Patiently looking
Jan 19, 2025
Voronoi (aka Visual Economist) made this map about service times at emergency rooms around the U.S.
This map shows why one shouldn’t just stick state-level data into a state-level map by default.
The data are median service times, defined as the duration of the visit from the moment a patients arrive to the moment they leave. For reasons to be explained below, I don’t like this metric. The data are in terms of hours and minutes, and encoded in the color scale.
As with any choropleth, the dominant features of this map are the shapes and sizes of various pieces but these don’t carry any data. The eastern seaboard contains many states that are small in area but dense in population, and always produces a messy, crowded smorgasbord of labels and guiding lines.
The color scale is progressive (continuous) making it even harder to gain an appreciation of the spatial pattern. For the sake of argument, imagine a truly continuous color scale tuned to the median service times in number of minutes. There would be as many shades as there are unique number of values on the map. For example, the state with 2 hr 12 min median time would receive a different shade than the one with 2 hr 11 min. Looking at the dataset, I found 43 unique values of median service time in the 52 states and territories. Thus, almost every state would wear its unique shade, making it hard to answer such common questions as: which cluster of states have high/medium/low median service times?
(As the underlying software may only be capable of printing a finite number of shades so in reality, there aren’t any true continuous scales. A continuous scale is just a discrete scale with many levels of shades. For this map, I’d group the states into at most five categories, requiring five shades.)
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We’re now reaching the D corner of the Trifecta Checkup (link).
I’d transform the data to relative values, such as an index against the median or average in the nation. The colors now indicate how much higher or lower is the state’s median service time than that of the nation. With this transformed data, it makes more sense to use a bidirectional color scale so that there are different colors for higher vs lower than average.
Lastly, I’m not sure about the use of median service time, as opposed to average (mean) service time. I suspect that the distribution is heavily skewed toward longer values so that the median service time falls below the mean service time. If, however, the service time distribution is roughly symmetric around the median, then the mean and median service times will be very similar, and thus the metric selection doesn’t matter.
Imagine you're the healthcare provider and your bonus is based on managing median service times. You have an incentive to let a small number of patients wait an extraordinary amount of time, while serving a bunch of patients who require relatively simple procedures. If it's a mean service time, the values of the extreme outliers will be spread over all the patients while the median service time is affected by the number of such outliers but not their magnitudes.
When I pulled down the publicly available data (link), I found additional data fields. The emergency room visits are further broken into four categories (low, medium, high, very high), and a median is reported within each category. Thus, we have a little idea how extreme the top values can be.
The following dotplot shows this:
A chart like this is still challenging to read since there are 52 territories, ordered by the value on a metric. If the analyst can say what are interesting questions, e.g. breaking up the territories into regions, then a grouping can be applied to the above chart to aid comprehension.