Health Care

Health Care is a featured research topic and an initiative at Harvard Business School.
 
Over the past several decades, HBS has built a foundation in health care research, from Clayton Christensen's application of disruptive innovations and Regina Herzlinger's concept of consumer-driven health care to Michael Porter's use of competitive strategy principles. Today our research focuses on 
  • how management principles and best practices from other industries can be applied;
  • how the process of innovation can be improved;
  • how principles of strategy and consumer choice can be utilized;
  • how information technology can expand access, decrease costs, and improve quality;
  • how new approaches in developing nations can impact global health.
  1. Health Leads: Reaching for Impact (A)

    V. Kasturi Rangan and Sarah Appleby

    Explores strategies to achieve system-level impact for a nonprofit focused on addressing patients' basic social needs through healthcare institutions. Founded in 1996 with a volunteer-staffed help desk at Boston Medical Center connecting low-income patients with basic resources like heating assistance, job training, and childcare programs, by 2013 the nonprofit had grown to 6 cities and 1,000 volunteers serving over 11,000 patients annually. At the end of a successful “proof plan” period, Health Leads Co-Founder and CEO Rebecca Onie and her team faced the question of how to make meeting patients’ social needs a standard part of health care in the U.S.: replicate Health Leads’ proven model or instigate a social care movement?

    Keywords: social enterprise; scaling social impact; nonprofit; healthcare; health care outcomes; health care reform; health care delivery; scaling social enterprise; Social Enterprise; Health; Health Industry; United States;

    Citation:

    Rangan, V. Kasturi, and Sarah Appleby. "Health Leads: Reaching for Impact (A)." Harvard Business School Case 517-022, September 2016. View Details
  2. How a Cancer Center Rapidly Developed Patient-Centered Outcome Measures

    Kevin P. Shah, Tracy E. Spinks and Thomas W. Feeley

    In 2014, The University of Texas MD Anderson Cancer Center created a streamlined process for developing measure sets for patient-centered outcomes, including provider-generated and patient-reported outcomes, at an accelerated pace. These comprehensive sets are integrated with electronic health records and incorporated into clinical practice, and they will underpin internal quality improvement and external benchmarking efforts.

    Keywords: Technology; Measurement and Metrics; Quality; Service Delivery; Health Care and Treatment; Health Industry; Texas;

    Citation:

    Shah, Kevin P., Tracy E. Spinks, and Thomas W. Feeley. "How a Cancer Center Rapidly Developed Patient-Centered Outcome Measures." NEJM Catalyst (August 17, 2016). View Details
  3. Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes

    Fayanju M. Oluwadamilola, Tinisha L. Mayo, Tracy E. Spinks, Seohyun Lee, Carlos H. Barcenas, Benjamin D. Smith, Sharon H. Giordano, Rosa F. Hwang, Richard A. Ehlers, Jesse C. Selber, Ronald Walters, Debu Tripathy, Kelly K. Hunt, Thomas A. Buchholz, Thomas W. Feeley and Henry M. Kuerer

    Purpose. Value in healthcare—i.e., patient-centered outcomes achieved per healthcare dollar spent—can define quality and unify performance improvement goals with health outcomes of importance to patients across the entire cycle of care. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. Methods. Contemporary breast cancer literature on treatment options, expected outcomes, and potential complications was extensively reviewed. Patient perspective was obtained via focus groups. Multidisciplinary physician teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration. Results. Outcomes were divided into 3 tiers that reflect the entire cycle of care: (1) health status achieved, (2) process of recovery, and (3) sustainability of health. Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria and specifications for reporting. Patient data sources will include the Epic Systems EHR and validated patient-reported outcome questionnaires administered via our institution’s patient portal. Conclusions. As healthcare costs continue to rise in the United States and around the world, a value-based approach with explicit, transparently reported patient outcomes will not only create opportunities for performance improvement but will also enable benchmarking across providers, healthcare systems, and even countries. Similar value-based breast cancer care frameworks are also being pursued internationally.

