Health Care
Health Care
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 CareSocial EnterpriseRecent Publications
Variation in Batch Ordering of Imaging Tests in the Emergency Department and the Impact on Care Delivery
By: Jacob C. Jameson, Soroush Saghafian, Robert S. Huckman and Nicole Hodgson
- February 2025 |
- Article |
- Health Services Research
Objectives: To examine heterogeneity in physician batch ordering practices and measure the impact of a physician's tendency to batch order imaging tests on patient outcomes and resource utilization.
Study Setting and Design: In this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates.
Data Sources and Analytic Sample: The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters.
Principal Findings: Findings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72-h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short-term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order.
Conclusions: This study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices.
Study Setting and Design: In this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates.
Data Sources and Analytic Sample: The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters.
Principal Findings: Findings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72-h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short-term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order.
Conclusions: This study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices.
Innovations in Evaluating Ambulatory Costs of Cystic Fibrosis Care: A Comparative Study Across Multidisciplinary Care Centers in Ireland and the United States
By: Emma Brady, Ryan C. Perkins, Kate Cullen, Gregory S. Sawicki, Robert S. Kaplan and Gerardine Doyle
- February 2025 |
- Article |
- NEJM Catalyst Innovations in Care Delivery
Lead clinicians at two large pediatric cystic fibrosis (CF) centers in the United States and Ireland measured and compared their ambulatory care costs. The clinicians selected three strata of patients (0–11 months, 1–5 years, and 6–17 years of age). Process maps were developed for each of the age cohorts at each site, and the costs of ambulatory care—with emphasis on routine CF clinic visits—were measured utilizing time-driven activity-based costing (TDABC). Variance analysis was applied to identify the components of cost variation between the two sites. The quantity variance showed that clinicians in Ireland spent 108% more time with patients than at the U.S. site; the skill mix variance showed the U.S. site with a 49% higher personnel cost mix, and the price (rate) variance showed that U.S. personnel had a 31% higher compensation level. The costing and variance analysis provided organizationally relevant insights into the distinctive features of each site’s CF care delivery processes and how costs could be reduced without adverse impact on patient outcomes.
The VideaHealth AI Factory: CEO Florian Hillen on Speed, Scale, and Innovation (A)
By: Tsedal Neeley, Levi Stroud, Ruth Page and Dave Habeeb
- January 2025 |
- Case |
- Faculty Research
Pre-abstract:
This multimedia case should be assigned to students in advance of class. Instructors should consider the timing of making the (B) Case videos available to students, as they may reveal key case details.
Abstract:
Florian Hillen, co-founder and CEO of VideaHealth, a startup using artificial intelligence (AI) to detect dental conditions on x-rays, spent the early years of his company laying the groundwork for an AI factory. This AI factory, designed to rapidly build and iterate on new AI products, was central to Hillen's vision of giving VideaHealth a competitive edge in the market. VideaHealth’s AI technology aspires to detect dental conditions on x-rays with a level of accuracy and consistency that would resonate with the needs of both individual dentists and Dental Service Organizations (DSOs). Yet, the puzzle remained: how precise and reliable would the AI's performance need to be to earn the trust of practitioners, enhance patient care, and seamlessly integrate into clinical workflows? The exact threshold of success was unclear, challenging Hillen to ensure the AI factory could continuously refine the technology to improve decision-making in dental practices.
Keywords: AI; Adoption; Diagnostics; Organization Design; Change Management; Disruption; Transformation; Health Care and Treatment; AI and Machine Learning; Technology Adoption; Disruptive Innovation; Technological Innovation; Management Style; Organizational Culture; Success; Technology Industry; Health Industry; United States
A Consensus Definition of Creativity in Surgery: A Delphi Study Protocol
By: Alex Thabane, Tyler McKechnie, Phillip Staibano, Vikram Arora, Goran Calic, Jason W. Busse, Sameer Parpia and Mohit Bhandari
- December 5, 2024 |
- Article |
- PLoS ONE
Introduction
Clear definitions are essential in science, particularly in the study of abstract phenomena like creativity. Due to its inherent complexity and domain-specific nature, the study of creativity has been complicated, as evidenced by the various definitions used to describe it and the multitude of tools which claim to measure it. Surgery is a safety-critical profession where creativity could be useful in navigating unforeseen problems and circumstances, as well as developing new innovations to improve patient outcomes. To validly and reliably study creativity in surgery, a surgery-specific definition is required. We aim to develop a consensus definition of creativity in surgery, utilizing the existing creativity literature and surgeon input.
