Dr. Anita L. Tucker is an Associate Professor of Business Administration in Technology and Operations Management and Marvin Bower Fellow at the Harvard Business School. Professor Tucker received her master's degree in Industrial Engineering and Operations Research from Purdue University and her doctorate from Harvard University. She worked for General Mills and General Dynamics as an engineer before obtaining her doctorate. She was an Assistant Professor at Wharton for four years before joining the faculty of the Harvard Business School.
Publications
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Article
| Academy of Management Best Paper Proceedings
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Designed for Workarounds: A Qualitative Study of Hospitals' Internal Supply Chains
A. Tucker, C. Folck, W. S. Heisler and L. Janisse
We examine the internal supply chains at two service organizations to discover the source of disruptions that erode employees' efficiency. Through in-depth qualitative research, including observations and interviews of over 80 individuals from 6 service delivery units and 8 support departments that provide them with equipment and supplies, we find that a lack of interconnectedness among interdependent departments-rather than errors or execution issues-leads to disruptions in the internal supply chains. We develop the concept of interconnectedness as four conditions of an internal supply chain: a focus on system-rather than individual department-performance; routines within departments that are connected to current customers' needs; deliberate knowledge translation across departmental boundaries to enable efficient response; and an infrastructure for daily management and continuous improvement of the chain's performance. Furthermore, we find that employees on the service delivery unit spent 12% of their day compensating for internal supply chain problems, which is a disproportionate amount of time compared to the support departments. We suggest that the burden of compensating for the disconnected internal supply chains fell to the service providers because they were the only department that had both the ability to translate customer orders into requirements for materials and the responsibility for securing these materials.
Keywords: Service Delivery;
Supply Chain;
Employees;
Performance Efficiency;
Health Industry;
Citation: Tucker, A., C. Folck, W. S. Heisler, and L. Janisse. "Designed for Workarounds: A Qualitative Study of Hospitals' Internal Supply Chains." Academy of Management Best Paper Proceedings (2012).
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Article
| Organization Science
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Deliberate Learning to Improve Performance in Dynamic Service Settings: Evidence from Hospital Intensive Care Units
I. M. Nembhard and A. L. Tucker
Dynamic service settings-characterized by workers who interact with customers to deliver services in a rapidly changing, uncertain, and complex environment (e.g., hospitals)-play an important role in the economy. Organizational learning studies in these settings have largely investigated autonomous learning via cumulative experience as a strategy for performance improvement. Whether induced learning through the use of deliberate learning activities provides additional performance benefits has been neglected. We argue that the use of deliberate learning activities offers performance benefits beyond those of cumulative experience because these activities counter the learning challenges presented by rapid knowledge growth, uncertainty, and complexity in dynamic settings. We test whether there are additional performance benefits to using deliberate learning activities and whether the effectiveness of these activities depends on interdisciplinary collaboration in the workgroup. We test our hypotheses in a study of 23 hospital neonatal intensive care units (NICUs) involved in a quality improvement collaborative. We find that using deliberate learning activities is associated with better workgroup performance, as measured by NICUs' risk-adjusted mortality rates for 2,159 infant patients, but only after two years. In the shorter term, using these activities is associated with worse performance. By the third year, the positive impact of using deliberate learning activities is similar to the benefit of cumulative experience (18% and 20% reduction in odds of mortality, respectively). Contrary to prediction, interdisciplinary collaboration mediates, rather than moderates, the relationship between using deliberate learning activities and workgroup performance. Thus, our data suggest that using deliberate learning activities fosters interdisciplinary collaboration.
Keywords: Experience and Expertise;
Customer Focus and Relationships;
Learning;
Health Care and Treatment;
Service Delivery;
Performance Improvement;
Quality;
Groups and Teams;
Cooperation;
Health Industry;
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Article
| Health Services Research
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Front-line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems
Anita L. Tucker, Sara J. Singer, Jennifer E. Hayes and Alyson Falwell
Objective. To link safety-related concerns raised by frontline staff about hospital work systems (operational failures) to the safety and efficiency of hospitals, and to contrast these concerns with national patient safety initiatives.
