Measuring the Efficacy of the World's Managers

Over the past seven years, Harvard Business School's Raffaella Sadun and a team of researchers have interviewed managers at some 10,000 organizations in 20 countries. The goal: to determine how and why management practices differ vastly in style and quality not only across nations, but also across various organizations and industries.

Rethinking the Fairness of Organ Transplants

Because of an organ shortage, hundreds or even thousands of people miss out on needed organ transplants each year. Business researchers at Harvard and MIT are rethinking how kidney transplants are allocated to give patients longer lives. An interview with professor Nikolaos Trichakis.

Fairness, Efficiency, and Flexibility in Organ Allocation for Kidney Transplantation

For many people who suffer end-stage renal disease, a kidney transplant is considered a potentially life-saving gift. Allocation policies for kidneys from deceased donors are thus of central importance and have to accomplish major objectives in alleviating human suffering, prolonging life, and providing nondiscriminatory, fair, and equal access to organs for all patients. In this paper, the authors focused on national allocation policies in the United States and the recent effort to revise the current policy. Their design of a national allocation policy focuses on perhaps the simplest, most common and currently used priority method, namely a point system. They also present four case studies in which they designed new policies under different scenarios.

US Healthcare Reform and the Pharmaceutical Industry

The 2010 Patient Protection and Affordable Care Act (ACA) will restructure the US health care market in the coming years. For the pharmaceutical industry, the ACA is likely to prove a mixed blessing. In this paper, Assistant Professor Arthur Daemmrich analyzes the political economy of health care, specifically concerning health care reform. He then considers how the ACA will affect the pharmaceutical sector, both quantitatively in terms of the size of the prescription drug market and qualitatively in terms of industry structure and competitive dynamics. Daemmrich also places the current reforms into historical context and describes the political negotiations that enabled passage of the ACA.

Measuring Teamwork in Health Care Settings: A Review of Survey Instruments

It is critical to accurately assess teamwork in health-care organizations. About 60 percent of primary-care practices in the United States use team-based models to coordinate work across the broad spectrum of health professionals needed to deliver quality care; in many other countries the percentage is almost 100 percent. While the benefits of effective teamwork are substantial, effective teamwork is often lacking in these settings, with negative consequences for patients. To date, little has been known about the survey instruments available to measure teamwork. In this paper Valentine, Nembhard, and Edmondson report the results of their systematic review of survey instruments that have been used to measure teamwork in various contexts. Their research helps to identify existing teamwork scales that may be most useful in testing theoretical models.

Experimental Researcher Helps Improve Health Care in Zambia

In seven years of field work in Zambia, Africa, professor Nava Ashraf's work is helping get low-cost health care products and services to the people who need them most. From the HBS Alumni Bulletin.

Making the Case for Consumer-Driven Health Care

Even as so-called Obamacare becomes a central issue in the 2012 presidential election, policymakers and academics continue the debate on how best to deliver affordable and efficient health care services to millions of Americans. In this video interview, professor Regina Herzlinger makes the case that consumers should have more say over their own care.

Empathy: The Brand Equity of Retail

Retailers can offer great product selection and value, but those who lack empathy for their customers are at risk of losing them, says professor Ananth Raman.

Attention Medical Shoppers: What Health Care Can Learn from Walmart and Amazon

At a Harvard Business School panel discussion on health care management, experts looked to the retail industry as a possible model for delivering medical services more effectively. Participants included Harvard's Robert Huckman, Raffaella Sadun, David Cutler, and Atul Gawande.

Individual Rationality and Participation in Large Scale, Multi-Hospital Kidney Exchanges

As kidney exchange moves from local networks to a national level, a new set of problems arises. One central issue, for example, is how individual hospitals can be motivated to participate. This paper by Itai Ashlagi (Sloan School of Management, MIT) and Alvin E. Roth (Harvard Business School) provides a theoretical framework to study and overcome the kinds of problems that can be anticipated.

Funding Unpredictability Around Stem-Cell Research Inflicts Heavy Cost on Scientific Progress

Funding unpredictability in human embryonic stem-cell research inflicts a heavy cost on all scientific progress, says professor William Sahlman.

How to Fix a Broken Marketplace

A pioneer in the field of market design, Harvard Business School professor Alvin E. Roth has helped to repair flawed market systems in fields ranging from kidney donation to high-school student placement.

The Work-Around Culture: Unintended Consequences of Organizational Heroes

Professor Anita Tucker shares findings from her research on the problems caused by "work-around cultures" in hospitals.

Turning Employees Into Problem Solvers

To improve patient safety, hospitals hope their staff will use error-reporting systems. Question is, how can managers encourage employees to take the next step and ensure their constructive use? New research by Julia Adler-Milstein, Sara J. Singer, and HBS professor Michael W. Toffel.