Methods and analysis
The objective of this study is to generate a consensus definition of creativity in surgery. We will first conduct a focus group comprised of 4–12 highly experienced surgeons to generate knowledge on surgeons’ perceptions, attitudes and beliefs about creativity in surgery, collect real-world examples of creativity in surgery, and obtain opinions on the existing definitions of creativity in the literature. The selection of focus group participants will be performed using purposive sampling of the chairs and/or chiefs of each surgical sub-specialty at our home institution. Several questions relating to creativity in surgery will be posed to the focus group, to be rated using a 7-point Likert scale and used as prompts for group discussion. We will also search MEDLINE, PsycINFO and EMBASE to find definitions of creativity in the scientific literature. Six definitions, chosen based on citation frequency and relevancy to surgery, will be presented to the focus group for ranking and discussion. Lastly, in addition to novelty and effectiveness, which are widely accepted as necessary components of creativity, the focus group will be asked to consider the necessity of other components for creativity in surgery, sourced from the scientific literature. Descriptive and thematic analyses are planned for the quantitative and qualitative data, respectively. The results of the focus group will be incorporated in the drafting of five definitions of creativity in surgery, which will be presented as initial Delphi statements in the Delphi study. For the Delphi panel, we will perform non-probability purposive sampling of surgeons and surgeon trainees at our home institution, with a minimum panel size of 12. Panellists will be asked to select the definition of creativity most relevant to surgery, with each Delphi round electronically delivered. After each round, the steering committee will meet to review the results and adjust the statements for the next round based on the feedback. A maximum of 5 rounds will be performed, or until consensus is reached (≥75% agreement). Recruitment is scheduled to begin on 1 August 2024.
Ethics and dissemination
All focus group and panellists will be given written and verbal information on the study and provide signed, informed consent. We plan to publish the results of our study in a creativity science- or surgery-focused journal to disseminate the results of our study to relevant stakeholders. We also plan to present the results of our research at local, national, and international conferences.
Clear definitions are essential in science, particularly in the study of abstract phenomena like creativity. Due to its inherent complexity and domain-specific nature, the study of creativity has been complicated, as evidenced by the various definitions used to describe it and the multitude of tools which claim to measure it. Surgery is a safety-critical profession where creativity could be useful in navigating unforeseen problems and circumstances, as well as developing new innovations to improve patient outcomes. To validly and reliably study creativity in surgery, a surgery-specific definition is required. We aim to develop a consensus definition of creativity in surgery, utilizing the existing creativity literature and surgeon input.
Methods and analysis
The objective of this study is to generate a consensus definition of creativity in surgery. We will first conduct a focus group comprised of 4–12 highly experienced surgeons to generate knowledge on surgeons’ perceptions, attitudes and beliefs about creativity in surgery, collect real-world examples of creativity in surgery, and obtain opinions on the existing definitions of creativity in the literature. The selection of focus group participants will be performed using purposive sampling of the chairs and/or chiefs of each surgical sub-specialty at our home institution. Several questions relating to creativity in surgery will be posed to the focus group, to be rated using a 7-point Likert scale and used as prompts for group discussion. We will also search MEDLINE, PsycINFO and EMBASE to find definitions of creativity in the scientific literature. Six definitions, chosen based on citation frequency and relevancy to surgery, will be presented to the focus group for ranking and discussion. Lastly, in addition to novelty and effectiveness, which are widely accepted as necessary components of creativity, the focus group will be asked to consider the necessity of other components for creativity in surgery, sourced from the scientific literature. Descriptive and thematic analyses are planned for the quantitative and qualitative data, respectively. The results of the focus group will be incorporated in the drafting of five definitions of creativity in surgery, which will be presented as initial Delphi statements in the Delphi study. For the Delphi panel, we will perform non-probability purposive sampling of surgeons and surgeon trainees at our home institution, with a minimum panel size of 12. Panellists will be asked to select the definition of creativity most relevant to surgery, with each Delphi round electronically delivered. After each round, the steering committee will meet to review the results and adjust the statements for the next round based on the feedback. A maximum of 5 rounds will be performed, or until consensus is reached (≥75% agreement). Recruitment is scheduled to begin on 1 August 2024.
