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.

Featured Works

Supplement | HBS Case Collection | February 2015
The Affordable Care Act (A): Legislative Strategy in the House of Representatives
Joseph L. Bower and Michael Norris
In early 2009, the Obama administration and the Democratically-led Congress began working on what would eventually become the Affordable Care Act. The (A) case in this series discusses the legislative strategy in the House of Representatives, where three different committees each had jurisdiction over health care legislation.
Keywords: health care; health care policy; Government and Politics; Government Administration; Health Care and Treatment; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (A): Legislative Strategy in the House of Representatives." Harvard Business School Supplement 315-032, February 2015. View Details
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Blog Post | Health Affairs Blog
Innovation in Health Care Education: A Call to Action
Regina E. Herzlinger, Vasant Kumar, Kevin Schulman and Karen Staman
Health care administration educators are at a crossroads: the health care sector is rife with inefficiencies, erratic quality, unequal access, and sky-high costs, complex problems which call for innovative solutions, and yet, according to our content analysis of top U.S. health administration schools and a recent article in the Lancet, our educational systems focus their curricula on isolated,theoretical subjects, such as analytics and quantitative problem solving, rather than the team-oriented, practical problem-solving skills required for innovation. All too often, when graduates of these programs enter the workforce, they find themselves unequipped to meet the challenges for innovation of 21st century health care.
Keywords: health care; health care education; Education; Health; Health Care and Treatment; Health Industry; Education Industry;

Citation:
Herzlinger, Regina E., Vasant Kumar, Kevin Schulman, and Karen Staman. "Innovation in Health Care Education: A Call to Action." Health Affairs Blog (January 29, 2015). http://healthaffairs.org/blog/2015/01/29/innovation-in-health-care-education-a-call-to-action/. View Details
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Article | Journal of Public Economics | December 2014
No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery
Nava Ashraf, Oriana Bandiera and B. Kelsey Jack
A substantial body of research investigates the effect of pay for performance in firms, yet less is known about the effect of non-financial rewards, especially in organizations that hire individuals to perform tasks with positive social spillovers. We conduct a field experiment in which agents recruited by a public health organization to sell condoms are randomly allocated to four groups. Agents in the control group are hired as volunteers, whereas agents in the three treatment groups receive, respectively, a small monetary margin on each pack sold, a large margin, and a non-financial reward. The analysis yields three main findings. First, non-financial rewards are more effective at eliciting effort than either financial rewards or the volunteer contract and are also the most cost-effective of the four schemes. Second, non-financial rewards leverage intrinsic motivation and, contrary to existing laboratory evidence, financial incentives do not appear to crowd it out. Third, the responses to both types of incentives are stronger when their relative value is higher. Indeed, financial rewards are effective at motivating the poorest agents, and non-financial rewards are more effective when the peer group is larger. Overall, the findings demonstrate the power of non-financial rewards to motivate agents in settings where there are limits to the use of financial incentives.
Keywords: incentives; non-monetary rewards; intrinsic motivation; Motivation and Incentives; Employees; Service Industry; Health Industry;

Citation:
Ashraf, Nava, Oriana Bandiera, and B. Kelsey Jack. "No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery." Journal of Public Economics 120 (December 2014): 1–17. View Details
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Case | HBS Case Collection | August 2001 (Revised January 2015)
SonoSite: A View Inside
Clayton Christensen and Jeremy Dann
After its spin-off from one of the world's largest ultrasound makers, Sonosite attempts to popularize a new kind of handheld ultrasound units. Sonosite needs to decide if it should focus on new markets that will value the portability and ease of use of its products, or if it should evolve its offerings so that they appeal to radiologists and cardiologists, the largest purchasers of ultrasound systems.
Keywords: Customers; Disruptive Innovation; Product Positioning; Demand and Consumers;

Citation:
Christensen, Clayton, and Jeremy Dann. "SonoSite: A View Inside." Harvard Business School Case 602-056, August 2001. (Revised January 2015.) View Details
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Case | HBS Case Collection | March 2014 (Revised December 2014)
Vision 2020: Takeda and the Vaccine Business
John A. Quelch and Margaret L. Rodriguez
In 2014, Yasuchika Hasegawa was orchestrating the transformation of Takeda from a Japanese pharmaceutical company with a global footprint into a global company with a Japanese heritage. A 33-year veteran of Takeda, Hasegawa-san was appointed president of Takeda in 2003 and chief executive in 2009. By 2013, Takeda was in the midst of implementing its new Vision 2020 plan, a strategic plan for the evolving global corporation, which included developing a global vaccine business.
Keywords: health care; global; NGO; public health; pharmaceutical industry; Japan; GSK; vaccine; supply chain; Market entry; Health; Health Care and Treatment; Trade; Market Entry and Exit; Global Strategy; Health Industry; Pharmaceutical Industry;

