Short Term Economic Traps and COVID-19 Response in Countries – Is there a trend?


As we reflect on the COVID-19 pandemic, we start to wonder how certain countries and regions are able to manage the pandemic better than others. By better, I mean fewer cases and containing the spread within their countries for a sustained period. Through science, we now know that effective containment of COVID-19 relies on preventive measures of wearing facemasks, washing hands, adherence to strict social distancing, monitoring daily health and avoiding public gathering to contain the spread. All of these mean that there is a definite economic loss in the short term due to the businesses closing, restrictions in outdoor events and travel and increase testing and quarantine. In certain countries and regions, this could mean revenues lost in trillions of dollars and thousands of jobs. Investors do not like these short-term closure of the economy and hence you would have seen unfavorable responses from the global stock markets between March and April. To avoid these losses, leaders in these countries favor reopening the economies and loosening the restrictions, which may seem like a sensible strategy. However, this may result in long-term complications including increase in cases, resurgence of a second wave and beyond. This classic short-term vs. long-term economic trap paradox has been extensively studied by academics. I myself found this paradox of focusing on short term results over long-term growth strategies to be true in a study of over 40 technology companies. Are countries falling into similar traps? I try to explore this issue in this blog.

To do this, I first compiled data on countries that are doing well in containing the spread as well as countries that are struggling in this journey. The following website gives real-time data on how the spread is happening globally. Note that the list changes every day as some countries move around these categories. There are three categories of countries:

  • Those that have gotten COVID-19 spread under control with the active cases going down
  • Those that are in the process of getting COVID-19 spread under control with active cases showing signs of going down
  • Those that are struggling to get COVID-19 spread under control with active cases going up.

A quick look at these countries across the three categories suggest they come from similar regions (e.g. continents) and have comparable population size and governance structure (e.g. democratic vs. oligarchy). So why did certain countries contain the spread better than others?

To understand this, I ended up collecting data on countries from (1) and (3). I excluded (2) since they are still not complete in containing the spread. There are 23 countries in category 1 and 27 in category 3. I also collected some information regarding the leaders of the government in these countries. In my previous studies looking at organizational effectiveness, I found that the functional background of the leaders are very important in managing healthcare related issues. For instance, in a study of hospital leaders managing patient experience, we found that leaders with medical background are better equipped to manage communication related aspects of care delivery. In another study of hospital leaders, we found that their leadership style is extremely important in effectively managing quality related issues. There is ample evidence in the field of management on the background of leaders when managing complex issues in their organization. Following these existing ideas, I specifically collected information regarding their backgrounds (education), age, and gender of the leaders (e.g. Presidents or Prime Ministers) of each of these countries. The table below gives these details for these countries. Category =1 represents the set of countries that have contained the spread while Category = 3 represents the set of countries that failed to contain the spread. As seen from table, there are no statistical differences in terms of the regions, size in terms of population between these two categories.

What are some differences?

We do find that countries containing the spread in category 1 have a slightly higher GDP per capita ($29,877) when compared to countries (category 3) that are failing to control ($19312). This does suggest some trends that richer countries are containing the spread better.

It is interesting to see that 40% of leaders (9 out of 23) from category 1 (i.e. countries containing spread) are female while only 3.70% of leaders (1 out of 27) from category 3 are female. These proportions are statistically significant (p<0.01) and this trend about female leaders are better managing COVID-19 crisis has been previously reported in the business press. For instance, management researchers have also found similar kind of response patterns when studying recalls and safety.

I also investigated two other characteristics of these leaders – namely Age and Education. When looking at the age of these leaders, we do find that leaders from category 1 are on an average 6 years younger (Average Age = 57 years) than those in category 3 (Average age = 63 years). This is in fact statistically significant (p<0.05). One possible explanation is that with increase in age, leaders tend to focus more on short-term economic traps when compared to long-term view. There is some support in the psychology and management literature on the relationship between risk taking tendencies and age. For instance, research shows that older CEOs are less likely to invest in R&D (long-term health of the firm) and are more likely to make diversified acquisitions to manage short-term health.

I also looked at the educational background of these leaders. In particular, I coded their education to be 1 if the leaders had an economics and/or business degree and 0 otherwise. It is interesting to find that a vast majority of leaders, around 42% (11 out of 26) from category 3 had an economics or business degree while only 8% of the leaders (2 out of 23) from category 1 had a business or economics degree. This was also statistically significant (p<0.05) suggesting that leaders with economic or business degree favor short-term needs from the market over long term.

While these trends are interesting to write a blog, I would like emphasize correlation is not causation and these are mere correlations observed in a small sample of data. Obviously, more analyses that are rigorous is required to make bold claims on these directional relationships. Nevertheless, it makes us wonder on some factors that may come into play as we think about these discussions and leaders locally.


