Does Technology Substitute for Nurses? Staffing Decisions in Nursing Homes

Over the past 10 years, many healthcare organizations have made significant investments in automating their clinical operations, mostly through the introduction of advanced information systems. Yet the impact of these investments on staffing is still not well understood. In this paper, we study the effect of information technology (IT)enabled automation on staffing decisions in healthcare facilities. Using unique nursing home IT data from 2006 to 2012, we find that the licensed nurse staffing level decreases by 5.8% in high-end nursing homes but increases by 7.6% in low-end homes after the adoption of automation technology. Our research explains this by analyzing the interplay of two competing effects of automation: the substitution of technology for labor and the leveraging of complementarity between technology and labor. We also find that increased automation improves the ratings on clinical quality by 6.9% and decreases admissions of less profitable residents by 14.7% on average. These observations are consistent with the predictions of an analytical staffing model that incorporates technology adoption and vertical differentiation. Overall, these findings suggest that the impact of automation technology on staffing decisions depends crucially on a facility's vertical position in the local marketplace.