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Health Care

Health Care

    • February 2015
    • Supplement

    The Affordable Care Act (A): Legislative Strategy in the House of Representatives

    By: 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.

    • February 2015
    • Supplement

    The Affordable Care Act (A): Legislative Strategy in the House of Representatives

    By: 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.

    • Blog Post

    Innovation in Health Care Education: A Call to Action

    By: 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.

    • Blog Post

    Innovation in Health Care Education: A Call to Action

    By: 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...

    • December 2014
    • Article

    No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery

    By: 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.

    • December 2014
    • Article

    No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery

    By: 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...

    • August 2001 (Revised January 2015)
    • Case

    SonoSite: A View Inside

    By: 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.

    • August 2001 (Revised January 2015)
    • Case

    SonoSite: A View Inside

    By: 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...

    • March 2014 (Revised December 2014)
    • Case

    Vision 2020: Takeda and the Vaccine Business

    By: 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.

    • March 2014 (Revised December 2014)
    • Case

    Vision 2020: Takeda and the Vaccine Business

    By: 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...

    • August 2015 (Revised August 2015)
    • Case

    Hoag Orthopedic Institute

    By: 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.

    • August 2015 (Revised August 2015)
    • Case

    Hoag Orthopedic Institute

    By: 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...

Initiatives & Projects

The Health Care Initiative and the Social Enterprise Initiative connect students, alumni, faculty, and practitioners to ideas, resources, and opportunities for collaboration that yield innovative models for health care practice.
Health Care
Social Enterprise

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.

Initiatives & Projects

The Health Care Initiative and the Social Enterprise Initiative connect students, alumni, faculty, and practitioners to ideas, resources, and opportunities for collaboration that yield innovative models for health care practice.

Health Care
Social Enterprise

Recent Publications

Health Care Innovation Opportunities Created by COVID-19 and How to Make Them Happen

By: Regina E. Herzlinger
  • 3 Jun 2023 |
  • Talk |
  • Faculty Research
The crush of patients created by COVID enabled the creation of sites for care outside the traditional hospital, such as retail pharmacies, ambulatory surgery centers, urgent care centers, telemedicine, and wireless sensors. Public policy mirrored these changes by allowing access to telemedicine and pharmaceuticals by mail and by redefining care of the home as an insured benefit and the ownership role of physicians. Some newly public health insurers added technology as a major asset, and VCs and PEs invested heavily in these new businesses. How sustainable is this new health care system, and what opportunities and risks does it create for patients, employers, and investors?
Keywords: Policy; Health Pandemics; Health Care and Treatment; Innovation and Invention; Health Industry; Insurance Industry
Citation
Related
Herzlinger, Regina E. "Health Care Innovation Opportunities Created by COVID-19 and How to Make Them Happen." Harvard Business School Alumni Reunion, Boston, MA, June 3, 2023. (Link to cases described in this talk.)

Decarbonizing Health Care: Engaging Leaders in Change

By: Vivian S. Lee, Kathy Gerwig, Emily Hough, Kedar Mate, Robert Biggio and Robert S. Kaplan
  • May 2023 |
  • Article |
  • NEJM Catalyst Innovations in Care Delivery
Health care leaders are often surprised to learn that their operations contribute significantly to a warming climate. In addition to their roles as responders to and victims of extreme weather events, health care organizations have an obligation to reduce their substantial greenhouse gas emissions as part of their overall mission to do no harm and to improve health. Representing close to one fifth of the U.S. gross domestic product, the health care sector can use its purchasing power to drive the transition to clean energy and a low-carbon supply chain for the rest of the nation. Moreover, much of the shift in focus to preventive models of care and safer, higher-quality care that reduces unnecessary utilization will naturally produce lower carbon footprints. With the Inflation Reduction Act of 2022, nonprofit organizations can now use the new tax credit provisions for renewable energy to support desired investments in buildings, energy infrastructure, and transportation, among others. Health care organizations and their global value chains can be influential and important catalysts for the journey to a net-zero carbon future. Here, the authors share recommendations for how leaders can build climate-smart strategies that take advantage of tax incentives and drive changes that can both energize their employees and build a more resilient system to care for their communities.
Keywords: Health Care; Decarbonization; Carbon Emissions; Net-zero Emissions; Climate Change; Health Care and Treatment; Health Industry
Citation
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Lee, Vivian S., Kathy Gerwig, Emily Hough, Kedar Mate, Robert Biggio, and Robert S. Kaplan. "Decarbonizing Health Care: Engaging Leaders in Change." NEJM Catalyst Innovations in Care Delivery 4, no. 5 (May 2023).

