Anita L. Tucker
12 Results
- 18 Apr 2013
- Working Papers
The Impact of Pooling on Throughput Time in Discretionary Work Settings: An Empirical Investigation of Emergency Department Length of Stay
Improving the productivity of their organizations' operating systems is an important objective for managers. Pooling—an operations management technique—has been proposed as a way to improve performance by reducing the negative impact of variability in demand for services. The idea is that pooling enables incoming work to be processed by any one of a bank of servers, which deceases the odds that an incoming unit of work will have to wait. Does pooling have a downside? The authors analyze data from a hospital's emergency department over four years. Findings show that, counter to what queuing theory would predict, pooling may actually increase procesdsing times in discretionary work settings. More specifically, patients have longer lengths of stay when emergency department physicians work in systems with pooled tasks and resources versus dedicated ones. Overall, the study suggests that managers of discretionary work systems should design control mechanisms to mitigate behaviors that benefit the employee to the detriment of customers or the organization. One mechanism is to make the workload constant regardless of work pace, which removes the benefit of slowing down. Read More
- 01 Mar 2013
- Working Papers
Hurry Up and Wait: Differential Impacts of Congestion, Bottleneck Pressure, and Predictability on Patient Length of Stay
This paper quantifies and analyzes trends related to the effects of increased workload on processing time across more than 250 hospitals. Hospitals are useful settings because they have varying levels of workload. In addition, these settings have high worker autonomy, which enables workers to more easily adjust their processing times in response to workload. Findings show that heavy load plays a significant role in processing times. Congestion is associated with longer lengths of stay. More surprisingly, when there is a high load of incoming patients from a low pressure area (emergency medical patients), current hospital inpatients' stays are longer compared to when incoming patients are from a high pressure area (emergency surgical patients). Furthermore, high predictability of the incoming patients (e.g. scheduled surgical patients) is associated with shorter lengths of stays for the current inpatients than when the incoming patients are less predictable (emergency surgical patients). In this study, there was no decrease in quality of care for patients with shorter lengths of stay. Read More
- 25 Feb 2013
- Working Papers
Fostering Organizational Learning: The Impact of Work Design on Workarounds, Errors, and Speaking Up About Internal Supply Chain Problems
In competitive environments, it is essential that organizations develop techniques that increase the willingness of employees to improve organizational performance. This is especially true in complex service organizations, such as hospitals, where employees have a wide range of discretionary activities that they can perform and lower levels of supervision. For this paper, the author conducted a series of laboratory experiments to test the possibility that managers can manipulate specific work circumstances to increase employees' willingness to speak up about problems, regardless of the employees' individual characteristics. Findings show that participants were more likely to contribute improvement suggestions when employees' role orientation was primed to include process improvement as part of daily work activities and when deliberate blockages made it difficult to work around problems in a way that conformed with policy. The study supports the notion that employee positive behavior can stem from deliberate work design, which falls under managers' jurisdiction, rather than solely from self-motivated employees. Overall, the research advances understanding of the influence of work design on two important employee behaviors-improvement-oriented action and risky workarounds that may harm customers. Read More
- 22 Aug 2012
- Working Papers
Key Drivers of Successful Implementation of an Employee Suggestion-Driven Improvement Program
Service organizations frequently implement improvement programs to increase quality. These programs often rely on employees' suggestions about improvement opportunities. Yet organizations face a trade-off with suggestion-driven improvement programs. Should managers use an "analysis-oriented" approach to surface a large number of problems, prioritize these, and select a small set of high priority ones for solution efforts? Or is it better to take an "action-oriented" approach, addressing problems raised by frontline staff regardless of priority ranking? In this paper the authors weigh the tradeoff between these two different approaches. Using data from 58 work groups in 20 hospitals that implemented an 18-month-long employee suggestion-driven improvement program, the authors find that an action-oriented approach was associated with higher perceived improvement in performance, while an analysis-oriented approach was not. The study suggests that the analysis-oriented approach negatively impacted employees' perceptions of improvement because it solicited, but not act on, employees' ideas. Read More
- 22 Aug 2012
- Working Papers
A Randomized Field Study of a Leadership WalkRounds™-Based Intervention
Hospitals face an imperative to improve quality, increase efficiency, and improve customer experience. Many hospitals utilize process improvement techniques to achieve these goals. One technique to involve senior managers, known in hospitals most commonly as Leadership WalkRounds™, is a program of visiting the organization's frontlines to observe and talk with employees while they do their work. The intention is that managers and frontline staff will work together to identify and resolve obstacles to efficiency, quality, or safety. (For brevity, the authors refer to it in this paper as WalkRounds™.) Rigorous testing of the effectiveness of process improvement interventions generally, and WalkRounds™ particularly, however, has been rare. This paper presents results from a field study that tested the effectiveness of a safety improvement program inspired by WalkRounds™. The authors compare pre-program and post-program measures of perceived improvement in performance (PIP) from work areas in hospitals that were randomly selected to implement the program, with pre- and post- measures from the same types of work areas in control hospitals. Findings show that, contrary to expectations, the WalkRounds™-based program was associated with decreased PIP. This study calls into question the general effectiveness of WalkRounds™ on employees' perceptions, which had been assumed in prior literature. Read More
- 21 Jan 2010
- Working Papers
Going Through the Motions: An Empirical Test of Management Involvement in Process Improvement
How can managers better lead their organizations to improve work processes? Describing their study of hospitals over an 18-month period, HBS professor Anita L. Tucker and Harvard School of Public Health professor Sara J. Singer detail how and why managers' taking action was more effective than their communicating about actions taken. Findings suggest, first, that taking action on known problems in specific work areas on at least a quarterly basis may improve the organizational climate for improvement. Second, the study indicates that managers would be well advised to take action-preferably substantive and intense action-in response to frontline workers' communications about problems. Overall, the research provides insight for senior managers who want to improve their organization's climate for process improvement. Read More
- 14 Aug 2007
- Working Papers
Improving Patient Outcomes: The Effects of Staff Participation and Collaboration in Healthcare Delivery
Health-care organizations have a well-documented, industry-wide need to improve their processes. To that aim, the Institute of Medicine has made at least 2 recommendations that focus on front-line staff—physicians, nurses, and respiratory therapists. The first recommendation states that front-line staff should be involved in unit decision-making and the design of work processes and workflow (participation). The second emphasizes respectful interactions among front-line staff, including information-sharing and coordinating activities to achieve organizational goals (collaboration). This study provides preliminary supporting evidence for the Institute of Medicine's recommendations to use a dual, front-line strategy of participation and collaboration to improve patient outcomes. Read More
- 05 Jul 2006
- Working Papers
Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units
How do hospital units, as complex service organizations, successfully implement best practices? Practices involve people and knowledge; people must apply knowledge to particular situations, so changing practices requires changing behavior. This study is a starting point for healthcare organizations to improve work practices. The researchers drew from literature on best practice transfer, team learning, and process change and developed four hypotheses to test at highly specialized hospital units that care for premature infants and critically ill newborns. Read More