Citation:
Quelch, John A., and Margaret L. Rodriguez. "Vision 2020: Takeda and the Vaccine Business." Harvard Business School Case 514-084, March 2014. (Revised December 2014.) View Details
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Case | HBS Case Collection | August 2015 (Revised August 2015)
Hoag Orthopedic Institute
Robert S. Kaplan and Jonathan Warsh
Two groups of orthopedic surgeons form a joint venture with a community hospital to establish Hoag Orthopedic Institute, a for-profit hospital and two ambulatory service centers. By controlling and integrating all aspects of the patients' medical treatment, the physicians deliver superior outcomes, which they communicate with an annual public outcomes report. They also introduce bundled payment contracts with three insurers for orthopedic surgeries, and join a multi-hospital study for applying time-driven activity-based costing to identify process improvement and cost reduction opportunities. The case concludes with HOI leaders examining several options for expansion and growth.
Keywords: outcomes measurement; bundled payment; health care; competitive strategy; activity-based costing and management; measurement and metrics; Measurement and Metrics; Activity Based Costing and Management; Competitive Strategy; Medical Specialties; Health Care and Treatment; Outcome or Result; Health Industry;

Citation:
Kaplan, Robert S., and Jonathan Warsh. "Hoag Orthopedic Institute." Harvard Business School Case 115-023, August 2015. (Revised August 2015.) View Details
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Recent Publications

Article | Harvard Business Review Digital Articles | October 6, 2020
COVID-19 Is Rewriting the Rules of Corporate Governance
Lynn S. Paine
Boards are facing a complex new reality as a result of COVID-19. The new environment is characterized by pressures and demands from various stakeholder groups, heightened expectations for societal engagement and corporate citizenship, and radical uncertainty about the future. These factors are complicating board decision-making and challenging the shareholder-centric model of governance that has guided boards and business leaders for the past several decades. A board’s ability to deliberate in a thorough and thoughtful, but efficient, manner and come to a considered conclusion around key issues will be a critical aspect of its effectiveness in the post-COVID era.
Keywords: Health Pandemics; Corporate Governance; Governing and Advisory Boards;

Citation:
Paine, Lynn S. "COVID-19 Is Rewriting the Rules of Corporate Governance." Harvard Business Review Digital Articles (October 6, 2020). View Details
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Article | Harvard Business Review Digital Articles | October 6, 2020
Test Your Board's Readiness for the Post-COVID Era
Lynn S. Paine
Research suggests that well-run boards take the process of self-evaluation quite seriously, often using a combination of director surveys and personal interviews to assess the functioning and effectiveness of the board, its committees, and its individual members. As boards prepare for their next round of self-evaluation, they will want to assess their capabilities and readiness to govern in the wake of COVID-19. This list offers a guide to the kinds of key questions and statements they should consider adding to their surveys or interview protocols.
Keywords: Health Pandemics; Governing and Advisory Boards; Performance Evaluation;

Citation:
Paine, Lynn S. "Test Your Board's Readiness for the Post-COVID Era." Harvard Business Review Digital Articles (October 6, 2020). View Details
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Working Paper | HBS Working Paper Series | 2020
Flight to Safety: How Economic Downturns Affect Talent Flows to Startups
Shai Benjamin Bernstein, Richard Townsend and Ting Xu
This paper investigates how economic downturns affect the flow of human capital to startups. Using proprietary data from AngelList Talent, we study how individuals’ online job searches and applications changed during the emergence of the COVID-19 crisis. We find that job seekers shifted their searches toward larger firms and away from early stage ventures, even within the same individual over time. Simultaneously, job seekers broadened their other search parameters, considering lower salaries and a wider variety of job types, roles, markets, and locations. Relative to larger firms, early stage ventures experienced a decline in the number of applications per job posting, a decline driven by higher quality and more experienced job seekers. This led to a deterioration in the quality of the human capital pool available to early stage ventures during the downturn. These declines hold within a firm as well as within a job posting over time. Our findings uncover a flight to safety channel in the labor market, which may amplify the pro-cyclical nature of entrepreneurial activities.
Keywords: startup labor market; flight to safety; COVID-19; recession; Business Startups; Human Capital; Business Cycles; Health Pandemics;