Countries Category (1-under control, 3 – not under control) Region Size (million of people) Per Capital Gdp (in $) Leader of the State Gender (1= Female, 0= Male) Age (in years) Background Education
Andorra 1 Europe 0.077 42305 Xavier Zamora 0 40 Master of Law (ESADE) 0
Bahamas 1 Central America 0.385 33494 Hubert Minnis 0 66 Doctor of Medicine 0
Barbados 1 Central America 0.287 18798 Mia Mottley 1 54 Law Degree 0
Belize 1 Central America 0.404 8576 Dean Barriw 0 69 Law Degree 0
Bhutan 1 Asia 0.754 9426 Lotay Tshering 0 51 Medicine 0
Burma 1 Asia 53 6707 Win Myint 0 68 Science 0
Cameroon 1 Africa 26 3820 Joseph Ngute 0 66 Law Degree 0
China 1 Asia 1400 20984 Xi Jinping 0 67 Chemical Engineering 0
Cuba 1 Central America 11.19 8822 Miguel Diaz Canel 0 50 Electronics Engineer 0
Denmark 1 Europe 5.8 51643 Mette Frederisken 1 44 Social Science 0
Estonia 1 Europe 1.3 37605 Kersti Kaljulaid 1 46 Business 1
Finland 1 Europe 5.5 46559 Sanna Marin 1 35 Administrative Science 0
Georgia 1 Europe 37 12409 Salome Zourabichvilli 1 68 Sciences 0
Hungary 1 Europe 9.7 35941 Janos Ader 0 61 Law Degree 0
NewZealand 1 Pacific/Australia 5 40226 Jacindra Arden 1 39 Communication 0
Cyprus 1 Europe 1.18 41572 Nicos Anastsiader 0 64 Law Degree 0
Iceland 1 Europe 0.364 54743 Guoni Johnanesson 0 52 Historian 0
Ireland (N. Ireland) 1 Europe 1.8 35000 Brandon Lewis 1 49 Law 0
Norway 1 Europe 5.6 79638 Erna Solberg 1 59 Economics 1
Malaysia 1 Asia 32 34567 Muhyiddin Yassin 0 72 Literature 0
Niger 1 Africa 22 1213 Mahamadou Issoufou 0 68 Engineering 0
Taiwan 1 Asia 23 55078 Tsai Ing-Wen 1 54 Law 0
Vietnam 1 Asia 96 8066 Nguyen Trong 0 76 Philosophy 0
Afghanistan 3 Asia 32 2024 Ashraf Ghani 0 71 Anthropologist 0
Albania 3 Europe 2.85 14866 Ilir Meta 0 51 Economics 1
Algeria 3 Africa 43.6 15765 Abdelmadjid Tebbounse 0 75 MBA 1
Argentina 3 South America 40.17 20055 Alberto Fernandez 0 61 Law 0
Australia 3 Pacific 25 54799 Scott Morrison 0 52 Economics 1
Brazil 3 South America 210 17016 Jair Bolsonaro 0 65 Military Academy 0
Cote d’Ivoire 3 Africa 26 6201 Alassane Ouattara 0 78 Economics 1
Egypt 3 Africa 100 14023 Abdul Fatttah- el-Sisi 0 66 Military Academy 0
Ecuador 3 South America 17 11701 Lenin Moreno 0 67 Psychology 0
Guatemala 3 Central America 17 8413 Alendra Falla 0 64 Economics 1
Haiti 3 Central America 11 1819 Joseph Jouthe 0 59 Engineer 0
Dominican Republic 3 Central America 10.7 20625 Danllo Medina 0 68 Economics 1
Kenya 3 Africa 47 4071 Uhru Kenyatta 0 59 Economics 1
US 3 North America 328 67426 Donald Trump 0 74 MBA 1
Venezuela 3 South America 28 2900 Nicolas Maduero 0 58 NA 0
Uzbekistan 3 Asia 34 9595 Shavkat Mirziyoyek 0 62 Technology Sciences 0
India 3 Asia 1352 9595 Narendra Modi 0 70 Political Science 0
Indonesia 3 Asia 267 34567 Joko Widodo 0 60 Forestry 0
Bangladesh 3 Asia 161 5453 Sheik Hasina 1 73 Political Science 0
Iraq 3 Asia 38 17952 Barham Salih 0 60 NA 0
Kazahstan 3 Asia 18.7 30178 Kassym-Jomrat Tokakye 0 67 International Relations 0
Colombia 3 South America 50.37 16267 Ivan Marquez 0 43 Law 0
Israel 3 Asia 9.27 40336 Benjamin Netanyahu 0 71 Architecture 0
Mexico 3 North America 128 21362 Andre Obrador 0 67 Public Administration 0
Poland 3 Europe 38 35651 Mateusz Morawiecki 0 52 Economics 1
Panama 3 Central America 4.2 28456 Laurentino Cohen 0 67 BBA 1
Ukraine 3 Asia 41 10310 Denys Shmyhal 0 45 Economics 1

Why are we choosing the wrong metrics?

