown, an associate professor of management and organizations at the Kellogg School, and Carlos Inoue of the University of Illinois at Urbana–Champaign used real-world data to show how one strategy—the creation of a formal, specialized role—can help address this challenge of task allocation.    

Chown and Inoue based their research on real-world data gleaned from hospitals—an environment that has long intrigued Chown. She and Inoue realized they could get access to a wealth of healthcare data from Brazil, where Inoue grew up.   

They focused on maternity wards in Brazilian hospitals, where the creation of a new, specialized role—the obstetric nurse—led to major changes in how hospitals assigned patients to healthcare providers. The researchers found that this new role helped hospitals more consistently pair patients with healthcare providers whose expertise matched the patients’ level of medical risk. Improved matching was, in turn, linked to better outcomes for mothers and newborns.  

The lesson is that simply having the right expertise on your team is not necessarily enough, according to Chown. “You have to pay attention to how that expertise is being used,” she says. “How do we make sure that tasks are being allocated to the right person in the right way?”  

Reforms in maternal care  

More than two million babies are born in Brazil each year and, historically, many of those children have been delivered via C-section. Between 2007 and 2012, for instance, roughly 50 percent of all births were via C-section. “There’s a lot of controversy about what the right C-section rate is, but most would agree that [Brazil’s] is higher than what one would expect,” says Chown.  

In a national effort to bring down the rate of C-sections, the Brazilian public healthcare system introduced the specialized obstetric-nurse role into some (though not all) of its hospitals over the past two decades. Obstetric nurses were formally trained and credentialed specialists who were able to manage vaginal deliveries without a doctor, though they were not allowed to perform C-sections.  

Prior to this effort, all births in Brazilian public hospitals, whether vaginal births or C-sections, were handled by physicians. The specific physician assigned to a patient, however, depended on who was on staff when the patient arrived. But this process changed when obstetric nurses were added to the fold. While doctors at hospitals with obstetric nurses still managed some vaginal deliveries, they no longer managed all of them. Instead, when an expectant mother came in, the hospital would assign the patient to either a doctor or an obstetric nurse. 

Learning about this new obstetric-nurse role encouraged Chown and Inoue to study the broader effects of this specialization. While many people had previously studied specialization in the context of coordination challenges (such as how to make experts work well on tasks together), Chown says, “nobody had really talked about this idea that the task-allocation problem also gets harder.”  

They realized that the challenge the hospitals now faced in deciding which patients should see doctors versus obstetric nurses—and whether patients ultimately end up with providers whose expertise fits their needs, an outcome the researchers call “professional–client matching”—would give them the perfect opportunity to study this process themselves. 

15 million births 

Chown and Inoue’s data set represented more than 15 million births between 2012 and 2022 and included detailed information on the mothers, healthcare providers, and hospitals. 

To figure out how well patients were being matched to providers, the researchers divided patients into three tiers (low, medium, or high) based on how medically risky their deliveries were. Then, they assigned the doctors and obstetric nurses to different groups (low-risk specialist, generalist, or high-risk specialist) based on the types of cases they had done in the past. Since vaginal births tended to be more common for lower-risk pregnancies, obstetric nurses tended to get more lower-risk patients, but they did still end up with patients across the spectrum. 

Because Chown and Inoue could see which patients ended up with which doctors or nurses, they could determine, for example, if low-risk patients had been paired with low-risk or high-risk specialists—and how these pairings changed over time. They were also able to run a control simulation that randomly assigned each day’s patients to the providers who were actually on shift that day, giving them a baseline with which they compared the real-world results. 

Shocking results 

The researchers found that before the introduction of obstetric nurses, patient assignment was basically as good as random.  

“This was shocking,” says Chown. “Even though they had physicians who were specialized in lower-risk births or specialized in high-risk births, they weren’t effectively utilizing that. The expertise was there, but it was kind of invisible.” 

But by adding the new specialized role, things changed. With providers formally divided into two visible categories, matching improved by 9.6 percentage points, representing a 30 percent increase from the average. Chown notes that roughly 60 percent of that increase reflects the changed mix of providers and patients in the pool—the mechanical effect of adding a new role. But the remaining 40 percent (about 3.9 percentage points) reflects something more: after adopting the new role, hospitals routed patients to appropriate providers better than chance, in a way they hadn’t before. 

“What it did is it created a role that was visible and explicitly focused on low-risk births,” Chown says. “So then that pathway became actionable in a way it wasn’t before.” 

Chown and Inoue were particularly excited to find that this improvement in patient–provider matching was linked to better health outcomes for mothers and children, including fewer complications and shorter hospital stays. The scope of the effect is modest but comparable to other maternity-care interventions studied by researchers, such as midwife-led continuity-of-care models. 

Ripe for further exploration 

Moving forward, Chown is interested in seeing if she can find similar kinds of improvement in other medical specialties, like cardiology, while also learning more about the hospital triage process. “This would be ripe to dig into more, to go to the triage group in a hospital and figure out how they’re actually making these decisions,” says Chown. 

Still, the researchers acknowledge that not every organization will benefit from the creation of specialized roles. 

Predictable workflows also increased the impact of the specialized role. When hospitals could anticipate incoming cases, they could plan assignments in advance and match patients to expertise deliberately, rather than reactively assigning whoever happened to be available. Likewise, hospitals with more organizational experience, where healthcare providers were more familiar with well-established workflows or systems within the hospital, also showed stronger results at first, though this tapered off as less-experienced hospitals caught up over time. 

Collectively, these additional findings suggest that “you can’t just take an intervention, see that it works somewhere, and then decide it’s going to work for you, too,” says Chown. “You have to think about what features of the organization or the environment are actually required to support that positive outcome.”