Token Economy-Based Hospital Bed Allocation to Mitigate Information Asymmetry: Proof-of-Concept Study Through Simulation Implementation

Shusuke Hiragi; Jun Hatanaka; Osamu Sugiyama; Kenichi Saito; Masayuki Nambu; Tomohiro Kuroda

doi:10.2196/28877

Token Economy-Based Hospital Bed Allocation to Mitigate Information Asymmetry: Proof-of-Concept Study Through Simulation Implementation

JMIR Form Res. 2022 Mar 4;6(3):e28877. doi: 10.2196/28877.

Authors

Shusuke Hiragi^{1

2

3}, Jun Hatanaka², Osamu Sugiyama⁴, Kenichi Saito¹, Masayuki Nambu⁵, Tomohiro Kuroda^{1

2}

Affiliations

¹ Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan.
² Graduate School of Informatics, Kyoto University, Kyoto, Japan.
³ Division of Health Science, Tazuke Kofukai Medical Research Institute, Osaka, Japan.
⁴ Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁵ Preemptive Medicine & Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan.

PMID: 35254264
PMCID: PMC8933802
DOI: 10.2196/28877

Abstract

Background: Hospital bed management is an important resource allocation task in hospital management, but currently, it is a challenging task. However, acquiring an optimal solution is also difficult because intraorganizational information asymmetry exists. Signaling, as defined in the fields of economics, can be used to mitigate this problem.

Objective: We aimed to develop an assignment process that is based on a token economy as signaling intermediary.

Methods: We implemented a game-like simulation, representing token economy-based bed assignments, in which 3 players act as ward managers of 3 inpatient wards (1 each). As a preliminary evaluation, we recruited 9 nurse managers to play and then participate in a survey about qualitative perceptions for current and proposed methods (7-point Likert scale). We also asked them about preferred rewards for collected tokens. In addition, we quantitatively recorded participant pricing behavior.

Results: Participants scored the token economy-method positively in staff satisfaction (3.89 points vs 2.67 points) and patient safety (4.38 points vs 3.50 points) compared to the current method, but they scored the proposed method negatively for managerial rivalry, staff employee development, and benefit for patients. The majority of participants (7 out of 9) listed human resources as the preferred reward for tokens. There were slight associations between workload information and pricing.

Conclusions: Survey results indicate that the proposed method can improve staff satisfaction and patient safety by increasing the decision-making autonomy of staff but may also increase managerial rivalry, as expected from existing criticism for decentralized decision-making. Participant behavior indicated that token-based pricing can act as a signaling intermediary. Given responses related to rewards, a token system that is designed to incorporate human resource allocation is a promising method. Based on aforementioned discussion, we concluded that a token economy-based bed allocation system has the potential to be an optimal method by mitigating information asymmetry.

Keywords: bed occupancy; decision-making; hospital administration; hospital management; organization; resource allocation; simulation; token economy.

©Shusuke Hiragi, Jun Hatanaka, Osamu Sugiyama, Kenichi Saito, Masayuki Nambu, Tomohiro Kuroda. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.03.2022.