Data Sources. Primary data include semi-structured interviews with frontline staff and 1732 staff identified operational failures at 20 U.S. hospitals from 2004-2006.
Study Design. Senior-level managers observed frontline staff work with particular attention to patient safety issues and facilitated open-discussion meetings with employees about their safety related concerns.
Data Collection. Hospitals submitted data on the operational failures they identified through their interactions with frontline workers. Data were analyzed for type of failure and frequency of occurrence. Interviews were conducted with frontline staff.
Principal Findings. The two most frequent categories of operational failures, equipment/supplies and facility issues, posed safety risks and diminished staff efficiency, but have not been priorities in national initiatives.
Conclusions. Our study suggests an underutilized strategy for improving patient safety and staff efficiency: leveraging frontline staff experiences with work systems to identify and remove operational failures. In contrast to the perceived tradeoff between safety and efficiency, fixing operational failures can yield benefits for both. Thus, prioritizing improvement of work systems in general, rather than focusing more narrowly on specific clinical conditions, can increase safety and efficiency of hospitals.
Keywords: Perspective;
Opportunities;
Safety;
Performance Efficiency;
System;
Failure;
Conferences;
Employees;
Management Analysis, Tools, and Techniques;
Experience and Expertise;
Health Care and Treatment;
Health Industry;
United States;
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Article
| Manufacturing & Service Operations Management
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An Empirical Study of System Improvement by Frontline Employees in Hospital Units
A. L. Tucker
Keywords: Information;
System;
Employees;
Health;
Health Industry;
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Article
| Management Science
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Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units
A. L. Tucker, I. Nembhard and A. C. Edmondson
Keywords: Practice;
Organizations;
Learning;
Health;
Information;
Health Industry;
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Article
| Health Services Research
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Operational Failures and Interruptions in Hospital Nursing
A. L. Tucker and S. Spear
Keywords: Operations;
Failure;
Health;
Health Industry;
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Article
| Journal of Operations Management
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The Impact of Operational Failures on Hospital Nurses and Their Patients
A. L. Tucker
Keywords: Operations;
Failure;
Health;
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Article
| Journal for Healthcare Quality
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A Case Study of Operational Failures in Home Healthcare
A. L. Tucker
Keywords: Operations;
Failure;
Health;
Information;
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Article
| California Management Review
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Why Hospitals Don't Learnfrom Failures: Organizational and Psychological Dynamics That InhibitSystem Change
A. Tucker and A. Edmondson
Keywords: Health Care and Treatment;
Health Industry;
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Article
| Journal of Organizational Change Management
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When Problem Solving Prevents Organizational Learning
Anita L. Tucker, Amy C. Edmondson and Steven Spear
Keywords: Problems and Challenges;
Organizations;
Learning;
Citation: Tucker, Anita L., Amy C. Edmondson, and Steven Spear. " When Problem Solving Prevents Organizational Learning." Journal of Organizational Change Management 15, no. 2 (2002). (Best paper proceedings, Academy of Management Conference, Healthcare Management Division.)
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Article
| Advances in Health Care Management
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Managing Routine Exceptions: A Model of Nurse Problem Solving Behavior
A. L. Tucker and Amy C. Edmondson
Keywords: Management;
Health;
Problems and Challenges;
Behavior;
Citation: Tucker, A. L., and Amy C. Edmondson. "Managing Routine Exceptions: A Model of Nurse Problem Solving Behavior." Advances in Health Care Management 3 (2002): 87–113.
