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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.
- 30 Apr 2012
- Research & Ideas
India’s Ambitious National Identification Program
The Unique Identification Authority of India has been charged with implementing a nationwide program to register and assign a unique 12-digit ID to every Indian resident—some 1.2 billion people—by 2020. In a new case, Professor Tarun Khanna and HBS India Research Center Executive Director Anjali Raina discuss the complexities of this massive data management project. 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.
- 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.
- 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.
- 06 Apr 2011
- Working Paper Summaries
Do Not Trash the Incentive! Monetary Incentives and Waste Sorting
Many cities encourage residents to sort their domestic trash into separate bins, for the sake of recycling some of it and thus reducing the amount of garbage that ends up in landfills. The problem is that sorting waste is not a fun activity, and not everyone is willing to do it. Using data from 95 municipalities in Italy, this paper discusses whether and how monetary incentives can encourage people to sort their trash. Research was conducted by Alessandro Bucciol of the University of Verona and the University of Amsterdam, Natalia Montinari of the University of Padua and the Max Planck Institute of Economics, and Marco Piovesan of Harvard Business School. Key concepts include: The paper discusses the pay-as-you-throw (PAYT) system, in which residents pay lower fees if they sort their trash than if they don't. The researchers found that the introduction of a PAYT system had a significant and positive net effect of 12.2 percent on the amount of trash that residents sort. This compares with a positive effect of 18.1 percent for the nonmonetary incentive of letting residents leave sorted bins outside their doors, rather than requiring them to carry their trash to drop-off bins on the street. Thus, the PAYT system is more of a complement than a substitute for the door-to-door collection system. However, the PAYT system does not affect the actual amount of waste each household creates. While the system induces residents to sort their trash, it does not induce them to produce less of it. 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.
- 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.
- 28 Jun 2010
- HBS Case
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. Key concepts include: The case offers valuable takeaways for future managers of any complex service organization. A key takeaway for students is the power of transparency as a mechanism for change. Benchmarking themselves to an internal standard helped the group get beyond rationalizing poor performance as an unavoidable consequence of the complexity of patient care. Closed for comment; 0 Comments.
- 14 Apr 2010
- Working Paper Summaries
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. Key concepts include: Large shares of Americans reduced their use of routine medical care since the economic crisis. These reductions were strongly related to economic distress brought on by the global financial crisis as measured by wealth loss and unemployment. The across-the-board reduction in medical care usage by Americans may speak to behavioral changes that reflect the national psyche broadly: The economic crisis in the United States—deeper and more widespread than elsewhere—may have touched the population at large, perhaps via negative expectations about the future. The cutbacks in health-care usage by people losing wealth or jobs, even in countries with "universal" systems, may reflect the fact that seeking care entails not only out-of-pocket expenses, but also costs of time away from work or job hunting. Reductions in routine care today might lead to undetected illness tomorrow and reduced individual health and well-being in the more distant future. Closed for comment; 0 Comments.
- 09 Dec 2009
- Working Paper Summaries
Mental Health in the Aftermath of Conflict
Wars are detrimental to the populations and the economy of affected countries. Over and above the human cost caused by deaths and suffering during a time of conflict, survivors of conflict are often left in poor economic circumstances and mental-health distress even after the conflict ends. How large are these costs? How long does it take for conflict-affected populations to recover from the mental stress of conflict? What policies are appropriate to assist mental health recovery? While considerable attention has been paid to post-war policies with regard to recovery in physical and human capital, mental health has received relatively less attention. The World Bank's Quy-Toan Do and HBS professor Lakshmi Iyer review the nascent literature on mental health in the aftermath of conflict, discuss the potential mechanisms through which conflict might affect mental health, and illustrate the findings from their study of mental health in a specific post-conflict setting: Bosnia and Herzegovina. Key concepts include: Mental health is an outcome that deserves greater attention from scholars and policymakers alike. Mental health is an important dimension of human capital. Mental health distress, while a matter of concern in and of itself, might also have adverse consequences for individuals' labor force participation and labor productivity in the post-conflict period, thereby delaying economic recovery after the conflict ends. Quantifying the effect of conflict on mental health is likely to be important for designing appropriate post-conflict policies for recovery. Somewhat surprisingly, findings showed no significant differences in overall mental health across people who experienced different levels of exposure to the conflict. People with more education, as well as those who move to a different locality after the conflict, suffer fewer conflict-related mental health consequences. Closed for comment; 0 Comments.
- 23 Nov 2009
- Research & Ideas
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. Key concepts include: Many health-care delivery issues are managerial rather than policy issues. Much debate on the U.S. stage assumes the current health-care delivery system is a given. Yet innovations in care delivery could potentially help patients and the U.S. health-care system overall. Bohmer's book explains how to create more knowledgeable, flexible, and responsive delivery organizations. Routine medical practice is a fertile source of innovations in care, in both what to do and how to do it. Closed for comment; 0 Comments.
- 05 Nov 2009
- Research & Ideas
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. Closed for comment; 0 Comments.
- 17 Sep 2009
- Working Paper Summaries
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. Key concepts include: Following the introduction of new CABG programs in Pennsylvania, volume shifted from incumbent programs to entrants and from lower- to higher-quality surgeons, thereby improving the overall quality of surgical outcomes. The repeal of CON in Pennsylvania improved the market for cardiac surgery by directing more volume to better doctors and increasing access to treatment. The benefit of reduced mortality from the increased use of high-quality surgeons roughly offset the fixed costs associated with free entry. Closed for comment; 0 Comments.
- 07 Aug 2009
- What Do You Think?
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; 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.