Ethics and dissemination
All focus group and panellists will be given written and verbal information on the study and provide signed, informed consent. We plan to publish the results of our study in a creativity science- or surgery-focused journal to disseminate the results of our study to relevant stakeholders. We also plan to present the results of our research at local, national, and international conferences.
Psychological Safety as an Enduring Resource amid Constraints
By: Hassina Bahadurzada, Amy C. Edmondson and Michaela J. Kerrissey
- 2024 |
- Article |
- International Journal of Public Health
While psychological safety is recognized as valuable in healthcare, its relationship to resource constraints is not well understood. We investigate whether psychological safety mitigates the negative impact of resource constraints on employees. Leveraging longitudinal survey data collected from healthcare workers before and during the COVID-19 crisis (N = 27,240), we examine how baseline psychological safety relates to employee burnout and intent to stay over time, and then investigate this relationship relative to resource constraints (i.e., the inadequacy of staffing and tools). Using hierarchical linear models, we find that psychological safety has enduring protective benefits for healthcare workers during periods of stress, and that these benefits mitigate the negative consequences of resource constraints for burnout and turnover intent over time. These findings extend the empirical basis for psychological safety and suggest that investments in building psychological safety can foster employee resilience and organizational commitment, even when resources are strained.
Blue Cross Blue Shield of Michigan (BCBSM): The AI Journey
By: Shikhar Ghosh
- December 2024 |
- Case |
- Faculty Research
In early 2024, Bill Fandrich, Executive VP and CIO of Blue Cross Blue Shield of Michigan (BCBSM), faced a critical decision about AI adoption within the organization. Fandrich had championed AI implementation at BCBSM. After successfully developing three AI applications, BCBSM had formed an industry consortium with other BCBS affiliates and developed a comprehensive strategy focused on transforming work processes. When research indicated that AI could automate 80% of the work done by 45 analysts in the government healthcare group, Fandrich proposed eliminating half of these positions—a proposal that met significant resistance.
The situation highlighted fundamental questions about AI implementation in large organizations: How fast should companies move to adopt AI capabilities? Who should drive the pace of implementation - business units responsible for results or technology leaders pushing innovation? While Fandrich viewed AI as a strategic necessity that would transform the business, others saw it as a tactical tool to be deployed gradually. As BCBSM expanded its AI initiatives across the $36 billion organization serving over 5 million members, Fandrich had to decide whether to push ahead or accept a more measured approach to change.
Keywords: AI, AI and Machine Learning, Blue Cross, Business Process Automation, Change Management, Digital Strategy, Digital Transformation, Generative AI, Health, Health Insurance, Innovation, Insurance Industry, IT Strategy, Leadership, Organizational Transformation, Technology, Non-Profit Organization, Michigan, United States.
Keywords: AI; Machine Learning; Blue Cross; Automation; Digital Strategy; Digital Transformation; Generative Ai; Health Insurance; Insurance Companies; Innovation; IT Strategy; Leadership; Organizational Transformations; Technology; Non-profit; Michigan; AI and Machine Learning; Health; Health Industry; Michigan
Demond Martin and WellWithAll
By: Hise Gibson, Archie L. Jones and Ai-Ling Jamila Malone
- November 2024 |
- Case |
- Faculty Research
This case study chronicles the transformative entrepreneurial path of Demond Martin, co-founder and CEO of WellWithAll, a health and wellness startup. Motivated by a pivotal life experience and deep concern for racial health inequities, Martin transitions from a successful hedge fund career to champion health equity through WellWithAll. He leverages his extensive network and industry reputation to forge strategic alliances with The Campbell’s Company, retail giants like Target and Thrive Markets, and health equity partners such as Advocate Health and the University of North Carolina at Charlotte. While tackling the challenges in the crowded supplements and energy drinks market, Martin is committed to investing 20% of profits into Black and Brown communities, aiming for a $300 million impact on racial health disparities over the next decade. Key themes include a late-career transition to entrepreneurship, leveraging relationships, team building, and scaling a mission-driven business.