Managerial Practices That Promote Voice and Taking Charge among Frontline Workers

How can front-line workers be encouraged to speak up when they know how to improve an organization's operation processes? This question is particularly urgent in the US health- care industry, where problems occur often and consequences range from minor inconveniences to serious patient harm. In this paper, HBS doctoral student Julia Adler-Milstein, Harvard School of Public Health professor Sara Singer, and HBS professor Michael W. Toffel examine the effectiveness of organizational information campaigns and managerial role modeling in encouraging hospital staff to speak up when they encounter operational problems and, when speaking up, to propose solutions to hospital management. The researchers find that both mechanisms can lead employees to report problems and propose solutions, and that information campaigns are particularly effective in departments whose managers are less engaged in problem solving.

Cincinnati Children's Hospital Medical Center

A recent Harvard Business School case by HBS professors Amy C. Edmondson and Anita Tucker explores how one hospital implemented its own version of health-care reform, taking overall performance levels from below average to the top 10 percent in the industry. From the HBS Alumni Bulletin.

The Economic Crisis and Medical Care Usage

The global economic crisis has taken a historic toll on national economies and household finances around the world. What is the impact of such large shocks on individuals and their behavior, especially on their willingness to seek routine medical care? In this research, Annamaria Lusardi of Dartmouth College, Daniel Schneider of Princeton University, and Peter Tufano of Harvard Business School find strong evidence that the economic crisis—manifested in job and wealth losses—has led to large reductions in the use of routine medical care. Specifically, more than a quarter of Americans reported reducing their use of such care, as did between 5 and 12 percent of Canadian, French, German, and British respondents.

Manager Visibility No Guarantee of Fixing Problems

Managers who merely put in time "walking the floor" are not doing enough when it comes to problem solving; in fact, it can make employees feel worse about their situation, says HBS professor Anita Tucker.

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.

Management's Role in Reforming Health Care

Health care managers are the missing link in debate over reform. Their skills and ideas are needed to sustain and improve upon multiple advances in the delivery of health care for the benefit of patients. An interview with HBS professor Richard M.J. Bohmer, MD, and an excerpt from his book Designing Care: Aligning the Nature and Management of Health Care.

A Market for Human Cadavers in All but Name?

A shortage of cadavers has hampered medical education and training, a market that entrepreneurs are stepping forward to address. HBS professor Michel Anteby argues that scholars must learn more about the market dynamics of this uncomfortable subject in order to inform political debate.

Operational Failures and Problem Solving: An Empirical Study of Incident Reporting

Operational failures occur within organizations across all industries, with consequences ranging from minor inconveniences to major catastrophes. How can managers encourage frontline workers to solve problems in response to operational failures? In the health-care industry, the setting for this study, operational failures occur often, and some are reported to voluntary incident reporting systems that are meant to help organizations learn from experience. Using data on nearly 7,500 reported incidents from a single hospital, the researchers found that problem-solving in response to operational failures is influenced by both the risk posed by the incident and the extent to which management demonstrates a commitment to problem-solving. Findings can be used by organizations to increase the contribution of incident reporting systems to operational performance improvement.

Input Constraints and the Efficiency of Entry: Lessons from Cardiac Surgery

Many professions rely on highly and variably skilled individuals. If a new firm is looking to enter a specific market, in addition to setting up a physical facility the company needs to hire or contract with specialized labor. In the short term, the supply of these specialists is relatively inelastic. From the point of view of economics, there remains a well-known potential for free entry to be inefficient when firms make entry decisions without internalizing the costs associated with the business they "steal" from incumbent firms. In 1996 Pennsylvania eliminated its certificate-of-need (CON) policy that had restricted entry by hospitals into expensive clinical programs, such as coronary artery bypass graft (CABG) programs—leading to an increase from 43 to 63 in the number of hospitals providing this service. HBS professor Robert Huckman and coauthors examine the welfare implications of entry in the market for cardiac surgery.

Why Can't Americans Get Health Care Right?

Change is desperately needed, agreed readers of Professor Jim Heskett's online forum. But how to make that change remains in doubt. What can Americans learn from solutions implemented by other countries? (Forum now closed; next forum begins September 4.)

Diagnosing the Public Health Care Alternative

With deep experience in health insurance reform, HBS faculty describe how improved competition in insurance plans could improve value for patients. Professors Regina E. Herzlinger, Robert Huckman, and Michael E. Porter take the pulse of a debate.

Broadening Focus: Spillovers and the Benefits of Specialization in the Hospital Industry

What is the optimal scope of operations for firms? This question has particular relevance for the US hospital industry, because understanding the effects of focus and spillovers might help hospitals determine how they should balance focusing in a single clinical area with building expertise in related areas. While some scholars argue that narrowing an organization's set of activities improves its operational efficiency, others have noted that seemingly unfocused operations perform at a high level and that a broader range of activities may in fact increase firm value. This study by HBS doctoral student Jonathan Clark and professor Robert Huckman highlights the potential role of spillovers—specifically complementary spillovers—in generating benefits from focus at the operating unit level.

