MAXIMIZERS AND SATISFICERS IN THE EMERGENCY DEPARTMENT

Purpose: We investigated whether being a maximizer or satisficer influences an Emergency Department (ED) provider’s individual throughput performance.

Methods: We hypothesized that, because of the workload and need to make decisions rapidly, ED providers will tend to be satisficers, rather than maximizers, and that those who are maximizers will see fewer patients per hour and use more resources than satisficers.  Attending physicians, residents, and mid-level providers from four affiliated acute-care hospitals were invited to take part in a web-based survey. The survey included a published, validated, 6-item maximization scale, which ranged from 1 to 7. A score of 4 or more indicated that an individual had maximizer tendencies. Each respondent was subsequently linked to an administrative database that reported that individual’s personal ED throughput performance in terms of patients-per-hour (PPH). Because of inherent variability in PPH due to different practice location and provider status, a median performance was computed for each group of providers (e.g. mid-levels at hospital A). Each individual was referenced to the median for their respective group, with a PPH greater than the median being identified as “fast”. Accordingly, each respondent was characterized as a maximizer or satisficer, and as fast or slow. A 2-by-2 contingency table was used to compute the chi-square.  We also used regression analysis to analyze the raw data, holding constant profession (physician, nurse practitioner, physician assistant), hospital, years in practice, and gender.

Results: Of the 173 providers who were invited to participate, 94 responded for an overall response rate of 54%. Three later declined to have their results included; complete data were available for 84 subjects. Scores on the maximization scale ranged from 1.82 to 5.83, with a mean of 3.84 and a median of 3.75. Raw PPH ranged from 0.13 to 2.95. The chi-square was 0.028 with a p-value of 0.867.  In the regression analysis, the maximization scale was never statistically significant.

Conclusions: Contrary to our hypothesis, the ED setting includes both maximizers and satisficers.  In addition, those who are maximizers do not see fewer patients per hour or use more resources.  It appears that ED providers who are maximizers have been able to overcome potential biases in decision-making.