Recovering from Critical Incidents: Evidence from Paramedic Performance

Abstract

Problem Definition:In service operations settings where the difficulty of jobs is unpredictable, workerscan encounter critical incidents (CIs)—jobs which are sufficiently disturbing to challenge workers’ copingmechanisms. We examine the impact of encountering CIs on subsequent operational performance of workers.Academic / Practical Relevance:Prior work has examined the effects of CIs on the long-term psycho-logical health of workers. We demonstrate that encountering CIs has a practically meaningful impact onoperational performance. We also examine the time-dependency and process-dependency of the effect, andanalyze whether it is mitigated by individual characteristics such as age or experience.Methodology:We use data on 902,002 ambulance activations conducted by paramedics at the LondonAmbulance Service (LAS). We define CIs as incidents where patients have a high probability of dying at thescene, and examine the impact of such events on the paramedics’ performance for the remainder of theirshifts. Our outcomes are the completion time of the ambulance activation and each of its five sub-processes.The exogenous assignment of CIs to paramedic crews allows a clean identification of our effect using ashift-level difference-in-differences specification.Results:Crews who have encountered one prior CI (two prior CIs) spend on average 2.6% (7.5%) moretime completing each remaining ambulance activation in the shift. The impact is strongest for the jobsimmediately following a CI but persists throughout the shift. The largest effects come from the sub-processeswhich are least standardized and where paramedics cannot rely on standard operating procedures. Theduration effect is larger for teams of older paramedics, but is simultaneously mitigated by experience.Managerial Implications:Our results show that CIs increase subsequent job duration and that more thanone CIs have a compounding, negative effect on operational performance. As a result, managers in settingswhere performance consistency is key would be advised not to assign new jobs to teams with recent CI experiences.