Clay Christensen on Disrupting Health Care

In The Innovator's Prescription, professor Clayton Christensen and his coauthors target disruptive innovations that will make health care both more affordable and more effective in the future. Q&A with Christensen. From the HBS Alumni Bulletin.

Applying the Care Delivery Value Chain: HIV/AIDS Care in Resource Poor Settings

The prevention and treatment of a complex disease such as HIV/AIDS in resource‐poor settings presents enormous challenges. Many of the social and economic factors that make populations living in these settings vulnerable to HIV/AIDS such as poverty, malnutrition, and political instability conspire to create barriers to effective care delivery. Understanding how interventions are related to each other and how local socioeconomic factors influence them is critical to effective program design. The Care Delivery Value Chain (CDVC) looks at care as an overall system, not as a series of discrete interventions, and describes the activities required to deliver care, illustrating their sequence and organization. Government agencies, philanthropic organizations, and non‐governmental organizations can use the framework to improve HIV/AIDS care delivery.

How to Revive Health-Care Innovation

Simple solutions to complex problems lead to breakthroughs in industries from retailing to personal computers to printing. So let's try health care, too. According to HBS professor Clayton M. Christensen and coauthors of The Innovator's Prescription, such disruption to an industry might look like a threat, but it "always proves to be an extraordinary growth opportunity." Book excerpt.

Creating Leaders for Science-Based Businesses

The unique challenges of managing and leading science-based businesses—certain to be a driver of this century's new economy—demand new management paradigms. At Harvard Business School, the opportunities start just across the street. From HBS Alumni Bulletin.

What Should Employers Do about Health Care?

Companies that cut health care costs without improving the overall value of care eventually pay a price in terms of employee absenteeism and chronic ailments. According to Harvard University professor and strategy expert Michael E. Porter and coauthors, the best way to truly reduce health care costs is to improve quality.

Pursuing a Deadly Opportunity

Cadavers are a necessity for medical students and researchers, but the business of supplying this market is a touchy moral and ethical issue. Harvard Business School professor Michel Anteby and research associate Mikell Hyman explore strategies used by both academic and entrepreneurial organizations that deal in the dead.

The Rise of Medical Tourism

Medical tourism—traveling far and wide for health care that is often better and certainly cheaper than at home—appeals to patients with complaints ranging from heart ailments to knee pain. Why is India leading in the globalization of medical services? Q&A with Harvard Business School's Tarun Khanna.

The FDA: What Will the Next 100 Years Bring?

With the possible exception of the Internal Revenue Service, no other governmental agency touches the lives of more Americans than the U.S. Food and Drug Administration, which ensures the safety of $1.5 trillion worth of consumer goods and medicines. Harvard Business School professor Arthur A. Daemmrich discusses the impact and challenges of the agency and his new book, Perspectives on Risk and Regulation: The FDA at 100.

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.

Is Health Care Making You Better—or Dead?

Professor Regina Herzlinger has been studying the U.S. health care system for decades, advocating for consumer-driven reform as the best remedy. But the slow pace of change, which she attributes to a fat-cat network of insurers, policymakers, hospitals, and even employers, has her fed up. Her new book, Who Killed Health Care? adopts the emotional language of a manifesto in demanding change to make health care more responsive to customers, affordable to those in need, and a hotbed of innovation and entrepreneurship.

Health Care Under a Research Microscope

Perhaps no industry has caught the research attention of Harvard Business School faculty as much as health care. Researchers are investigating business-focused solutions on everything from improving team work among surgical teams to developing market motivations that increase the use of water purification in poor villages.

What Is the Government's Role in U.S. Healthcare?

Healthcare will grab ever more headlines in the U.S. in the coming months, says Jim Heskett. Any service that is on track to consume 40 percent of the gross national product of the world's largest economy by the year 2050 will be hard to ignore. But are we addressing healthcare cost issues with the creativity they deserve? What do you think?

Improving Public Health for the Poor

Microfinance may offer a window on new methods for widening access to healthcare for the poor, says Harvard Business School's Michael Chu. He and colleagues at the Harvard School of Public Health have embarked on a new project to serve this critical sector. Bringing together public healthcare and market forces "could have huge impact," he says.

Competition the Cure for Healthcare

Michael Porter is considered by many the world's foremost authority on competition and strategy. He discusses the need for fundamental reform in the way the United States delivers healthcare. Q&A.

Using Competition to Reform Healthcare

In their new book, HBS Professor Michael Porter and Elizabeth Olmsted Teisberg argue that the very structure of U.S. healthcare must be redesigned to create value and effective competition throughout the system. An excerpt from Redefining Health Care: Creating Value-Based Competition on Results.