    Keywords: Health Disorders; Value; Health Care and Treatment; Performance Improvement; Health Industry;

    Citation:

    Oluwadamilola, Fayanju M., Tinisha L. Mayo, Tracy E. Spinks, Seohyun Lee, Carlos H. Barcenas, Benjamin D. Smith, Sharon H. Giordano, Rosa F. Hwang, Richard A. Ehlers, Jesse C. Selber, Ronald Walters, Debu Tripathy, Kelly K. Hunt, Thomas A. Buchholz, Thomas W. Feeley, and Henry M. Kuerer. "Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes." Annals of Surgical Oncology 23, no. 8 (August 2016). (Published online early, March 15, 2016.) View Details
  4. How to Pay for Health Care

    Michael E. Porter and Robert S. Kaplan

    The United States stands at a crossroads in how to pay for health care. Fee for service, the dominant model in the United States and many other countries, is now widely recognized as perhaps the biggest obstacle to improving health care delivery. A battle is currently raging, outside of the public eye, between the advocates of two radically different payment approaches: capitation and bundled payments. The stakes are high, and the outcome will define the shape of the health care system for many years to come, for better or for worse. In this article, the authors argue that although capitation may deliver modest savings in the short run, it brings significant risks and will fail to fundamentally change the trajectory of a broken system. The bundled payment model, in contrast, triggers competition between providers to create value where it matters—at the individual patient level—and puts health care on the right path. The authors provide robust proof-of-concept examples of bundled payment initiatives in the United States and abroad, address the challenges of transitioning to bundled payments, and respond to critics' concerns about obstacles to implementation.

    Keywords: Health Care and Treatment; Finance; Health Industry; United States;

    Citation:

    Porter, Michael E., and Robert S. Kaplan. "How to Pay for Health Care." Harvard Business Review 94, nos. 7-8 (July–August 2016): 88–100. View Details
  5. Alnylam: Building a Biotechnology Powerhouse

    Kevin Schulman

    Alnylam is an early stage biomedical technology focused on commercial development of a novel technology platform, siRNA. This technology offered promise to treat rare genetic disorders that could not be treated with other technologies. Alnlyam's development entailed the aggressive assembly of an intellectual property portfolio around their core platform technology, the development of a licensure strategy with large-cap pharmaceutical firms (which included the co-development of a delivery platform for their technology), and finally a clinical development strategy. The case illustrates the challenges of drug development based on novel scientific frameworks, as well as the promise of "personalized" medicine.

    Keywords: Technological Innovation; Commercialization; Health Disorders; Intellectual Property; Biotechnology Industry;

    Citation:

    Schulman, Kevin. "Alnylam: Building a Biotechnology Powerhouse." Harvard Business School Case 316-113, June 2016. View Details
  6. Vaccination Rates Are Associated with Functional Proximity but Not Base Proximity of Vaccination Clinics

    John Beshears, James J. Choi, David Laibson, Brigitte C. Madrian and Gwendolyn I. Reynolds

    Background: Routine annual influenza vaccinations are recommended for persons 6 months of age and older, but less than half of U.S. adults get vaccinated. Many employers offer employees free influenza vaccinations at workplace clinics, but even then take-up is low.

    Objective: To determine whether employees are significantly more likely to get vaccinated if they have a higher probability of walking by the clinic for reasons other than vaccination.

    Method: We obtained data from an employer with a free workplace influenza vaccination clinic. Using each employee’s building entry/exit swipe card data, we test whether functional proximity—the likelihood that the employee walks by the clinic for reasons other than vaccination—predicts whether the employee gets vaccinated at the clinic. We also test whether base proximity—the inverse of walking distance from the employee’s desk to the clinic—predicts vaccination probability.

    Participants: A total of 1,801 employees of a health benefits administrator that held a free workplace influenza vaccination clinic.

    Results: A 2 SD increase in functional proximity is associated with a 6.4 percentage point increase in the probability of vaccination (total vaccination rate at company=40%), even though the average employee’s desk is only 166 meters from the clinic. Base proximity does not predict vaccination probability.

