Deadline Effect in Stroke Patient Care: A Temporal Motivation Theory Perspective of Process Management

Stroke is a highly time-sensitive medical emergency, and earlier treatment is crucial. Drawing on Temporal Motivation Theory, we investigate a “deadline effect” in stroke care and analyze how two deadlines, that is, a medically oriented one (administering Tissue Plasminogen Activator, TPA, within 4.5 h of symptom onset) and a goal-oriented one (the 60-min in-hospital target from Target:Stroke), shape care consistency. We define a deadline effect as a variable task processing rate under time pressure from a pending task completion deadline, which can cause inconsistent care. Clinicians may work more slowly when patients arrive soon after symptom onset, given ample time remains before the 4.5-h TPA window. Using an accelerated-failure-time model and addressing patient selection bias, we find that shorter onset-to-door times correlate with longer door-to-needle times, and vice versa, confirming the medically oriented deadline effect. As a result, care time may vary considerably based on how much of the TPA window remains. Under Target:Stroke, a goal-driven national initiative in the United States to improve stroke care quality, stroke teams face an additional 60-min in-hospital deadline. Our findings show that the initiative prompts stroke teams to prioritize the tighter goal and maintain a more consistent care pace, regardless of patients' arrival times. Our mechanism analyses reveal two boundary conditions for the main findings: (i) when the downstream time segment ends with a mid-point patient care milestone rather than the strict TPA administration deadline or (ii) when the system congestion level is high, the main findings do not hold, advancing the deadline effect literature from an operational standpoint. Furthermore, our major findings are robust to other confounding factors and model assumptions, ruling out alternative explanations. Notably, post hoc analyses confirm that Target:Stroke fosters consistent time performance without adversely affecting other health outcomes, advocating its efficacy. In sum, we highlight the operational implications of multiple deadlines in stroke care, extending the broader deadline effect literature. For hospital clinicians, properly set goals can stabilize care processes and strengthen overall performance, emphasizing the strategic value of well-designed deadlines in time-critical healthcare settings.