Teamwork and Moral Hazard among Emergency Department Physicians

It is widely believed that organizations that deliver efficient care emphasize teamwork. However, the mechanism behind this possible relationship is unknown in health care and more generally. I investigate this question by studying emergency physicians who work in two settings differing only in the extent they manage work together: In a “nurse-managed” system patients are assigned by a triage nurse “manager,” and in a “self-managed” system physicians decide among themselves which patients to treat. The self-managed system increases throughput productivity by 10-13%. I show that essentially all of this net effect can be explained by reducing a moral hazard, in which physicians attempt to avoid work by delaying the discharge of patients. I find evidence that this reduction likely occurs by better information between peers and its use in the self-managed system to assign patients.