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Working Paper
| HBS Working Paper Series
| 2013
The Impact of Pooling on Throughput Time in Discretionary Work Settings: An Empirical Investigation of Emergency Department Length of Stay
Hummy Song, Anita L. Tucker and Karen L. Murrell
We conduct an empirical investigation on the impact of pooling tasks and resources on throughput times in a discretionary work setting. We use an Emergency Department's (ED) patient-level data (N = 234,334) from 2007 to 2010 to test our hypotheses. We find that when the ED's work system had pooled tasks and resources, patients' lengths of stay were longer than when the ED converted to having dedicated tasks and resources. More specifically, we find that dedicated systems resulted in a 9% overall decrease in length of stay, which corresponds to a 25-minute reduction in length of stay for an average patient of medium severity in this ED. We propose that the improved performance comes from a reduction in social loafing and a more distributed utilization of shared resources. These benefits outweigh the expected efficiency gains from pooling, which are commonly predicted by queuing theory.
Keywords: pooling;
discretionary work;
social loafing;
shared resources;
empirical operations;
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Working Paper
| HBS Working Paper Series
| 2012
Hurry Up and Wait: Differential Impacts of Congestion, Bottleneck Pressure, and Predictability on Patient Length of Stay
Jillian Berry Jaeker and Anita L. Tucker
High work load, from high inventory levels, impacts unit processing times, but prior operations management studies have found conflicting results regarding direction. Thus, it is difficult to predict inventory's effects on productivity a priori, inhibiting effective capacity management in high load systems. We categorize load into in-process inventory (congestion) and incoming inventory, decomposing the latter into its levels of bottleneck (BN) pressure and predictability, and quantify the magnitudes and directions of change on processing times. Using data from 283 hospitals, we find (1) high congestion increases a patient's hospital stay up to 28%, indicating inefficiencies from overloaded resources; (2) a patient stays up to 11.7% longer if there is a high load of incoming low BN pressure patients, consistent with the slowdown associated with "social loafing"; (3) a patient’s stay is up to 10.2% shorter when there is a high incoming load of predictable patients, consistent with workload smoothing.
Keywords: Workload;
Processing times;
healthcare;
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Working Paper
| HBS Working Paper Series
| 2012
Fostering Organizational Learning: The Impact of Work Design on Workarounds, Errors, and Speaking Up About Internal Supply Chain Problems
Anita L. Tucker
A potential avenue for organizational learning is frontline employees' experience with internal supply chain problems. However, extensive research has established that employees rarely speak up to managers about problems. They tend to work around problems without additional effort to create organizational learning. This paper tests the premise that managerial action, via work design, can alter this dynamic. We use laboratory experiments to test the impact of three work design variables on proactive, improvement-oriented behaviors, workarounds, and errors. We find that two out of the three work design variables were effective at inducing proactive improvement-oriented behavior. Our results suggest that small changes in job design can reduce employee silence about organizational problems. Furthermore, we test the impact of the variables on risky workarounds and errors to account for unanticipated negative effects of work design to facilitate speaking up.
Keywords: health care;
process improvement;
organizational learning;
behavioral operations;
prosocial behavior;
experiments;
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Working Paper
| HBS Working Paper Series
| 2012
A Randomized Field Study of a Leadership WalkRoundsTM -Based Intervention
Anita L. Tucker and Sara J. Singer
Background: Leadership WalkRoundsTM have been widely adopted as a technique for improving patient safety and safety climate. WalkRoundsTM involve senior managers directly observing frontline work and soliciting employees' ideas about improvement opportunities. However, the hypothesized link between WalkRoundsTM-based programs and performance has not been rigorously examined in a set of randomly selected hospitals. Objective: To fill this research gap, we conducted a randomized field study of a WalkRoundsTM-based program.
Research Design: Fifty-six work areas from 19 randomly selected hospitals agreed to implement an 18-month long WalkRoundsTM-based program to improve safety. We compared their results to 138 work areas in 48 randomly selected control hospitals. Participants: We conducted the program in four types of clinical work areas: operating rooms/post-anesthesia care units; emergency departments, intensive care units, and medical/surgical units. We collected survey data from nurses in those work areas. Measures: To measure the program's impact, we collected pre and post survey data on perceptions of improvement in performance (PIP)—a proxy for quality and an important organizational climate antecedent for positive, discretionary behaviors of frontline staff. We compare change in PIP in the treatment work areas to the same type of work areas in control hospitals.
