Robert S. Huckman, PhD
Assistant Professor, Harvard Business School

Cohort Turnover and Productivity:
The July Phenomenon in Teaching Hospitals

May 6, 2005
12:00 - 1:30 PM

Colonial Penn Center Auditorium

Abstract Paper


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 in a hospital's reliance on residents for the provision of care. In fact, the most-intensive teaching hospitals manage to avoid significant effects on mortality following this turnover. We provide a preliminary examination of 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.

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