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• Working Paper | HBS Working Paper Series | 2016

  Cohort Turnover and Operational Performance: The July Phenomenon in Teaching Hospitals

  Hummy Song, Robert S. Huckman and Jason R. Barro

  We consider the impact of cohort turnover—the planned simultaneous exit of a large number of experienced employees and a similarly sized entry of new workers—on operational performance in the context of teaching hospitals. Specifically, we examine the impact of the annual July turnover of residents in U.S. teaching hospitals on the average length of hospital stay and mortality rate in teaching hospitals relative to a control group of non-teaching hospitals. Despite the anticipated nature of the cohort turnover and the supervisory structures that exist in teaching hospitals, the annual July turnover of residents results in increased resource utilization (i.e., longer average length of stay) for both minor and major teaching hospitals, relative to a control group of non-teaching hospitals. We find limited evidence of negative effects on quality as measured by mortality rates. In major teaching hospitals, we find evidence of a substantial anticipation effect that presents as a gradual decrease in operational performance beginning several months before the actual cohort turnover. We identify higher overall quality of nursing and increased intensity of potential quality assurance as managerial levers for mitigating the decrease in hospital operational performance both at the time of and in the months leading up to the cohort turnover.

  Keywords: health care; health care operations; Hospitals; productivity; empirical operations; Service Delivery; Training; Performance Productivity; Health Care and Treatment; Health Industry; United States;

  Citation:

  Song, Hummy, Robert S. Huckman, and Jason R. Barro. "Cohort Turnover and Operational Performance: The July Phenomenon in Teaching Hospitals." Harvard Business School Working Paper, No. 16-039, September 2015. (Revised September 2016. Finalist, 2015 POMS College of Healthcare Operations Management Best Paper Competition.)  View Details

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• Article | Permanente Journal | Summer 2014

  Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

  Frontline care providers in hospitals spend at least 10% of their time working around operational failures, which are situations where information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at two hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of over 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments' routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals' internal supply departments. Four dimensions of interconnectedness include (1) hospital-level—rather than department-level—performance measures; (2) internal supply department routines that respond to specific patients' needs rather than to predetermined stocking routines; (3) knowledge that is necessary for efficient handoffs of materials is translated across departmental boundaries; and (4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries.

  Keywords: Supply Chain; Health Care and Treatment; Failure; Business Processes; Health Industry;

  Citation:

  Tucker, Anita L., W. Scott Heisler, and Laura D. Janisse. "Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals." Permanente Journal 18, no. 3 (Summer 2014): 33–41.  View Details

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• Case | HBS Case Collection | April 2013 (Revised March 2014)

  Dignity Health: Prevention of Retained Sponges

  Anita L. Tucker and Lydia Ypsse Kim

  Citation:

  Tucker, Anita L., and Lydia Ypsse Kim. "Dignity Health: Prevention of Retained Sponges." Harvard Business School Case 613-092, April 2013. (Revised March 2014.)  View Details

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