Technology, Skills, and Performance: The Case of Robots in Surgery (Job Market Paper)

In this paper, I investigate the potential of new technologies to reduce disparities in healthcare provision. Differences in providers’ skills may cause variation in patient outcomes. The adoption of new technologies, like robots, can be a solution to this problem if technological gains are decreasing in users’ skills or may exacerbate existing variation in performance otherwise. In England, the diffusion of surgical robots coincided with an improvement in average performance and a convergence in outcomes between high and lower-skilled surgeons. I study whether this pattern can be attributed to the adoption of robots using the universe of inpatient admissions for prostate cancer surgery. To identify the effects of robotic surgery on patient outcomes, I exploit quasi-random variation in the geographic allocation of robots within a structural model, allowing for selection and heterogeneity in treatment effects. I find that robots shorten patients’ length of stay in hospital and decrease the incidence of adverse events from surgery, but their effects depend on surgeons’ skills. The robot has little impact on the performance of highly skilled surgeons, while lower skilled surgeons gain the most from it. I also uncover a strong pattern of negative selection on both observable and unobservable characteristics. Although the attainable gains are higher for lower-skilled surgeons, they use the robot the least. My results suggest that the potential benefit of a new technology largely depends on how it combines with the skills of individual users.

Listen to my JMP at the Visible Hand Podcast

Available also at

Crowding, Contact Time, and Health Outcomes with David C. Chan, Jonathan Gruber, and Stephenson Strobel

Killer Deals: The Impact of Hospital Mergers on Hospital Quality with Thomas P. Hoe

This paper studies the impact of hospital mergers on the quality of clinical care. We use an event study framework to evaluate the population of hospital mergers in the English NHS between 2006 and 2015. We find that mergers have immediate and persistent negative impacts on clinical quality. Our estimates indicate that on average, a merger increased the likelihood of death by 0.4 percentage points and the likelihood of readmission by 0.9 percentage points. Under very conservative assumptions, these effects are valued at approximately 4 per cent of annual hospital costs.

“Firms’ Gender Composition and Women’s Employment” with Mimosa Distefano and Tanya Surovtseva

We analyse the impact of gender composition of peers and management at the time of labour market entry on employment outcomes of women. We find that entering the labor market in a firm at the same time as other female entrants is associated with lower employment rate among women in a short and medium run. Initial employment in firms with more female managers seems to be conductive to higher employment rates, especially in the medium and long run. Firm’s gender composition also has a significant impact on maternity. Having more female managers in the initial firm increases the probability of having children and of coming back full-time after maternity leave.

Summary in INPS Relazione Annuale 2022 : here article: here

Other fields

Using real time Location Data to measure bed-side contact time between nurses and patients” with Ann-Marie Cannaby, Vanda Carter, Thomas Hoe, and Stephenson Strobel, submitted.

Measuring nursing movements using real time tracking data at the Royal Wolverhampton Hospital Trust with Ann-Marie Cannaby, Vanda Carter, Thomas Hoe, and Stephenson Strobel, Spatial and Spatio-temporal Epidemiology, November (2022)

The feasibility and validity of using a real time location system to measure bed side contact time”, with Ann-Marie Cannaby, Vanda Carter, Thomas Hoe, and Stephenson Strobel, Journal of Research in Nursing, November (2021)