Citation:
Bernstein, Shai Benjamin, Richard Townsend, and Ting Xu. "Flight to Safety: How Economic Downturns Affect Talent Flows to Startups." Harvard Business School Working Paper, No. 21-045, September 2020. View Details
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Article | Brookings Papers on Economic Activity | Fall 2020
Sizing Up Corporate Restructuring in the COVID Crisis
Robin Greenwood, Benjamin Iverson and David Thesmar
In the wake of the COVID-19 pandemic, the financial and legal system will need to deal with a surge of financial distress in the business sector. Some firms will be able to survive, while others will face bankruptcy and thus need to be liquidated or reorganized. Many surviving firms will need to be downsized or acquired. In normal times, this triage is supported by the court system, banks, and financial markets. The goal of this paper is to size up the coming surge of financial distress, list the challenges it presents in the current environment, and offer potential policy solutions. Overall, our analysis suggests that the two key issues will be court congestion and excess liquidation and failure of small firms.
Keywords: COVID-19; Health Pandemics; Economy; System Shocks; Financial Crisis; Restructuring;

Citation:
Greenwood, Robin, Benjamin Iverson, and David Thesmar. "Sizing Up Corporate Restructuring in the COVID Crisis." Brookings Papers on Economic Activity (Fall 2020). View Details
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Article | Nature Human Behaviour | October 2020
Why Time Poverty Matters for Individuals, Organisations, and Nations
Ashley V. Whillans, Laura Giurge and Colin West
Over the last two decades, global wealth has risen. Yet, material affluence has not translated into time affluence. Instead, most people today report feeling persistently “time poor”—like they have too many things to do and not enough time to do them. This is critical because time poverty is linked to lower well-being, physical health, and productivity. For example, in our analysis of 2.5 million Americans, subjective feelings of time poverty had a stronger negative effect on well-being than being unemployed. However, individuals, organisations, and policymakers often overlook the pernicious effects of time poverty. Billions of dollars are spent each year to alleviate material poverty, while time poverty is often ignored or exacerbated. In this Perspective, we discuss the organisational, institutional, and psychological factors that explain why time poverty is often under appreciated. We argue that scientists, policymakers, and organisational leaders need to devote more attention and resources toward understanding and reducing time poverty to promote psychological and economic well-being.
Keywords: time poverty; Health; Welfare or Wellbeing; Human Needs; Global Range;

Citation:
Whillans, Ashley V., Laura Giurge, and Colin West. "Why Time Poverty Matters for Individuals, Organisations, and Nations." Nature Human Behaviour 4, no. 10 (October 2020): 993–1003. View Details
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Article | Management Science | October 2020
Task Selection and Workload: A Focus on Completing Easy Tasks Hurts Long-Term Performance
Diwas S. KC, Bradley R. Staats, Maryam Kouchaki and Francesca Gino
How individuals manage, organize, and complete their tasks is central to operations management. Recent research in operations focuses on how under conditions of increasing workload individuals can decrease their service time, up to a point, in order to complete work more quickly. As the number of tasks increases, however, workers may also manage their workload by a different process—task selection. Drawing on research on workload, individual discretion, and behavioral decision-making, we theorize and then test that under conditions of increased workload, individuals may choose to complete easier tasks in order to manage their load. We label this behavior task completion preference (TCP). Using six years of data from a hospital emergency department, we find that physicians engage in TCP, with implications for their performance. Specifically, TCP helps physicians manage variance in service times; however, while it initially appears to improve shift-level throughput volume, after adjusting for the complexity of the work completed, TCP is related to worse throughput. Moreover, we find that engaging in easier tasks, as compared to hard ones, is related to lower learning in service times. We then turn to the lab to replicate conceptually the short-term task selection effect under increased workload and show that it occurs due to both fatigue and the sense of progress individuals get from task completion. These findings provide another mechanism for the workload-speedup effect from the literature. We also discuss implications for both research and the practice of operations in building systems to help people succeed.
Keywords: healthcare; knowledge work; discretion; Workload; Employees; Health Care and Treatment; Decision Making; Performance Effectiveness; Performance Productivity;

