Robert Huckman is an Assistant Professor at Harvard Business School, where
he teaches the second-year course in Operations Strategy and has previously
taught the first-year course in Technology and Operations Management.
He is also a faculty research fellow in the health care program of the
National Bureau of Economic Research. Professor Huckman's research focuses
on the linkages between organizational characteristics, technological
choice, and operating performance, with an emphasis on the health care
industry. His articles have appeared in publications including the American
Economic Review Papers and Proceedings, Health Affairs, the Journal of
Health Economics, and Management Science.
Professor Huckman received a Ph.D. in Business Economics from Harvard
University and an A.B. in Public Policy, summa cum laude, from Princeton
University, where he was elected to Phi Beta Kappa.
Prior to his graduate studies, Professor Huckman was a Principal and
Founding Equity Member of Stamos Associates, Inc., a strategy and operations
consulting firm serving clients in the health care industry. In 1997,
Stamos Associates was acquired by Perot Systems, Inc. Professor Huckman
has also worked as an Associate at Booz·Allen & Hamilton, Inc.
We consider the
impact of cohort turnover--the simultaneous exit of a large
number of experienced employees and a similarly sized entry of new
workers--on productivity in the context of teaching hospitals. In
particular, we examine the impact of the annual July turnover of house
staff (i.e., residents and fellows) in American teaching hospitals on
levels of resource utilization (measured by risk-adjusted length of
hospital stay) and quality (measured by risk-adjusted mortality
rates). Using patient-level data from roughly 700 hospitals per year over
the period from 1993 to 2001, we compare monthly trends in length of stay
and mortality for teaching hospitals to those for non-teaching hospitals,
which, by definition, do not experience systematic turnover in July. We
find that the annual house-staff turnover results in increased resource
utilization (i.e., higher risk-adjusted length of hospital stay) for both
minor and major teaching hospitals and decreased quality (i.e., higher
risk-adjusted mortality rates) for major teaching hospitals. Further,
these effects with respect to mortality are not monotonically increasing
a hospital's reliance on residents for the provision of care. In fact,
most-intensive teaching hospitals manage to avoid significant effects
mortality following this turnover. We provide a preliminary examination
the roles of supervision and worker ability in explaining why the
most-intensive teaching hospitals appear able to reduce turnover's negative
effect on performance.