HEALTHCARE OPERATIONS IN HIGH-STAKES CLINICAL SETTINGS: WORKLOAD, TECHNOLOGY, AND CLINICAL DECISION-MAKING

Background: This dissertation investigates how operational pressures, workload dynamics, and technological interventions shape patient care quality and service efficiency in high-stakes healthcare settings. Methodology and Results: This dissertation applies operational management concepts, causal inference methods, and econometrics to improve healthcare operations management. The first study (Chapter 1) examines how different dimensions of workload influence voluntary attrition among ICU nurses. While greater patient responsibility within a shift is associated with higher engagement and a lower likelihood of quitting, sustained cumulative workload, overtime shifts, and exposure to patient mortality significantly increase voluntary turnover. The second study (Chapter 2) evaluates the adoption of a Virtual Nurse (VN) model on patient outcomes. The implementation reduces patient length of stay by 7.18% and decreases 30- and 60-day readmission rates by approximately 2%. The third study (Chapter 3) shifts focus to the Emergency Department and examines how operational pressures influence physicians’ discretionary clinical decisions, specifically the ordering of resource-intensive diagnostic tests such as CT scans. The results show that increased multitasking, proximity to shift end, and accumulated prior patient interactions reduce the likelihood of ordering a CT scan. Conclusion: This dissertation advances the understanding of how workload, technology, and clinical decision-making interact to shape operational and clinical outcomes in high-acuity healthcare environments. The findings offer actionable managerial insights on workload design, task delegation, and the strategic integration of virtual workforce solutions to sustain high-quality care under operational pressure.