Falling Insulin Prices—What Just Happened?

By: Leemore S. Dafny
  • April 20, 2023 |
  • Article |
  • NEJM.org
Recently, more than 100 years after insulin was developed, manufacturers announced price reductions for insulin products. Pressure to reduce prices had long been building, so why would they act now?
Keywords: Price; Health Care and Treatment; Public Opinion; Demand and Consumers; Pharmaceutical Industry
Citation
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Dafny, Leemore S. "Falling Insulin Prices—What Just Happened?" NEJM.org (April 20, 2023).

We Need an Operation Warp Speed for Long COVID

By: Esther K. Choo and Scott Duke Kominers
  • April 5, 2023 |
  • Article |
  • Scientific American (website)
With millions of people affected and at least $1 trillion of economic value at stake, long COVID is our next national health emergency.
Keywords: COVID; COVID-19; COVID-19 Pandemic; Scientific Research; Policy; Health Policy; Innovation; Science; Public Finance; Public Health; Health Disorders; Health Care and Treatment; Human Capital
Citation
Read Now
Related
Choo, Esther K., and Scott Duke Kominers. "We Need an Operation Warp Speed for Long COVID." Scientific American (website) (April 5, 2023).

Roche: ESG and Access to Healthcare

By: George Serafeim, Susanna Gallani and Benjamin Maletta
  • March 2023 |
  • Case |
  • Faculty Research
In May 2022, Roche Group, one of the largest healthcare companies in the world, hosted its first ESG investor event focused exclusively on its efforts to impact access to healthcare. While Roche had recently set an ambitious goal to double the number of patients that had access to its innovative medicines and diagnostic solutions within ten years, it was not at all clear how the firm should structure its resource allocation criteria, performance evaluations, reporting and incentive systems to align efforts internally toward these goals. Group CFO and CIO Alan Hippe was presented with two options, none of which he was particularly enthusiastic about. One was to lower the hurdle rate for projects related to ESG issues, thus relaxing profit expectations. The alternative was to incorporate a set of minimum ESG requirements in all of Roche’s new project proposals. In this case, however, the risk was to reduce the focus on ESG from a strategic priority to a compliance exercise. In the presentation shared with investors at the ESG event, access to healthcare had been positioned as Roche’s greatest contribution to society. This type of public commitment required more than a compliance-level of effort. In September, Alan Hippe would sit down with the executive committee to chart a path for integrating ESG issues into Roche’s project selection and business planning. Hippe went on to define three objectives for ESG at Roche, “we need to align on targets, we need to get resource allocation right, and we need to report both internally and externally.”
Keywords: ESG (Environmental, Social, Governance) Performance; Sustainable Finance; Growth Strategy And Execution; Sustainability Targets; Impact Evaluation; Healthcare Access; Healthcare Innovation; Healthcare Systems; Healthcare Operations; Finance; Strategy; Health Testing and Trials; Health Care and Treatment; Growth Management; Measurement and Metrics; Innovation Strategy; Corporate Social Responsibility and Impact; Health Industry; Pharmaceutical Industry; Switzerland; North America; Europe; Asia; Latin America; Africa
Citation
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Serafeim, George, Susanna Gallani, and Benjamin Maletta. "Roche: ESG and Access to Healthcare." Harvard Business School Case 123-075, March 2023.