Citation:
KC, Diwas S., Bradley R. Staats, Maryam Kouchaki, and Francesca Gino. "Task Selection and Workload: A Focus on Completing Easy Tasks Hurts Long-Term Performance." Management Science 66, no. 10 (October 2020). View Details
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Working Paper | HBS Working Paper Series | 2020
Bankruptcy and the COVID-19 Crisis
Jialan Wang, Jeyul Yang, Benjamin Iverson and Ray Kluender
We examine the impact of the COVID-19 economic crisis on business and consumer bankruptcies in the United States using real-time data on the universe of filings. Historically, bankruptcies have closely tracked the business cycle and contemporaneous unemployment rates. However, this relationship has reversed during the COVID-19 crisis thus far. While aggregate filing rates were very similar to 2019 levels prior to the severe onset of the pandemic, filings by consumers and small businesses dropped dramatically starting in mid-March, contrary to media reports and many experts' expectations. The total number of bankruptcy filings is down by 27 percent year-over-year between January and August. Consumer and business Chapter 7 filings rebounded moderately starting in mid-April and stabilized around 20 percent below 2019 levels, but Chapter 13 filings remained at 55-65 percent below 2019 levels through the end of August. In contrast to the 2007-9 recession, states with a larger increase in unemployment between April and July experienced greater drops in bankruptcies. Although they make up a small share of overall bankruptcies, Chapter 11 filings by large corporations have increased since 2019, and are up nearly 200 percent year-over-year from January through August. These patterns suggest that the financial experiences of consumers, small businesses, and large corporations have diverged during the COVID-19 crisis. Large businesses have continued to seek and receive relief from the bankruptcy system as they would during a normal recession, and relatively wealthy homeowners have on average benefited from the fiscal stimulus and housing moratoria mandated by the CARES Act and other policies. However, non-homeowners and small businesses may face financial, physical, and technological barriers to accessing the bankruptcy system, especially in the areas hardest-hit by unemployment.
Keywords: bankruptcy; financial distress; COVID-19; Insolvency and Bankruptcy; Financial Crisis; Health Pandemics; United States;

Citation:
Wang, Jialan, Jeyul Yang, Benjamin Iverson, and Ray Kluender. "Bankruptcy and the COVID-19 Crisis." Harvard Business School Working Paper, No. 21-041, September 2020. View Details
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Case | HBS Case Collection | September 2020
Walmart Health: Scaling During a Pandemic
Robert S. Huckman, Yoonjin Min and Marissa Thiel
Amidst the onset of COVID-19 pandemic in the United States, Marcus Obsborne, Vice President for Health and Wellness Transformation at Walmart was planning to scale its new health care clinic business, Walmart Health, to additional locations in Georgia and beyond. Walmart Health aimed to differentiate its offerings from those of competing retail clinics, most notably by offering a wider range of sevices including visits with primary care physicians, dentists, and behaviroal health specialists. Osborne wondered how the pandemic might affect the growth of Walmart Health. How quickly and where should the clinics scale across the country? What services should Walmart Health offer to address broader gaps in public health exposed by the COVID-19 pandemic? Finally, how could Osborne and his team prove the value proposition of Walmart Health to both customers and the leadership of Walmart?
Keywords: Health Care and Treatment; Health Pandemics; Health; Health Industry; United States; Arkansas; Georgia (state, US); Texas;

Citation:
Huckman, Robert S., Yoonjin Min, and Marissa Thiel. "Walmart Health: Scaling During a Pandemic." Harvard Business School Case 621-061, September 2020. View Details
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Case | HBS Case Collection | September 2020
Merck: COVID-19 Vaccines
Willy C. Shih
COVID-19 infections were still climbing across the U.S. and many other parts of the world in September 2020, and it seemed that every time Ken Frazier, the CEO of Merck & Co. consented to an interview in recent months he always seemed to hear the same question, “Where’s Merck?” The company, a leader in the global vaccine business had a low public profile even though it was working assiduously on two vaccine candidates for the SARS-CoV-2 virus that causes COVID-19. The U.S. Government had initiated a high profile program—Operation Warp Speed (OWS)—to accelerate the development of vaccines, but Merck was notably absent. Should Merck seek or accept funding from OWS, and what terms might accompany such an agreement?
Keywords: Health Pandemics; Health Testing and Trials; Innovation and Management; Innovation Strategy; Technological Innovation; Business Strategy; Pharmaceutical Industry;

Citation:
Shih, Willy C. "Merck: COVID-19 Vaccines." Harvard Business School Case 621-028, September 2020. View Details
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Case | HBS Case Collection | September 2020
&pizza: Leading an ‘Employee-First’ Company During a Period of Societal Challenges
Francesca Gino and Jeffrey Huizinga
&Pizza is a pizza chain that in the spring of 2020 finds its business completely up-ended by the COVID-19 crisis and shut-down. Many companies in the restaurant and hospitality sector responded to the crisis by shutting down their operations and laying off employees. &Pizza’s leader took a different approach: as the company pivoted mainly to a delivery model, he realized there would be added strain on his employees, and so he decided to not only avoid lay-offs, but to increase wages and provide other benefits to its Tribe (i.e., the employees).
Keywords: Agility; crisis; culture; values; Health Pandemics; Crisis Management; Leadership; Organizational Culture; Values and Beliefs;

Citation:
Gino, Francesca, and Jeffrey Huizinga. "&pizza: Leading an ‘Employee-First’ Company During a Period of Societal Challenges." Harvard Business School Case 921-017, September 2020. View Details
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