Health Care

90 Results

 

Has Apple Reinvented the Watch?

Ryan Raffaelli has one big question about the Apple Watch: Will anyone other than existing Apple users buy it? Why Apple's new wearable falls short of radical innovation. Open for comment; 0 Comments posted.

Food Stamp Entrepreneurs: How Public Assistance Enables Business Bootstrapping

Gareth Olds finds a definitive link between an increase in access to government assistance programs and an increase in new company formation. Open for comment; 7 Comments posted.

Have a Better Idea To Improve Health Care?

Harvard launches an open competition to promote already proven innovations that could increase the quality and lower the cost of health care. Closed for comment; 0 Comments posted.

The Business of Behavioral Economics

Leslie John and Michael Norton explore how behavioral economics can help people overcome bad habits and change for the better. Open for comment; 4 Comments posted.

Climbing Down from the Ivory Tower

Nava Ashraf explains why it makes sense for field researchers to co-produce knowledge with the people they study and serve. Open for comment; 5 Comments posted.

Marketing Obamacare

HBS Professor John Quelch contends that the success of the Affordable Care Act depends more on marketing than it does on policy. And in Connecticut, he's got just the state to prove it. Open for comment; 4 Comments posted.

Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals

Nearly all managers must deal with the consequences of employee turnover within their organizations. Despite the importance of this issue, several authors have observed that academic attention has been disproportionately focused on the causes rather than consequences of turnover. To investigate consequences more closely, the authors of this paper focus on the effects of turnover in a particularly high-stakes setting: teaching hospitals. Specifically, the authors examine the effects on productivity of cohort turnover-the planned simultaneous exit of a large number of experienced employees-in this case, medical residents and fellows-and a similarly sized entry of new residents and fellows. Typically, at (or slightly before) the beginning of every July, the most senior residents at teaching hospitals move on to permanent medical positions or fellowships at other hospitals, and recent medical school graduates arrive as first-year residents. The authors examine the impact of the July turnover on hospital productivity using data on all patient admissions from a large, multi-state sample of American hospitals over a 16-year period. By comparing trends in teaching hospitals to those for non-teaching hospitals over the course of the year, they find significant negative effects of the residency turnover on hospital efficiency as measured by risk-adjusted, average length of stay. Overall, the cohort turnover of resident physicians in teaching hospitals reduces medical productivity by increasing resource utilization and, to a lesser degree, decreasing quality. The authors discuss implications for labor turnover in other types of organizations. Read More

Research Symposium 2014

Harvard Business School professors presented their research to colleagues, with topics including speaking up at work, a manager's responsibility to capitalism, and a strategy to fix the health care system. Open for comment; 0 Comments posted.

How Electronic Patient Records Can Slow Doctor Productivity

Electronic health records are sweeping through the medical field, but some doctors report a disturbing side effect. Instead of becoming more efficient, some practices are becoming less so. Robert Huckman's research explains why. Open for comment; 11 Comments posted.

The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay

Improving efficiency and customer experience are key objectives for managers of service organizations including hospitals. In this paper, the authors investigate queue management, a key operational decision, in the setting of a hospital emergency department. Specifically, they explore the impact on throughput time depending on whether an emergency department uses a pooled queuing system (in which a physician is assigned to a patient once the patient is placed in an emergency department bed) or a dedicated queuing system (in which physicians are assigned to specific patients at the point of triage). The authors measured throughput time based on individual patients' length of stay in the emergency department, starting with arrival to the emergency department and ending with a bed request for admission to the hospital or the discharge of a patient to home or to an outside facility. The findings show that, on average, the use of a dedicated queuing system decreased patients' lengths of stay by 10 percent. This represented a 32-minute reduction in length of stay—a meaningful time-savings for the emergency department and patients alike. The authors argue that physicians in the dedicated queuing system had both the incentive and ability to make sure their patients' care progressed efficiently, so that patients in the waiting room could be treated sooner than they otherwise would have. Read More

Encourage Breakthrough Health Care by Competing on Products Rather Than Patents

For too long, the science behind breakthrough therapeutics has been locked behind patents held by universities. Richard Hamermesh proposes the market compete on solutions rather than intellectual property rights. Open for comment; 0 Comments posted.