Comparison of COVID-19 Hospitalization Costs across Care Pathways: A Patient-level Time-driven Activity-based Costing Analysis in a Brazilian Hospital

By: Ricardo Bertoglio Cardoso, Miriam Allein Zago Marcolino, Milena Soriano Marcolino, Camila Felix Fortis, Leila Beltrami Moreira, Ana Paula Coutinho, Nadine Oliveira Clausell, Junaid Nabi, Robert S. Kaplan, Ana Paula Beck da Silva Etges and Carisi Anne Polanczyk
  • 2023 |
  • Article |
  • BMC Health Services Research
The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations. This study used time-driven activity-based costing to estimate COVID-19 patient-level hospital costs in a Brazilian hospital for COVID-19 care management for 208 patients, stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. The most expensive care pathway was the ICU only, registering a median cost per patient of $13,519. All care pathways that included the ICU unit registered a higher cost per patient. The findings of how patient-level cost varied with Covid-19 care pathway can be used to develop sustainable value-reimbursement strategies in middle-income countries such as Brazil.
Keywords: Health Care and Treatment; Cost; Health Industry; Brazil
Citation
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Cardoso, Ricardo Bertoglio, Miriam Allein Zago Marcolino, Milena Soriano Marcolino, Camila Felix Fortis, Leila Beltrami Moreira, Ana Paula Coutinho, Nadine Oliveira Clausell, Junaid Nabi, Robert S. Kaplan, Ana Paula Beck da Silva Etges, and Carisi Anne Polanczyk. "Comparison of COVID-19 Hospitalization Costs across Care Pathways: A Patient-level Time-driven Activity-based Costing Analysis in a Brazilian Hospital." BMC Health Services Research 23, no. 198 (2023).

Translating Information into Action: A Public Health Experiment in Bangladesh

By: Reshmaan Hussam, Kailash Pandey, Abu Shonchoy and Chikako Yamauchi
  • 2023 |
  • Working Paper |
  • Faculty Research
While models of technology adoption posit learning as the basis of behavior change, information campaigns in public health frequently fail to change behavior. We design an information campaign embedding hand-hygiene edutainment within popular dramas using mobile phones, randomly distributed to households in Bangladesh. We document substantial improvements in handwashing and health, but no change in hygiene knowledge. Employing machine learning techniques with temporal data on media exposure and handwashing, we find that both cumulative and immediate exposure is correlated with washing, consistent with cue-based habituation. Results highlight how behavior change may be induced by tacit, rather than explicit, knowledge acquisition.
Keywords: Handwashing; Public Health; Health; Information; Behavior; Change
Citation
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Hussam, Reshmaan, Kailash Pandey, Abu Shonchoy, and Chikako Yamauchi. "Translating Information into Action: A Public Health Experiment in Bangladesh." Working Paper, February 2023.

A Randomized Trial of Behavioral Nudges Delivered through Text Messages to Increase Influenza Vaccination among Patients with an Upcoming Primary Care Visit

By: Mitesh S. Patel, Katherine L. Milkman, Linnea Gandhi, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Modupe Akinola, John Beshears, Jonathan E. Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew D. Hilchey, Jillian Hmurovic, Leslie John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, Michelle N. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N. Evans, Seung Hyeong Lee, Christopher K. Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G. Volpp and Angela L. Duckworth
  • 2023 |
  • Article |
  • American Journal of Health Promotion
Purpose: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.
Design: Randomized, controlled trial.
Setting: Two health systems in the Northeastern US between September 2020 and March 2021.
Subjects: 74,811 adults.
Interventions: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content.
Measures: Influenza vaccination.
Analysis: Intention-to-treat.
Results: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (p = .005). The top performing text message described the vaccine to the patient as “reserved for you” and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; p < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as “reserved for you.” None of the interventions performed worse than control.
Conclusions: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.
Keywords: Vaccination; Health Care and Treatment; Interpersonal Communication; Communication Technology; Behavior; Health Industry
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Patel, Mitesh S., Katherine L. Milkman, Linnea Gandhi, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Modupe Akinola, John Beshears, Jonathan E. Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew D. Hilchey, Jillian Hmurovic, Leslie John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, Michelle N. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N. Evans, Seung Hyeong Lee, Christopher K. Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G. Volpp, and Angela L. Duckworth. "A Randomized Trial of Behavioral Nudges Delivered through Text Messages to Increase Influenza Vaccination among Patients with an Upcoming Primary Care Visit." American Journal of Health Promotion 37, no. 3 (2023): 324–332.

