Susan Feng Lu is on a mission to help the elderly get high-quality care.
“As the only child in my family, I've always pondered how I could provide excellent care for my aging parents,” Lu says. “In my quest, I recalled an old saying from my cultural background that emphasizes treating the elderly with the same respect and care we would give to our own parents. This led me to dedicate nearly two decades of research to the nursing home industry.”
Lu is the Gerald Lyles Rising Star Professor of Management at Purdue’s Mitchell E. Daniels, Jr. School of Business and an award-winning researcher trained in economics and operations management. Her overarching objectives have consistently revolved around minimizing costs, maximizing social welfare, and efficiently and effectively allocating resources. Leveraging the tools of game theory, econometrics and optimization methodologies, her work delves into what drives healthcare delivery performance.
In 2023, Lu offered expert testimony at a hearing of the United States Senate Special Committee on Aging. She is also an affiliated faculty of healthcare engineering at the Regenstrief Center for Healthcare Engineering in Purdue’s Discovery Park district.
“Managing the efficiency of healthcare delivery presents a formidable challenge for countries grappling with aging populations and insufficient healthcare resources,” Lu says. “My aim is to understand the impacts of public policies and technological innovations on the operational and managerial aspects of elderly care.”
One focus of Lu’s research is information transparency between patients and healthcare professionals, which is essential to providing high-quality care. “Publicly disclosing quality information about individual nursing homes allows consumers to identify high-quality providers, reduces search costs and enhances firms' responsiveness to quality issues,” she says.
Still, information transparency does not guarantee immediate quality improvement due to two major concerns, Lu says. First, medical providers may selectively choose patients to improve their scores on report cards, a practice known as “cherry picking.” Second, providers may focus only on excelling along the disclosed quality dimensions while neglecting the undisclosed ones, which is referred to as “teaching to the test.”
“Access to diverse dimensions of individual nurse data, including working conditions, factors influencing work-life balance, employment history, demographics, education and geographic distribution, provide us with valuable insights into the dynamics of the nurse workforce.”
Although the Center for Medicare and Medicaid Services (CMS) has done a good job of gathering quality data from nursing homes, Lu’s research finds that social media platforms, particularly Yelp, exert a dominant influence over government report cards in shaping nursing home demand. “While higher Yelp ratings correlated with increased net incomes for nursing homes, there is less evidence that these ratings motivated quality improvements among the facilities,” she adds.
Given those results, Lu says the CMS should acknowledge social media platforms as valuable sources of information and collaborate with reputable platforms to promote the public awareness of government report cards.
“Similar collaborations have produced positive outcomes in the restaurant industry, where displaying government hygiene scores on Yelp resulted in a significant decrease in consumers’ willingness to patronize restaurants with low scores,” she says. “By embracing the potential of social media platforms, we can leverage their influence to drive informed decision-making and positively shape the choices people make regarding nursing home care.”
Telemedicine became more common during the global COVID-19 pandemic, limiting doctor’s office and hospital visits to ensure safety for everyone. But rather than diminish the quality of care, research from Susan Feng Lu at the Daniels School of Business finds that increasing wider use of telemedicine in the emergency room (ER) can yield positive results for patients and providers alike.
Overcrowding in ERs is a common and nagging problem. It is not only costly for hospitals, but also compromises care quality and patient experience. Lu say finding ways to improve ER care delivery is important, as long as it actually works.
“The adoption of telemedicine leads to a larger reduction in ER length of stay when there is a demand surge or supply shortage,” Lu says. “Importantly, this improvement does not come at the expense of care quality or patient cost.”
Lu’s research found that on average, telemedicine availability in the ER significantly reduces average patients’ length of stay, which is partially driven by the flexible resource allocation. It also shows more specifically the impact telemedicine can have in reducing ER congestion and provides positive implications.
“We’ve seen the great promise of telemedicine application and hopefully the unexpected enrollment of such policies alongside this research can help get the process underway to help more healthcare facilities use this technology in ERs and elsewhere,” Lu says. “Policymakers can play a role as well by reducing regulatory barriers that inhibit more expansive use of telemedicine and by creating incentives that encourage hospitals to more broadly adopt telemedicine in emergency rooms.”
In addition to quality disclosure, Lu says healthcare institutions must carefully consider their staffing choices since they have a direct bearing on patient outcomes and expenses. However, choosing the appropriate personnel levels can frequently be a challenge due to behavioral, technological and regulatory issues.
For example, the healthcare sector has witnessed widespread reports of nurse burnout resulting from excessive overtime assignments. In response, several states have implemented laws prohibiting mandatory overtime. However, Lu’s research shows that despite the good intentions behind such policies, they inadvertently lead to a decline in the quality of care provided by nursing homes.
“The imposition of caps on mandatory overtime hours prompted nursing homes to make unfavorable staffing adjustments, such as substituting full-time nurses' overtime hours with those offered by contract nurses,” Lu says. “Regrettably, these changes ultimately resulted in a severe deterioration of care quality in nursing homes.”
Lu says there are two commonly recognized methods to address the issues brought on by the labor market's scarcity of nurses. The first strategy seeks to increase the nursing profession's attractiveness, including pay raises and benefits, flexible work hours and enhanced working conditions. The second strategy is to promote nursing immigration, which involves hiring licensed nurses from other nations.
“Access to diverse dimensions of individual nurse data, including working conditions, factors influencing work-life balance, employment history, demographics, education and geographic distribution, is crucial,” Lu adds. “Such data provides us with valuable insights into the dynamics of the nurse workforce, allowing for evidence-based decision-making and targeted staffing strategies.”
Concern over the possible negative effects of facilities purchased by private equity firms and ownership conversions from nonprofits to for-profits has also grown in recent years, and Lu is one of the few scholars to address the issue.
Examining the impact of nonprofit ownership conversion on nursing homes, Lu has found that those facing higher levels of financial distress are more likely to undergo nonprofit (NP) to for-profit (FP) conversions. She highlights the need for policymakers to enhance oversight over NP to FP conversions, particularly in nursing homes that exhibit significant financial distress prior to the change.
“In addition, the findings suggest that managers should avoid the pitfall of reducing registered nurse staffing levels and instead focus on streamlining overhead operations,” Lu says. “This approach allows for increased operational efficiency without compromising the quality of care provided.”
“By embracing the potential of social media platforms, we can leverage their influence to drive informed decision-making and positively shape the choices people make regarding nursing home care.”
Ownership disclosure is another area of Lu’s research. Lawsuits alleging patient abuse or neglect sharply increased in a number of plaintiff-friendly states throughout the second part of the 1990s, so she looked at the asset-shielding strategies that developed in these states in response to this worrying trend.
The investigation revealed two noteworthy trends: big chains selling properties to smaller, less judgmental owners; and less tendency to name chain-owned properties after the main company or sibling properties.
“Public ownership disclosure is a potent tool for curbing asset-shielding practices in huge chains and enforcing responsibility,” Lu says. “The bad reputation and effects of subpar care inside a single unit can spread to the larger ownership organization if ownership information is made visible. Because of this spillover effect, large chains have a strong motivation to regularly monitor the quality of care provided across all of their units.”
In addition to improving care through increased transparency, strategic staffing and ownership disclosure, Lu says there are high expectations for the emergence and advancement of robotics capable of assisting the elderly in their daily activities, including walking, toileting and bathing.
“There needs to be a collective exploration of creative ideas and innovative approaches to support and revitalize the nursing home industry,” she says. “I hope that through collaborative efforts, thoughtful policies and technological advancements, we can create an environment where nursing homes thrive as compassionate and reliable sources of care for our aging population.”
