  Customer slowdown describes the phenomenon that a customer's service
requirement increases with experienced delay. In healthcare settings, there is
substantial empirical evidence for slowdown, particularly when a patient's
delay exceeds a certain threshold. For such threshold slowdown situations, we
design and analyze a many-server system that leads to a two-dimensional Markov
process. Analysis of this system leads to insights into the potentially
detrimental effects of slowdown, especially in heavy-traffic conditions. We
quantify the consequences of underprovisioning due to neglecting slowdown,
demonstrate the presence of a subtle bistable system behavior, and discuss in
detail the snowball effect: A delayed customer has an increased service
requirement, causing longer delays for other customers, who in turn due to
slowdown might require longer service times.