Results: On average, compared to control work areas, our WalkRoundsTM-based program was associated with a statistically significant decrease in PIP of .17 on a 5-point scale (4.5%). Conclusions: Our study calls into question the general effectiveness of WalkRoundsTM on employees' perceptions, which had been assumed in prior literature.
Keywords: quality improvement;
patient safety;
culture;
implementation research;
Health Care and Treatment;
Service Operations;
Performance Improvement;
Safety;
Quality;
Programs;
Perception;
Research;
Outcome or Result;
Health Industry;
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Working Paper
| HBS Working Paper Series
| 2012
Key Drivers of Successful Implementation of an Employee Suggestion-Driven Improvement Program
Anita L. Tucker and Sara J. Singer
Service organizations frequently implement improvement programs to increase quality. These programs often rely on employees' suggestions about improvement opportunities. Organizations face a trade-off with such suggestion-driven improvement programs. On one hand, the improvement literature recommends that managers focus organizational resources on surfacing a large number of problems, prioritizing these, and selecting a small set of high priority ones for solution efforts. The theory is that soliciting a large number of ideas from employees will surface a set of higher priority problems than would have been identified with a less extensive search. Scarce organizational resources can be allocated to resolving the set of problems that provide the greatest improvement in performance. We call this an "analysis-oriented" approach. On the other hand, managers can allocate improvement resources to addressing problems raised by frontline staff, regardless of priority ranking. This "action-oriented" approach enables more resources to be spent on resolving problems because prioritization receives less attention. To our knowledge, this tradeoff between analysis and action in process improvement programs has not been empirically examined. To fill this gap, we randomly selected 20 hospitals to implement an 18-month long employee suggestion-driven improvement program; 58 work areas participated. Our study finds that an action-oriented approach was associated with higher perceived improvement in performance, while an analysis-oriented approach was not. Our study suggests that the analysis-oriented approach negatively impacted employees' perceptions of improvement because it solicited, but did not act on, employees’ ideas. We discuss the conditions under which this might be the case.
Keywords: Health Care and Treatment;
Service Operations;
Performance Improvement;
Programs;
Employees;
Quality;
Resource Allocation;
Perception;
Health Industry;
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Case
| HBS Case Collection
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2013
Dignity Health: A Portfolio of Improvement Projects
Anita L. Tucker and Lydia Ypsse Kim
Citation: Tucker, Anita L., and Lydia Ypsse Kim. "Dignity Health: A Portfolio of Improvement Projects." Harvard Business School Case 613-092, April 2013.
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Supplement
| HBS Case Collection
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2013
Cincinnati Children’s Hospital Medical Center, Video Supplement 2012
Anita Tucker and Amy Edmondson
Keywords: process improvement;
leadership succession;
healthcare;
quality and safety;
transparency;
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Case
| HBS Case Collection
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2013
(Revised from original 2012 version)
Learning About Reducing Hospital Mortality at Kaiser Permanente
Anita Tucker
In 2011, Kaiser Permanente Northern California (KPNC) region's efforts to reduce mortality in their 21 hospitals is showing promise. They developed and launched a region-wide initiative to improve the treatment of sepsis, a serious and often deadly medical condition. The case illustrates the challenges of spreading change in a complex, highly interdependent organization, and presents an alternative framework to traditional management models for addressing such situations. It also asks students to consider how change should be made under conditions of uncertainty, in which best performances remain unknown.
Keywords: Change Management;
Health Care and Treatment;
Performance Improvement;
Health Industry;
California;
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Teaching Note
| HBS Case Collection
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2012
(Revised from original 2012 version)
Learning How to Reduce Hospital Mortality at Kaiser Permanente (TN)
Anita Carson Tucker
Citation: Tucker, Anita Carson. "Learning How to Reduce Hospital Mortality at Kaiser Permanente (TN)." Harvard Business School Teaching Note 612-098, May 2012. (Revised from original May 2012 version.)