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.

The Hidden Market for Babies

Surrogates. Fertility clinics. Egg donors. Adoption. It's time to recognize (and perhaps regulate) the huge market being created by reproductive technologies, says HBS professor Debora L. Spar. She discusses her new book, The Baby Business.

From Turf Wars to Learning Curves: How Hospitals Adopt New Technology

Turf wars and learning curves influence how new technology is adopted in hospitals. HBS professors Gary Pisano and Robert Huckman discuss the implications of their research for your organization.

New Learning at American Home Products

In Alfred D. Chandler Jr's new history of the modern chemical and pharma industries, American Home Products follows a singular path to success. An excerpt from Shaping the Industrial Century.

Entrepreneurial Hospital Pioneers New Model

A "Robin Hood" cardiac hospital in India—which charges wealthy patients, yet equally welcomes the destitute—is an exciting example of entrepreneurship in the subcontinent, says HBS professor Tarun Khanna.

Learning Tradeoffs in Organizations: Measuring Multiple Dimensions of Improvement to Investigate Learning-Curve Heterogeneity

How and why experience leads to performance improvement has made the learning curve an important management topic for sites ranging from nuclear power plants to cardiac surgical units. This new research looks deeper at learning curves by focusing on learning rates in technology adoption in similar organizations along multiple, potentially competing dimensions. Using longitudinal data from sixteen hospitals that are adopting a new technology for cardiac surgery, it specifically studies two dimensions: efficiency and application innovation and the potential tradeoff between efficiency and application innovation. It also asks how such tradeoffs are influenced.

Side Effects: The Case of Propecia

Selling Propecia was a difficult marketing task for Merck & Co., and was recently the subject of a case study debated by Harvard Business School alumni.

Solving the Health Care Conundrum

Executive summary of a presentation on reforming health care made by Professor Michael Porter at a Harvard Business School Publishing Virtual Seminar.

Health Care Research and Prospects

A groundbreaking project at Harvard Business School is bringing together faculty, researchers, and students to probe issues in health care management. An interview with Professor Gary P. Pisano.

Why Europe Lags in Pharmaceuticals and Biotech

Governmental, cultural and academic differences are hurting Europe’s chances of gaining on the U.S. Can anything be done?

Sometimes Success Begins at Failure

Projects that appear to be duds may have unintended upsides—Viagra started life and failed as a drug for hypertension. Here are tips for turning negative test results into gold.

The Business Case for Diabetes Disease Management

Diabetes is a tough disease to tackle. A case-study discussion led by HBS professor Nancy Beaulieu asked why it is so complex for business and society, and what might be done to curb its incidence.

The Business of Babies

The demand for babies by infertile couples and other would-be parents is huge—and little discussed. HBS professor Debora L. Spar looks at the market realities.

Making Biotech Work as a Business

What will it take for biotechnology to fulfill its economic potential? Participants need to think twice about the strategies and assumptions that are driving the industry, says HBS professor Gary P. Pisano.

Healthcare Conference Looks At Ailing Industry

What's plaguing healthcare? Experts including HBS professor Clayton Christensen make the diagnosis on future trends for biology and medicine—and the business opportunities within—at the 2^nd HBS Alumni Healthcare Conference.

How Technological Disruption Changes Everything

From countries to companies, HBS Professor Clayton Christensen sees disruptive technologies upsetting applecarts all over the globe. In his talk at the HBS Global Alumni Conference 2001, Christensen discussed how disruptive technologies could change forever the health field, Microsoft, and even the Harvard Business School.

The Business of Biotech

On the cusp of what most analysts agree will be the age of biotechology, Professor Gary P. Pisano and four HBS alums on the front lines of the biotech revolution offer their views of the challenges, issues and opportunities facing the industry in the laboratory, the boardroom and the marketplace.

What's an Internet Business Model? Ask a Health Care Professional

Health care and the Internet are well-matched for each other, quipped one panelist at the IS2K conference, "because no one wants to pay for either." Quips aside, the health care field is emerging as one of the busiest laboratories for exciting new business models—and the stakes are high indeed. In a discussion moderated by HBS Professor Lynda Applegate, experts in this burgeoning realm of Internet activity talked about what their businesses are doing to change the rules, all while trying to fulfill their primary goal of earning patients' trust.

Putting Health Care Consumers in the Driver's Seat

Amid rising costs, changing attitudes and increasing dissatisfaction with the existing health care system, the development of consumer-driven health care is a given: the question, according to participants in an HBS conference chaired by Professor Regina A. Herzlinger, is not If, but When.

Growing Pains: Prescriptions for U.S. Health Care

The health care industry may look seriously ill, says HBS Professor Clayton M. Christensen, but it's merely suffering the growing pains of a natural evolution as technology forces change at both the high and low ends of the market.