For several years, I have had the fortune of studying healthcare organizations up close – some of them high performing in terms of patient care, cost and experience while others are not. One of the common element that unites the management teams in these organizations regardless of their actual performance is the fact that they prioritize safety over any other outcomes. That is, patient (and sometimes provider) safety climate is the first and foremost metric over cost of care and patient experience. Of course, these outcomes are not completely independent since safe care can lead to better experience and low cost over time.

Numerous times I have heard people suggest that this industry can learn from other industries such as manufacturing and services on how to create processes and good operations. I agree – but let me also tell you that other industries can certainly learn one thing from healthcare. The industry’s undivided focus on safety over anything else. I am writing this blog after observing the shocking line of events that occurred at Boeing. Just a simple google search using the words “Boeing” and “safety” would fill your browser with series of articles on how this organization prioritized shareholder value over customer safety. On numerous occasions they had ample evidence on the design and the safety issues of the 737-Max product line but this was ignored repeatedly by the leadership citing that delays and additional testing would result in bad market performance and lowering of shareholder value. I refer to shareholder value, market performance and profitability as an outcome metric (also sometimes referred to as lagged metric). The fundamental issue is that focusing on outcome metrics by themselves alone would result in short term gains but long term losses. Rather a focus on process metric such as safety may in the short term create some pain but over the long term is undoubtedly the best strategy for the organization. History has taught us this lesson repeatedly. A great example that shows this work is the leadership of Paul O’Neill at Alcoa. He transformed the company from being the worst productive organization to the best productive and profitable organization by focusing on one process measure – i.e. – worker safety. The culture at Alcoa was transformed into one that prioritizes worker safety over anything else. The results in terms of the outcomes followed through this transformation. That is, processesàculture & behaviorsàprocess measures à Outcome measures. So why are other organizations missing this link?

I am writing this blog not just reflecting on the Boeing’s troubled management focus but also hearing that the new CEO Dave Calhoun getting appointed today. What is troubling is the wrong way to incentive the leader, his hefty compensation package ($26.5 million) is focused on getting the 737 max out of the crisis – an outcome based measure in my opinion. Are we making the same mistake again? Wouldn’t this tradeoff with other product line priorities at Boeing? Why are we not thinking on process baffles me as an academic researcher!

Does Office of Patient Experience Matter in Improving the Delivery of Care?

Source: @IBCMED

Improving the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores has always been a challenge for US hospitals. Hospitals with poor HCAHPS scores can lose up to 2% of their Medicare reimbursements, which equates to a several million dollars for an average sized hospital. Using data from over 3615 hospitals between the years 2007-2014, we studied how hospitals improve their HCAHPS scores. We found that it is common from hospitals to use resources from their existing administrative offices such as office of quality and patient safety to improve HCAHPS but are less successful. This is because, elements of HCAHPS such as communication with the nurses and physicians are often considered less tangible and hence difficult to improve when compared to evidenced-based measures such as length of stay reduction. Performing well on HCAHPS therefore requires hospitals to change their operating routines and organizational culture.  To accomplish these tasks, we found that a certain proportion of hospitals are undertaking a number of initiatives that are unique to this industry. One such initiative includes setting up the Office of Patient Experience (OPX). An OPX is generally tasked with developing and implementing best patient experience practices to ensure that the hospital delivers consistent patient-centered care. It is different from other entities such as “Patient Council” and “Patient Relations Office,” which historically have been responsible for interfacing with the patients, surveying patients and resolving patient issues.  One example of this office and how it operates can be found at the Cleveland Clinic

Our Findings

We collected extensive data on the setting up and operations of these offices in the US. Between 2007 and 2014, we found that there were 132 hospitals that had an OPX within their organizational structure. We also find that this number continues to grow in recent years. Our results suggest that hospitals with an OPX are associated with 1.95% higher HCAHPS for each year of operation. We also found that hospitals that have higher residents and treating high acute patients (measured using case mix index) benefit from these offices to manage patient and provider variations.  Specifically, for hospitals with high CMI, we observe a 6.5% improvement in HCAHPS for each year increase in operation of the OPX, with no significant impact observed for hospitals with low CMI. Similarly, for hospitals with high resident intensity, we observe a 1.8% improvement in HCAHPS for each year increase in operation of the OPX, and only 0.9% improvement observed for hospitals with low resident intensity. Hence greater benefits of an OPX are realized by hospitals with high CMI or high resident intensity. This estimate offers the first empirical evidence to the efficacy of these administrative innovations. The significance of these improvements in HCAHPS are better highlighted when compared to only a 0.85% annual improvement in HCAHPS for hospitals that did not have an OPX.

