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- 22 Aug 2012
- Working Paper Summaries
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. Key concepts include: There is a tradeoff because organizations must make allocation decisions between resolving a smaller number of higher priority problems and resolving a larger number of lower priority problems. In this study, an action-oriented approach was manifested by a higher percentage of solved problems that were considered "easy" to solve, which enabled more problems to be addressed with the same set of human and organizational resources. In contrast, the analysis-oriented approach, as characterized by identifying and solving higher priority problems, was not associated with higher perceived improvement in performance. Organizations should focus on increasing their capacity to act on improvement suggestions rather than generating suggestions and prioritizing them. Improvement programs are more likely to change employees' perceptions when they result in action being taken to resolve problems rather than when they are a symbolic show of manager interest. Closed for comment; 0 Comments.
- 22 Aug 2012
- Working Paper Summaries
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. Key concepts include: This study shows that participating in this particular program actually decreased perceived improvement in performance (PIP), on average. Compared to control work areas, the WalkRounds -based program was associated with a statistically significant decrease in PIP. This is an important result because, despite the limited evidence base, many hospitals throughout the U.S. and U.K. have implemented similar programs under the assumption that WalkRounds will improve organizational climate. The study provides a cautionary tale that visits by senior managers to the frontlines of the organization will not necessarily increase staff perceptions of performance improvement. Failure to meet expectations, once raised, can negatively impact organizational climate. Unless such programs are implemented with authentic motivation to identify and resolve issues, they may yield a negative return on the money invested. Closed for comment; 0 Comments.
- 09 Aug 2012
- Working Paper Summaries
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. Key concepts include: As long as there is such a high percentage of highly sensitized patients, long chains will help by increasing the number of these patients who can receive transplants, and each altruistic donor can have a big effect. Closed for comment; 0 Comments.
- 03 Jul 2012
- Research & Ideas
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; 0 Comments.
- 15 Feb 2012
- Working Paper Summaries
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. Key concepts include: Individuals learn more from their own success than from their own failure or from the success of others. The failure of others has a greater learning effect on individual performance than does others' successful experience. Certain types of experience help to make individuals more open to learning from their own failures. Individuals may be more open to reflect on their own failures and learn from them when they have greater experience with success. Seeing failures in others makes failure not only more acceptable, but it also makes one's own failure less threatening to one's own identity. In addition, the failure of others provides valuable knowledge that can be used for ongoing problem solving. Organizations may need to find other ways to make their members feel capable and interpret failures in ways that do not threaten their self-image. Closed for comment; 0 Comments.
- 28 Nov 2011
- Research & Ideas
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. Key concepts include: A new empirical model for allocating available kidneys to patients provides the potential for a system with greater fairness and longer life outcomes for those who receive transplants. The method—the work of Nikolaos Trichakis of Harvard Business School and Dimitris Bertsimas and Vivek F. Farias, both of MIT's Sloan School—can help policy designers create the most equitable point system based on their chosen constraints and criteria. In early simulations, the model suggests that life-year expectancies for the program can be increased by up to 8 percent, depending on variables plugged into the process. Closed for comment; 0 Comments.
- 28 Oct 2011
- Working Paper Summaries
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. Key concepts include: This is a novel method for designing allocation policies based on point systems in a systematic, data-driven way. The method offers flexibility to policymakers to select the fairness constraints desired, as well as the prioritization criteria on which the point system will be based. Critically, this method achieves an 8 percent increase in anticipated extra life-year gains, as demonstrated by numerical simulations, which are based on the statistical and simulation tools currently in use by US policymakers. Closed for comment; 0 Comments.
- 11 Oct 2011
- Working Paper Summaries
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. Key concepts include: Since the United States is the world's largest prescription drug market and has among the fewest price control mechanisms, the ACA holds significance to pharmaceutical firms internationally. Over the course of its implementation in coming years, the ACA will significantly expand prescription drug use, including at the relative expense of other health services. In 2015, Daemmrich projects pharmaceutical spending between $435 and $440 billion (12.5 percent of total health care spending) and in 2020 it will near $700 billion (14 percent of total health care spending). Congress and the Department of Health and Human Services will be hard pressed to explain increased drug spending to consumers, especially compared to Europe and Japan where reference pricing (capping prices at an average within a therapeutic category or among peer countries) has become the norm. The ACA nevertheless holds the potential for the United States to be the first country to break out of the silo framework that dominates health budgeting in countries using reference price systems and to instead set budgets at the disease (or patient) level, linked to health outcomes. Closed for comment; 0 Comments.
