- 08 Jun 2015
- Working Paper Summaries
Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
There are large regional variations in rates of medical treatments in the United States and other countries. What drives such variation? This paper develops a model of supply of and demand for health care, and suggests that a large degree of regional variation appears to be explained by differences in physician beliefs about the efficacy of particular therapies. As much as 35 percent of end-of-life Medicare expenditures and 12 percent of overall Medicare expenditures are explained by physician beliefs that cannot be explained by patient preferences or justified by evidence of clinical effectiveness. Closed for comment; 0 Comments.
- 27 May 2015
- Research & Ideas
Build 'Scaffolds' to Improve Performance of Temporary Teams
Many critical tasks are performed by teams created on the fly, but lack of stability can hinder their performance. Amy Edmondson and Melissa Valentine use the idea of scaffolds to produce greater collaboration and efficiency on temporary teams. Open for comment; 0 Comments.
- 06 Apr 2015
- Research & Ideas
After Germanwings, More Attention Needed on Employee Mental Health
The Germanwings tragedy catapulted the issues of mental health and corporate risk and responsibility into the world's headlines. Professor John Quelch argues it's time for companies to make employee mental health more than an afterthought. Open for comment; 0 Comments.
- 02 Apr 2015
- Research & Ideas
Digital Initiative Summit: Freeing Patient Data to Enable Innovation
It's difficult to have innovation without data—which is one reason why the health care industry in the United States is too expensive. One remedy: Make the patient the customer. Open for comment; 0 Comments.
- 01 Apr 2015
- Research & Ideas
The Slow, Steady Battle to Fix Cancer Care
Thomas Feeley is on a quest to make payment procedures for cancer patients easier, hopefully less expensive, and in the process help change how health care is delivered in America. Open for comment; 0 Comments.
- 26 Jan 2015
- Research & Ideas
National Health Costs Could Decrease if Managers Reduce Work Stress
Joel Goh and colleagues estimate that workplace stress is responsible for up to 8 percent of national spending on health care and contributes to 120,000 deaths a year. Is better management the fix? Open for comment; 0 Comments.
- 27 Dec 2014
- Working Paper Summaries
How Should We Pay for Health Care?
Improving provider incentives and reimbursement must become a central component in health care reform. Payments need to align with the value delivered to patients: better health outcomes delivered at lower costs. Today, however, deeply‐flawed reimbursement approaches actively discourage providers from delivering value to their patients. In this paper the authors argue that reimbursement through bundled payments is the only approach that aligns providers, payers, and suppliers in a healthy competition to increase patient value. The authors describe the principles of value‐based bundled payments, how such bundles should be constructed, and why they believe this reimbursement method best aligns everyone's interests around value. They show how recent improvements in measuring patient's outcomes and the cost of care are overcoming the past barriers to wider adoption of bundled payments. They conclude by describing how bundled payments can transform competition in health care, and the longer‐term implications for providers, payers, employers, and health care delivery systems. Key concepts include: A value‐based bundled payment is a single payment for treating a patient with a specific medical condition across a full cycle of care. A bundled payment should cover all the procedures, tests, drugs, devices, and services during inpatient, outpatient, and rehabilitative care for a patient's medical condition. The limited adoption of value‐based bundles to date has been caused by today's fragmented structure for delivering healthcare, and inadequate or non‐existent measurement of costs and outcomes at the medical‐condition level. Recent advances in value‐based healthcare delivery concepts set the stage for much more widespread adoption of value-based bundled payments. Closed for comment; 0 Comments.
- 31 Oct 2014
- Op-Ed
Ebola’s Call To Arms About Disaster Preparedness
US health care has just received a critical wake-up call. Risk management tools used to handle normal disruptions are completely inadequate to quell a major catastrophe such as Ebola, says Gautam Mukunda. Open for comment; 0 Comments.
- 18 Aug 2014
- Research & Ideas
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.
- 06 Aug 2014
- Research & Ideas
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; 0 Comments.
- 16 Jul 2014
- HBS Case
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; 0 Comments.
- 31 Jan 2014
- Working Paper Summaries
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. Key concepts include: This study tests the impact of a queuing system structure on the throughput time of patients in an emergency department that had recently switched from a pooled queuing system to a dedicated queuing system. Patients experienced faster throughput times when physicians were working in a dedicated queuing system as opposed to a pooled queuing system. The benefits of a dedicated queuing system may be due to greater visibility into one's workload and the increased ability for physicians to manage patient flow. Closed for comment; 0 Comments.
- 05 Dec 2013
- Op-Ed
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. Closed for comment; 0 Comments.
- 15 Jul 2013
- Research & Ideas
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. Closed for comment; 0 Comments.
- 18 Apr 2013
- Working Paper Summaries
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. Key concepts include: This research offers practical insights for workplace managers and health care policymakers. In workplaces where workers have discretionary control, the potential negative effects of designing pooled systems must be carefully considered. This has implications for designing and managing staffing structures and workflows, particularly in the context of service delivery organizations. Managers should consider implementing group incentives rather than individual incentives to motivate workers. This may encourage fast workers to reduce their speed just enough so that they will not negatively affect the productivity of others by over-utilizing shared resources. While workplaces often seek to incentivize workers through pay-for-performance programs that focus on individual productivity, a group-level approach may help counteract the negative effects that fast workers exhibit on overall productivity levels. In health care, emergency departments may benefit from implementing non-pooled work systems in which patients are assigned to a doctor-nurse team immediately upon arrival. Closed for comment; 0 Comments.
- 21 Nov 2012
- Research & Ideas
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; 0 Comments.
- 05 Sep 2012
- What Do You Think?
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.
- 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.
Consumer-centered Health Care Depends on Accessible Medical Records
There is a problem with medical records—they are scattered everywhere. John Quelch discusses approaches to integrate patient data so that medical professionals and patients can make better decisions. Open for comment; 0 Comments.