    Conclusions and Relevance: Minor changes in the environment can have substantial effects on the probability of vaccination. If these results generalize, health systems should emphasize functional proximity over base proximity when locating preventive health services.

    Keywords: Geographic Location; Employees; Health Care and Treatment;

    Citation:

    Beshears, John, James J. Choi, David Laibson, Brigitte C. Madrian, and Gwendolyn I. Reynolds. "Vaccination Rates Are Associated with Functional Proximity but Not Base Proximity of Vaccination Clinics." Medical Care 54, no. 6 (June 2016): 578–583. View Details
  7. When Doctors Go to Business School: Career Choices of Physician-MBAs

    Damir Ljuboja, Brian W. Powers, Benjamin Robbins, Robert S. Huckman, Krishna Yeshwant and Sachin Jain

    There has been substantial growth in the number of physicians pursuing Master of Business Administration (MBA) degrees over the past decade, but there is continuing debate over the utility of these programs and the career outcomes of their graduates. The authors analyzed the clinical and professional activities of a large cohort of physician-MBAs by gathering information on 206 physician graduates from the Harvard Business School MBA program who obtained their degrees between 1941 and 2014. Key outcome measures that were examined include medical specialty, current professional activity, and clinical practice. Chi square tests were used to assess the correlations in the data. Among the careers that were tracked (n = 195), there was significant heterogeneity in current primary employment. The most common sectors were clinical (27.7%), investment banking/finance (27.0%), hospital/provider administration (11.7%), biotech/device/pharmaceutical (10.9%), and entrepreneurship (9.5%). Overall, 84% of physician-MBAs entered residency; approximately half (49.3%) remained clinically active in some capacity and only one-fourth (27.7%) reported clinical medicine as their primary professional role. Among those who pursued residency training, the most common specialties were internal medicine (39.3%), emergency medicine (10.4%), orthopedic surgery (9.2%), and general surgery (8.6%). Physician-MBAs trained in internal medicine were significantly more likely to remain clinically active (63.8% vs 42.4%; P = .01). Clinical activity and primary employment in a clinical role decreased after degree conferment. After completing their education, a majority of physician-MBAs divert their primary professional focus away from clinical activity. These findings reveal new insights into the career outcomes of physician-MBAs.

    Keywords: medical education; MD; MBA; Physicians; training; Executive Education; Training; Personal Development and Career; Health Care and Treatment; Health Industry; United States;

    Citation:

    Ljuboja, Damir, Brian W. Powers, Benjamin Robbins, Robert S. Huckman, Krishna Yeshwant, and Sachin Jain. "When Doctors Go to Business School: Career Choices of Physician-MBAs." American Journal of Managed Care 22, no. 6 (June 2016): e196–e198. View Details
  8. Understanding Psychological Safety in Healthcare and Education Organizations: A Comparative Perspective

    Amy C. Edmondson, Monica Higgins, Sara J. Singer and Jennie Weiner

    Psychological safety plays a vital role in helping people overcome barriers to learning and change in interpersonally challenging work environments. This article focuses on two such contexts—health care and education. The authors theorize differences in psychological safety based on work type, hierarchical status, and leadership effectiveness. Consistent with prior research, the authors employ cross-industry comparison to highlight distinctive features of different professions. The goal is to illuminate similarities and differences with implications for future psychological safety research. To do this, the authors review relevant literature and present analyses of large data samples in each industry to stimulate further research on psychological safety in both sectors, separately and together.

    Keywords: healthcare organizations; Organizations; Health Care and Treatment; Health Industry;

    Citation:

    Edmondson, Amy C., Monica Higgins, Sara J. Singer, and Jennie Weiner. "Understanding Psychological Safety in Healthcare and Education Organizations: A Comparative Perspective." Special Issue on the Role of Psychological Safety in Human Development. Research in Human Development 13, no. 1 (2016): 65–83. View Details
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