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
Creating Workplaces Free of Forever Chemicals
By: Joseph G. Allen, Heather A. Henrikson and Michael W. Toffel
- April 8, 2025 |
- Article |
- Harvard Business Review Digital Articles
Forever chemicals are toxic and widely used in buildings and yet they remain on the rise globally with little regulation to control them. In the United States, for example, Environmental Protection Agency (EPA) regulations currently cover only forever chemicals in water—and only six of the more than 10,000. But organizations have a responsibility and role to play in eliminating them from workplaces in the same way they might have asbestos in years past. At Harvard University and several corporations, leaders are following a simple, two-part playbook: Demand transparency from suppliers and avoid entire classes of chemicals.
Niramai: An AI Solution to Save Lives
By: Rembrand Koning, Maria P. Roche and Kairavi Dey
- March 2025 |
- Case |
- Faculty Research
Founded in 2017, Niramai developed Thermalytix, a breast cancer screening tool. Thermalytix used a high-resolution thermal sensing device and machine learning algorithms to analyze thermal images and detect tumors. Its patented solution leveraged big data analytics, AI, and ML for reliable, early, and accurate breast cancer screening. Early clinical trials showed that the solution was equal to or, in some instances, more accurate than mammography available in India. The team was elated that they had developed an effective, low-cost, easier-to-use, non-invasive, and less painful solution for patients.
As Manjunath considered the next phase of Niramai’s growth, she wondered if it was time to raise another round of funds and conduct a new, comprehensive clinical study. Should the trial be conducted in the U.S., where it would be significantly more expensive but with the possibility of an exponentially higher payout if the trials were successful? Or should they raise a smaller round now, do a larger trial in a populous developing country such as Indonesia, and focus on lower-to-middle-income countries?
Expert Patients’ Use of Avoidable Health Care
By: Amitabh Chandra, Pragya Kakani and Simone Matecna
- 2025 |
- Working Paper |
- Faculty Research
We measure whether expert patients – those trained as physicians and nurses – have fewer emergency department visits and the reasons for these differences. Relative to similar patients physicians and nurses had 19.8% and 5.1% fewer ED visits, principally due to fewer avoidable visits. The differences in avoidable visits between physicians and other patients were largest for diagnoses commonly requiring prescriptions, which physicians often self-prescribed. Our results suggest that improving access to prescriptions for acute symptoms, more than improving patient education, may reduce avoidable health care.
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.
Gavi and the 'Next' Pandemic
By: Tarun Khanna and Kerry Herman
- January 2025 (Revised March 2025) |
- Case |
- Faculty Research
In 2025, CEO Dr. Sania Nishtar and her team consider the lessons the Global Alliance for Vaccine and Immunizations (GAVI) learned from the pandemic. GAVI successfully brought COVID-19 vaccines to large swaths of the undeveloped and under-developed world by pooling countries’ needs and deploying innovative financing instruments to procure vaccines. Once COVID was identified as a pandemic, in the face of a raft of financial and logistical challenges, Gavi quickly mobilized to add procuring COVID-19 vaccines for low- and middle-income countries to its regular vaccine and immunization efforts. Now in the aftermath of the pandemic, Nishtar is assessing how to best embed into Gavi’s operational DNA the many innovative solutions developed during the pandemic-related chaos of securing and delivering vaccines, while she and her team prepare for what unknowns may come next.
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.
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: 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; Adoption; Technology Industry; Health Industry; United States
The Shouldice Hospital Today
By: James Heskett and Roger Hallowell
- December 2024 (Revised March 2025) |
- Case |
- Faculty Research
The leadership and staff of Shouldice Hospital in Toronto, Canada have, for 75 years, sought to do one thing better than any other hospital in the world, repair inguinal hernias. For some years, a possible second hospital in another market has been under consideration. Restrictions on private medical services in Canada make expansion outside the country increasingly attractive. Shouldice has been approached by one of the leading medical institutions in the United States possibly to undertake a joint venture in that country. Is this finally the time to make the move? If so, should Shouldice partner in a joint venture or go it alone? If it were to expand, what steps would have to be taken to preserve Shouldice's fabled organization culture?
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.