Natura: Weathering the Pandemic at Brazil's Cosmetic Giant

By: Brian Trelstad, Pedro Levindo and Carla Larangeira
  • January 2023 |
  • Case |
  • Faculty Research
Brazil's Natura, a multi-brand cosmetics group, has taken several measures to safeguard the livelihoods of its thousands of employees and millions of sales representatives during the COVID-19 health and economic crisis. The company has also made strides in its efforts to increase digital sales. Now the purpose-driven group must decide whether to vocalize its opposition to private companies buying COVID-19 vaccines to inoculate their employees before priority groups in Brazil's public health system.
Keywords: COVID-19 Pandemic; ESG Reporting; Acquisition; Customer Focus and Relationships; Decision Making; Social Entrepreneurship; Environmental Sustainability; Environmental Management; Climate Change; Ethics; Moral Sensibility; Values and Beliefs; Global Strategy; Corporate Governance; Health Pandemics; Human Resources; Human Capital; Crisis Management; Growth and Development Strategy; Marketing; Distribution Channels; Supply Chain; Corporate Social Responsibility and Impact; Mission and Purpose; Organizational Culture; Customer Ownership; Relationships; Business and Community Relations; Business and Stakeholder Relations; Networks; Partners and Partnerships; Science-Based Business; Reputation; Human Needs; Social Issues; Strategy; Equality and Inequality; Beauty and Cosmetics Industry; Brazil; Latin America
Citation
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Trelstad, Brian, Pedro Levindo, and Carla Larangeira. "Natura: Weathering the Pandemic at Brazil's Cosmetic Giant." Harvard Business School Case 323-065, January 2023.

Digital Public Health Interventions at Scale: The Impact of Social Media Advertising on Beliefs and Outcomes Related to COVID Vaccines

By: Susan Athey, Kristen Grabarz, Michael Luca and Nils Wernerfelt
  • January 23, 2023 |
  • Article |
  • Proceedings of the National Academy of Sciences
Public health organizations increasingly use social media advertising campaigns in pursuit of public health goals. In this paper, we evaluate the impact of about $40 million of social media advertisements that were run and experimentally tested on Facebook and Instagram, aimed at increasing COVID-19 vaccination rates in the first year of the vaccine roll-out. The 819 randomized experiments in our sample were run by 174 different public health organizations and collectively reached 2.1 billion individuals in 15 languages. We find that these campaigns are, on average, effective at influencing self-reported beliefs - shifting opinions close to 1% at baseline with a cost per influenced person of about $3.41. Combining this result with an estimate of the relationship between survey outcomes and vaccination rates derived from observational data yields an estimated cost per additional vaccination of about $5.68. There is further evidence that campaigns are especially effective at influencing users’ knowledge of how to get vaccines. Our results represent, to the best of our knowledge, the largest set of online public health interventions analyzed to date.
Keywords: COVID-19 Pandemic; Public Health; Vaccines; Social Media; Advertising; Power and Influence; Health Care and Treatment
Citation
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Athey, Susan, Kristen Grabarz, Michael Luca, and Nils Wernerfelt. "Digital Public Health Interventions at Scale: The Impact of Social Media Advertising on Beliefs and Outcomes Related to COVID Vaccines." e2208110120. Proceedings of the National Academy of Sciences 120, no. 5 (January 23, 2023).
More Publications

Faculty

Michael E. Porter
Regina E. Herzlinger
Robert S. Kaplan
Robert S. Huckman
Ariel D. Stern
Amy C. Edmondson
Richard G. Hamermesh
John A. Quelch
Alvin E. Roth
Leemore S. Dafny
Amitabh Chandra
James E. Austin
→See All

HBS Working Knowlege

    • 07 Jun 2023

    3 Ways to Gain a Competitive Advantage Now: Lessons from Amazon, Chipotle, and Facebook

    Re: Rebecca A. Karp
    • 06 Jun 2023

    The Opioid Crisis, CEO Pay, and Shareholder Activism

    Re: Suraj Srinivasan
    • 05 Jun 2023

    Is the Anxious Achiever a Post-Pandemic Relic?

    Re: James L. Heskett
→More Articles

Harvard Business Publishing

    • December 9, 2020
    • Article

    Give Employees Cash to Purchase Their Own Insurance

    By: Regina E. Herzlinger and Barak D. Richman
    • March 2023
    • Case

    Roche: ESG and Access to Healthcare

    By: George Serafeim, Susanna Gallani and Benjamin Maletta
→More Harvard Business Publishing
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