- 22 Sep 2011
- Working Paper Summaries
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. Key concepts include: Researchers often develop a new scale for their project rather than adapt existing scales. It would be better to utilize existing, psychometrically valid scales when possible so that cumulative knowledge of teamwork can be built. Many scales have been developed to assess teamwork. However, only eight scales satisfy the standard psychometric criteria the authors identified, and only three of those have been significantly associated with non-self-reported outcomes. Future research needs to clarify the concept of teamwork. Currently, the variation in ways of conceptualizing teamwork even within the scales that do show relationships to outcomes of interest makes it difficult to know what dimensions are core versus peripheral to the concept. The criteria set forth in this article should be considered standard research practice, and as such the scales that the authors identified are worthy of attention. Closed for comment; 0 Comments.
- 13 Jul 2011
- Research & Ideas
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; 0 Comments.
- 04 Jul 2011
- Research & Ideas
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. Closed for comment; 0 Comments.
- 19 May 2011
- Research & Ideas
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. Closed for comment; 0 Comments.
- 04 Apr 2011
- Research & Ideas
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. Open for comment; 0 Comments.
- 24 Mar 2011
- Working Paper Summaries
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. Key concepts include: The paper addresses the growing problem of providing hospitals with incentives to participate fully in a national kidney exchange, in order to achieve the gains that exchange on a large scale makes possible. Hospitals might be reluctant to enter a national exchange if it means they would have to give up kidneys to other institutions that could be used in their own patients. In large markets it is possible to redesign the matching mechanisms to guarantee individually rational allocations to hospitals at very modest cost in terms of "lost transplants." If care is taken in how kidney exchange mechanisms are organized, the problems of participation may be less troubling in large exchange programs than they are starting to be in multi-hospital exchanges as presently organized. Closed for comment; 0 Comments.
- 05 Jan 2011
- Op-Ed
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; 0 Comments.
- 08 Nov 2010
- Research & Ideas
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. Key concepts include: Successful marketplaces must be "thick, uncongested, and safe." Sufficient "thickness" means there are enough participants in the market to make it thrive. "Congestion" is what can happen when markets get too thick too fast: there are heaps of potential players, but not enough time for transactions to be made, accepted, or rejected effectively. "Safety" refers to an environment in which all parties feel secure enough to make decisions based on their best interests, rather than attempts to game a flawed system. Closed for comment; 0 Comments.
- 05 Nov 2010
- Research & Ideas
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. Key concepts include: Work-around cultures are pervasive in health care. Frequent work-arounds can be costly and impair organizational effectiveness. There are benefits to work-arounds which can be compelling on the individual level. Organizational policies and managerial behavior create a culture for work-arounds or systemic problem solving. The solution to work-arounds is an improvement-oriented culture. Closed for comment; 0 Comments.
- 30 Aug 2010
- Research & Ideas
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. Key concepts include: Patient-safety information campaigns can help hospital staff do more than just report problems when they occur. Thanks to information campaigns, frontline workers increased the rate of suggesting constructive solutions to problems by 74 percent. The frequency increased even more when unit managers joined in problem solving. By serving as role models, managers who actively engage in problem solving can lead their frontline workers to create and share solutions. Closed for comment; 0 Comments.
- 25 Aug 2010
- Working Paper Summaries
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. Key concepts include: Front-line workers offer more solutions to operational problems in departments whose managers are more engaged in problem solving. Information campaigns that promote process improvement generate more solutions from front-line workers, especially from workers whose managers are less routinely engaged in problem solving. Efforts at the organizational level can compensate for managers who cannot or do not create an environment that inspires front-line workers to speak up. Closed for comment; 0 Comments.
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; 0 Comments.