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Case
| HBS Case Collection
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2013
(Revised from original 2011 version)
Cleveland Clinic: Improving the Patient Experience
Ananth Raman and Anita L. Tucker
Healthcare has traditionally focused on medical outcomes and financial performance. The big question is always, "How much is it going to cost?" What would happen, though, if healthcare also considered the question of "How does the patient feel?" This case looks at the Cleveland Clinic's attempt to answer the latter question by attempting to institutionalize empathy as part of its delivery of care.
Keywords: Health Care and Treatment;
Customer Satisfaction;
Performance Improvement;
Service Delivery;
Value Creation;
Personal Characteristics;
Human Needs;
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Case
| HBS Case Collection
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2010
The Cleveland Clinic: Improving the Patient Experience (Abridged)
Ananth Raman, Anita L. Tucker and Rachel Gordon
Healthcare has traditionally focused on medical outcomes and financial performance. The big question is always, "How much is it going to cost?" What would happen though if healthcare also considered question of "How does the patient feel?" This case looks at the Cleveland Clinic's attempt to answer the latter question by attempting to institutionalize empathy as part of its delivery of care.
Keywords: Customer Satisfaction;
Ethics;
Health Care and Treatment;
Six Sigma;
Performance Improvement;
Safety;
Value Creation;
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Case
| HBS Case Collection
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2011
(Revised from original 2009 version)
Cincinnati Children's Hospital Medical Center
Anita L. Tucker and Amy C. Edmondson
The case describes an organization's use of the science of improvement to transform their process quality from below average to the top 10% in their industry. The case outlines the protagonist's strategy of developing internal experts who are trained in a common methodology for making improvement and spreading these ideas in their work units.
Keywords: Change Management;
Experience and Expertise;
Leading Change;
Measurement and Metrics;
Service Delivery;
Performance Improvement;
Health Industry;
Ohio;
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Teaching Note
| HBS Case Collection
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2010
Cincinnati Children's Hospital Medical Center (TN)
Anita L. Tucker
Teaching Note for 609109.
Keywords: Quality;
Performance Improvement;
Management Practices and Processes;
Strategy;
Business Units;
Science;
Health Industry;
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Case
| HBS Case Collection
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2010
(Revised from original 2008 version)
Patient Flow at Brigham and Women's Hospital (A)
Anita L. Tucker and Jillian Alexandra Berry
Brigham and Women's Hospital challenged a team of physicians to improve patient flow from the Emergency Department to Intensive Care Units (ICUs). One of the team members, Selwyn Rogers, Director of the Surgical Intensive Care Unit (SICU) at Brigham and Women's Hospital, encountered workarounds by two physicians attempting to transfer their patients to the SICU because the other ICUs were full. Reflecting on the wasted effort and confusion caused by the workarounds, Rogers sent an email outlining the situation to the team. His email generated a negative backlash and chain of defensive emails from involved staff who felt criticized.
Keywords: Change Management;
Health Care and Treatment;
Service Operations;
Business Processes;
Performance Productivity;
Conflict and Resolution;
Health Industry;
Massachusetts;
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Supplement
| HBS Case Collection
|
2010
(Revised from original 2008 version)
Patient Flow at Brigham and Women's Hospital (B)
Anita L. Tucker and Jillian Alexandra Berry
The B Case is an email from the ED Director. He clarifies where the process deviations occurred.
Keywords: Change Management;
Health Care and Treatment;
Service Operations;
Business Processes;
Performance Productivity;
Conflict and Resolution;
Health Industry;
Massachusetts;
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Teaching Note
| HBS Case Collection
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2012
(Revised from original 2010 version)
Patient Flow at Brigham and Women's Hospital (TN) (A) and (B)
Anita L. Tucker
Teaching Note for 608171 and 608172.
