Using agency analysis to develop a comprehensive understanding of throughput times in the emergency department

Typically patients in the emergency department experience long waiting times, primarily caused by process inefficiencies (Schellein et al. in Anaesthesist 58(2):163-170, 2009). Furthermore, the emergency departments have a significant impact on the revenue generation for the hospital (Schnellen 2008). Thus the emergency department should be made an important area of focus to design and develop appropriate measures for optimisation. Literature reports different inefficiencies such as "loss" of patients in the radiology (Andersson and Karlberg in Health Policy 55(3):187-207, 2001) or social loafing (Morton and Bevan in Health Policy 85(2):207-217, 2008). The present article adopts a socio-technical perspective and focuses on information asymmetries between the various actors as a key reason for these inefficiencies. In so doing, the paper provides an analysis of the emergency department using principal-agent theory (PAT), suggests a software-based monitoring system in order to reduce information asymmetries and evaluates this system in an empirical investigation.