Increased Speed Equals Increased Wait: The Impact of a Reduction in Emergency Department Ultrasound Order Processing Time

This study of ultrasound test orders in hospital emergency departments (EDs) shows that, paradoxically, increasing capacity in a service setting may not alleviate congestion, and can actually increase it due to increased resource use. Specifically, the study finds that reducing the time it takes to order an ultrasound counter intuitively increases patient throughput time as a result of increased ultrasound use without a corresponding increase in quality of care. Furthermore, the authors show that in the complex, interconnected system or hospitals, changes in resource capacity affects not only the patients who receive the additional resources, but also other patients who share the resource, in this case, radiology. These results highlight how demand can be influenced by capacity due to behavioral responses to changes in resource availability, and that this change in demand has far reaching effects on multiple types of patients. Interestingly, the increased ultrasound ordering capacity was achieved by removing what appeared to be a "wasteful" step in the process. However, the results suggest that the step may not have been wasteful as it reduced inefficient ultrasound orders. In healthcare, these results are very important as they provide an explanation for some of the ever-increasing costs: reducing congestion through increased capacity results in even more congestion due to higher resource use. Overall, the study suggests an operations-based solution of increasing the cost/difficulty of ordering discretionary but sometimes low-efficacy treatments to address the rise in healthcare spending. Therefore, to improve hospital performance it could be optimal to put into place "inefficiencies" to become more efficient. Read More

Organizational Factors that Contribute to Operational Failures in Hospitals

Despite a pressing need to do so, hospitals are struggling to improve efficiency, quality of care, and patient experience. Operational failures—defined as instances where an employee does not have the supplies, equipment, information, or people needed to complete work tasks—contribute to hospitals' poor performance. Such failures waste at least 10 percent of caregivers' time, delay care, and contribute to safety lapses. This paper seeks to increase hospital productivity and quality of care by uncovering organizational factors associated with operational failures so that hospitals can reduce the frequency with which these failures occur. The authors, together with a team of 25 people, conducted direct observations of nurses on the medical/surgical wards of two hospitals, which surfaced 120 operational failures. The team also shadowed employees from the support departments that provided materials, medications, and equipment needed for patient care, tracing the flow of materials through the organizations' internal supply chains. This approach made it possible to discover organizational factors associated with the occurrence and persistence of operational failures. Overall, the study develops propositions that low levels of internal integration among upstream supply departments contributed to operational failures experienced by downstream frontline staff, thus negatively impacting performance outcomes, such as quality, timeliness, and efficiency. Read More

The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance

This study examines the relationship between hospital's focus on both conformance and experiential dimensions of quality and their impact on financial and clinical outcomes. Conformance quality measures the level of adherence to evidence-based standards of care achieved by the hospitals. Experiential quality, on the other hand, measures the extent to which caregivers consider the specific needs of the patient in care and communication, as perceived by the patient. These are important dimensions to investigate because hospitals may face a tension between improving clinical outcomes and maintaining their financial bottom-line. However, little has been known on the joint impact of these dimensions on hospital performance in terms of cost and clinical quality. The authors' study, which examined data from multiple sources for the 3,458 U.S. acute care hospitals, is a first step towards understanding these relationships. Results show that hospitals with high levels of combined quality are typically associated with higher costs, but better clinical outcomes, as measured by length of stay and readmissions. These results suggest that hospitals face a tradeoff between cost performance and clinical outcomes. The study also finds that the effect of conformance quality on length of stay is dependent on the level of experiential quality. Taken together, these findings underline the important synergy that exists between conformance and experiential quality with regards to clinical outcomes, a topic that has been completely overlooked in the extant literature. Read More

Five Imperatives for Improving Health Care

Leaders from Harvard's medical and business schools are exploring ways to improve health care delivery. In a new study, their Forum on Healthcare Innovation delivers five key imperatives. Open for comment; 13 Comments posted.

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

Learning Curve: Making the Most of Outsourcing

Companies that view outsourcing as an easy way to offload commodity work are missing powerful improvements to be gained by working closely with service providers, says Professor Robert S. Huckman. Open for comment; 5 Comments posted.

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

The Novelty Paradox & Bias for Normal Science: Evidence from Randomized Medical Grant Proposal Evaluations

A key task for executives and managers involved with innovation is to evaluate new ideas and proposals. In the sciences, one longstanding hypothesis contends that research ideas outside the mainstream are susceptible to being discounted, rejected, or ignored. These days, expert peer review in academic science is the approach most relied upon for enabling research agendas and providing research funds. Are novel research projects—those deviating from existing research paradigms—treated with a negative bias in expert evaluations? In this paper, the authors investigate how nascent scientific hypotheses are evaluated, specifically looking at the process by which medical research grant proposals are assessed by "gatekeepers": in this case, elite researchers from a leading medical school. Innovation requires novelty—but novelty, as this paper shows, is not appreciated and is in fact penalized. These findings help explain concerns about incrementalism in science and also point at the challenge that most organizations face when dealing with novel topics Read More

What Health Care Managers Need to Know--and How to Teach Them

Health care business managers are under tremendous pressure to become more innovative, more productive, more accountable. The question, asks Regina Herzlinger, is who is going to teach them these skills? Open for comment; 7 Comments posted.