Keywords: Customers; Diversity; Ethnicity; Race; Health; Recruitment; Leadership Style; Management Style; Marketing; Brands and Branding; Marketing Strategy; Product Marketing; Product Launch; Product Positioning; Organizational Culture; Mission and Purpose; Relationships; Trust; Business Strategy; Competition; Competitive Strategy; Competitive Advantage; Investment; Consumer Products Industry; Retail Industry; Health Industry; United States; Chicago; Boston; Atlanta; North Carolina; District of Columbia
Polish Agro: Where Do We Grow from Here?
By: Willy C. Shih, Lena Duchene and Daniela Beyersdorfer
- November 2024 |
- Case |
- Faculty Research
By July 2024, Polish Agro had grown into one of Poland’s fastest-growing agribusinesses, with €230 million in revenue, 82 employees, and operations across Northern Poland. The company supported farmers with essential agricultural inputs like fertilizers and seeds, while purchasing, aggregating, and reselling their outputs. Led by CEO Mathias Eisert, Polish Agro had also ventured into biofertilizers, aligning with new EU sustainability regulations and aiming to differentiate itself in a highly competitive market. These innovative products offered a buffer against commoditization, yet scaling them posed challenges due to Polish Agro’s highly consultative business model and limited sales force. This case study examines Polish Agro’s growth journey amidst disruptions like COVID-19 and the war in Ukraine and evaluates strategic options for sustaining and expanding its market position, including enhancing trading capabilities, investing in brand development, and digitalizing sales channels.
Keywords: Plant-Based Agribusiness; Distribution; Volatility; Customer Focus and Relationships; Customer Value and Value Chain; Climate Change; Environmental Regulation; Profit; Trade; Digital Strategy; Innovation Strategy; Crisis Management; Growth and Development Strategy; Resource Allocation; Advertising; Brands and Branding; E-commerce; Business and Community Relations; Networks; Adaptation; Adoption; Competitive Advantage; Business Model; Health Pandemics; War; Agriculture and Agribusiness Industry; Europe; Poland
The Health Costs of Cost Sharing
By: Amitabh Chandra, Evan Flack and Ziad Obermeyer
- November 2024 |
- Article |
- Quarterly Journal of Economics
What happens when patients suddenly stop their medications? We study the health consequences of drug interruptions caused by large, abrupt, and arbitrary changes in price. Medicare’s prescription drug benefit as-if-randomly assigns 65-year-olds a drug budget as a function of their birth month, beyond which out-of-pocket costs suddenly increase. Those facing smaller budgets consume fewer drugs and die more: mortality increases 0.0164 percentage points per month (13.9%) for each $100 per month budget decrease (24.4%). This estimate is robust to a range of falsification checks and lies in the 97.8th percentile of 544 placebo estimates from similar populations that lack the same idiosyncratic budget policy. Several facts help make sense of this large effect. First, patients stop taking drugs that are both high value and suspected to cause life-threatening withdrawal syndromes when stopped. Second, using machine learning, we identify patients at the highest risk of drug-preventable adverse events. Contrary to the predictions of standard economic models, high-risk patients (e.g., those most likely to have a heart attack) cut back more than low-risk patients on exactly those drugs that would benefit them the most (e.g., statins). Finally, patients appear unaware of these risks. In a survey of 65-year-olds, only one-third believe that stopping their drugs for up to a month could have any serious consequences. We conclude that far from curbing waste, cost sharing is itself highly inefficient, resulting in missed opportunities to buy health at very low cost ($11,321 per life-year).
Characteristics of Creative Individuals: An Umbrella Review Protocol
By: Alex Thabane, Tyler McKechnie, Phillip Staibano, Goran Calic, Colin Kruse, Jason W. Busse, Samee Parpia and Mohit Bhandari
- October 10, 2024 |
- Article |
- PLoS ONE
The properties of creative products–novelty and usefulness–are generally agreed upon by researchers. Yet, consensus is lacking on which personal and environmental factors contribute to an individual’s creative potential, or to what extent. substantial research work has been conducted in this area, leading to the publication of many systematic reviews and meta-analyses collating the available evidence. However, many of these reviews have differing methodological and theoretical characteristics, and often report conflicting results. To summarize the current review literature on factors associated with creativity and better understand the similarities and discrepancies among reviews on the same topic, we plan to conduct an umbrella review of reviews.