Keywords: Business Processes;
Change;
Employees;
Emotions;
Health Care and Treatment;
Health Industry;
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Case
| HBS Case Collection
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2007
(Revised from original 2001 version)
Children's Hospital and Clinics (A)
Amy C. Edmondson, Michael Roberto and Anita L. Tucker
Describes the major phases of an initiative designed to transform the organization and enhance patient safety. Raises interesting questions about how to encourage candid discussion about failures while continuing to hold people accountable for their performance.
Keywords: Health Care and Treatment;
Leading Change;
Business Processes;
Organizational Change and Adaptation;
Organizational Culture;
Performance Improvement;
Safety;
Health Industry;
Citation: Edmondson, Amy C., Michael Roberto, and Anita L. Tucker. " Children's Hospital and Clinics (A)." Harvard Business School Case 302-050, September 2007. (Revised from original November 2001 version.)
Research Summary
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Overview
by
Anita L. Tucker
Keywords: Quality;
Safety;
Operations;
Problems and Challenges;
Health;
Customers;
Decision Making;
Information;
Value;
System;
Food and Beverage Industry;
Health Industry;
Service Industry;
Construction Industry;
Auto Industry;
Banking Industry;
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Research Summary
Front-Line Organizational Learning
by
Anita L. Tucker
Dr. Tucker uses operations management and organizational learning theory to understand and improve front-line work processes. Specifically, she examines the conditions under which the problem solving routines of front-line workers are likely to result in positive organizational learning and change. Her research focuses on healthcare organizations and issues related to patient safety, efficiency, patient experience, and implementing best practices. She is currently working with healthcare organizations, such as Kaiser Permanente and Duke University Hospital to study the impact of hospitals' internal supply chains on patient outcomes and staff efficiency. She is also conducting a series of laboratory experiments on medication administration to understand the conditions under which nurses will speak up to improve their work systems. Her research is partially funded by a grant from the Gordon and Betty Moore Foundation. Dr. Tucker has received numerous awards for her research including a 2006 Sloan Industry Studies Fellowship, 2004 AcademyHealth Dissertation award, the 2004 Accenture Award for her article with Amy C. Edmondson in California Management Review, and three best paper awards from Academy of Management conferences.
Awards & Honors
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Anita L. Tucker: "Designed for Workarounds: A Qualitative Study of Hospitals' Internal Supply Chains" (with C. Folck, W.S. Heisler, and L. Janisse) was selected for publication in the 2012 Academy of Management Best Paper Proceedings.
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Anita L. Tucker: Finalist for the 2011 Best Industry Studies Paper Award from the Industry Studies Association and INFORMS for "Deliberate Learning to Improve Performance in Dynamic Service Settings: Evidence from Hospital Intensive Care Units" with Ingrid Nembhard (Organization Science, 2011).
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Anita L. Tucker: Winner of the 2008 Most Outstanding Abstract at the AcademyHealth Annual Research Meeting.
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Anita L. Tucker: Awarded a 2006 Sloan Industry Studies Fellowship.
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Anita L. Tucker: Named a 2006 Outstanding Reviewer by the Health Care Management Division of the Academy of Management.
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Anita L. Tucker: Winner of the 2004 Accenture Award for "Why Hospitals Don't Learn from Failures: Organizational and Psychological Dynamics That Inhibit System Change" (with Amy Edmondson, California Management Review, winter 2003).
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Anita L. Tucker: Winner of the 2004 AcademyHealth Outstanding Dissertation Award for "Organizational Learning from Operational Failures" (Harvard University, 2003).
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Anita L. Tucker: Winner of the 2003 George S. Dively award for dissertation research for "Organizational Learning from Operational Failures" (Harvard University, 2003).
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Anita L. Tucker: Winner of the 2002 Best Student Paper from the Operations Management Division of the Academy of Management.
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