Colocation and Scientific Collaboration: Evidence from a Field Experiment

In recent years there has been considerable interest in the policy arena on fostering collaborative and especially interdisciplinary collaborations. Yet there is scant evidence on how to do this in practice. To learn how team members find each other in the scientific community and decide to collaborate, the authors designed and carried out an experiment involving Harvard University and its affiliated hospitals. Results suggest that matching between scientists may be subject to considerable frictions, even among scientists in relatively close geographic proximity and in the same organizational system. However, even a brief and focused event facilitating face-to-face interactions can be useful for the formation of new scientific collaborations. Read More

The Unexpected Link Between Cadavers and Careers

Illustrating the strange socializing power of our occupational pursuits, a new study by professor Michel Anteby and colleagues finds a strong association between jobs and corpse donations. Open for comment; 2 Comments posted.

Will Business Management Save US Health Care?

Summing Up: Problems confronting the US health care system are much larger and broader than those that can be solved by management in the absence of other remedies, readers tell Jim Heskett. Open for comment; 28 Comments posted.

Employee-Suggestion Programs That Work

The key to operating a successful employee-suggestion program is to stop spending so much time on big-bang projects and focus on solving "low-hanging-fruit" problems. Research by Anita L. Tucker and Sara J. Singer. Open for comment; 13 Comments posted.

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

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

The Need for (Long) Chains in Kidney Exchange

It is illegal in the U.S. and in most of the world to buy or sell organs for transplantation. Kidney exchange arises because a healthy person has two kidneys and can donate one to a person in need of a transplant. But a donor and his or her intended recipient may be incompatible. An incompatible patient-donor pair can exchange with another pair, or with more than one other pair, in a cycle of exchanges among patient-donor pairs that allows each patient to receive a kidney from a compatible donor. In addition, sometimes exchange can be initiated by an altruistic donor who does not designate a particular intended patient, and in that case a chain of exchanges need not form a closed cycle. This paper seeks to understand why such longer chains have become increasingly important in practical kidney exchange. The answer has to do with the growing percentage of patients for whom finding a compatible donor is difficult. These "highly sensitized" patients are those for whom finding a transplantable kidney is difficult, even from a donor with the same blood type, because of tissue-type incompatibilities. This paper shows that highly sensitized patients are the ones to benefit from longer cycles and chains, and that this does not harm low-sensitized patients. Read More

HBS Faculty on Supreme Court Health Care Ruling

We asked three Harvard Business School faculty members, all experts in the health care field, to provide their views on various facets of one of this country's most important and complex problems. Open for comment; 12 Comments posted.

Learning from My Success and From Others’ Failure: Evidence from Minimally Invasive Cardiac Surgery

The importance of failure in the learning process is well recognized. In organizations as work grows increasingly fragmented—more specialized and divided into smaller tasks—the role of individuals in organizational learning becomes more important. This paper examines how individuals learn directly from their own past experience, and indirectly from the past experience of others. Focusing on one particular performance outcome, the quality of surgeries, findings indicate that individuals learn the most from their own successes and the failures of others, possibly because in both cases they attribute the outcomes to internal rather than external factors. This research has implications for healthcare and organizations more generally. Research by KC Diwas, Bradley R. Staats, and Francesca Gino. Read More

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. Closed for comment; 19 Comments posted.

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. Closed for comment; 16 Comments posted.

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. Read More

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. Read More

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. Read More

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. Closed for comment; 5 Comments posted.

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. Open for comment; 19 Comments posted.

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. Open for comment; 15 Comments posted.

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. Open for comment; 7 Comments posted.

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. Read More

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. Open for comment; 6 Comments posted.

How to Fix a Broken Marketplace

Alvin E. Roth was a co-winner of the Nobel Prize in Economic Science this week for his Harvard Business School research into market design and matching theory. This article explores his research. Open for comment; 5 Comments posted.

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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

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. Read More

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. Read More

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. Read More

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. Read More

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.) Closed for comment; 103 Comments posted.

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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

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. Read More

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. Read More

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? Closed for comment; 66 Comments posted.

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. Read More

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. Read More

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. Read More

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

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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? Read More

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. Read More

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. Read More

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. Read More

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. Read More

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 2nd HBS Alumni Healthcare Conference. Read More

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. Read More

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. Read More

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. Read More

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. Read More

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. Read More