Given the effectiveness of OPXs in improving HCAHPS, we conducted additional analyses  to investigate the cost of implementing these offices. We find that the operating costs, which include expenses incurred in every aspect of a hospital’s operations, reduce by 1.4% for each year of its existence.  These are also sizable improvements in operating efficiencies, especially given the low margins of operation for a vast majority of hospitals – the median operating margin for hospitals in 2018 was 1.7% .

Finally, taking cues from our interviews with the OPX and hospital staff at a prominent teaching hospital, we also investigated the impact of the background of the CXO (medical vs. non-medical) on the effectiveness of an OPX. In our dataset, we find that only a small proportion of the CXOs (14.5%) had a medical background, i.e., a nursing (RN, BSN) or MD/DO degree. Preliminary evidence suggests that a CXO with a medical background is more effective at improving EQ than a non-medical CXO. Specifically, a hospital with a medical CXO observes a 1.6% improvement in HCAHPS, compared to a 0.1% improvement in HCAHPS for a non-medical CXO, with each year of OPX operation. This suggests an interesting managerial insight on how to lead these offices in a hierarchical industry such as healthcare. Taken together, these results offer preliminary insights on the role and efficacy of these new administrative innovations in the healthcare industry. It also offers important policy implications to CMS on how to prioritize and manage HCAHPS.


How to transition care after surgery? Insights from research

Some anxiety is perfectly normal for kidney transplant patients, but new research suggests that medical staff can help patients feel more at ease when they leave the hospital and that could decrease the chances they’ll be readmitted.

High levels of anxiety a week after a kidney transplant patient went home more than doubled the chances he or she would be readmitted within 30 days of release, researchers found.

And anxiety was higher for patients who received inconsistent directions related to post-discharge care while in the hospital and who reported less-than-optimal empathy on the part of nurses, doctors and other caregivers, researchers from The Ohio State University Fisher College of Business and Wexner Medical Center report in September’s Journal of Surgical Research.

Aravind Chandrasekaran

“The more patient-centric the care, the more trust the patient had in the information provided, the lower the anxiety level after discharge,” said Aravind Chandrasekaran, study co-author and an associate professor of operations and associate director of Fisher’s Center for Operational Excellence.

“If you’re anxious, you’re going to come back.”

Readmissions can happen for true medical reasons – such as a patient taking the wrong medications or not adhering to post-transplant safety measures.

Susan Moffatt-Bruce

They can also arise when the worried well return unnecessarily, said Susan Moffatt-Bruce, study co-author, cardiothoracic surgeon and chief quality and patient safety officer at Ohio State’s Wexner Medical Center.

“Sometimes we can make ourselves unwell because we’ve been so anxious,” she said.

Standardizing post-transplant care and training caregivers to convey more empathy during their educational interactions could go a long way toward keeping new kidney recipients well and out of the hospital, the study concluded.

“It comes down to understanding the whole patient,” Moffatt-Bruce said. “With some simple interventions, including being kind and being present, we can make a difference.”

About 17,000 people receive kidney transplants each year in the United States and more than 100,000 are on the waiting list, according to 2014 data from the Health Resources and Services Administration. More than 30 percent of them are readmitted within 30 days of their release, previous research has found.

When patients head home, good self-care – including taking medications properly and avoiding infection risks – is critical for maintaining good health.

But the list of instructions for transplant patients is long and it can be confusing, Chandrasekaran said. On top of that, patients sometimes hear conflicting advice from different members of their care team.

Prior to beginning the study, he and his collaborators reasoned that anxiety after discharge could be a significant player in the high rate of readmissions.

Ohio State’s research team first interviewed 20 patients who received a transplant at the Wexner Medical Center to get a handle on the quality of care delivered during hospitalization. In general, the interviews suggested that information conveyed to patients varied depending on the caregiver and was delivered “in a somewhat rushed manner.”

Researchers also shadowed the care team to listen first-hand to the instructions they gave transplant patients after their surgeries.

One example of inconsistent advice they witnessed: One nurse recommended “a lot of fluids,” another said to drink two liters a day and another told the patient to consume 100 ounces.

“There must have been 16 different ways to tell them to drink a lot of water,” Chandrasekaran said, adding that this wasn’t because the nurses weren’t following protocol. Rather, they were passing along various guidelines they’d been told over the years.

The researchers then used information from those shadowing experiences and the initial 20 interviews to develop surveys given to another 77 kidney recipients, 24 of whom were readmitted within 30 days.

“We wanted to see what was it that caused them to have anxiety and what could we do to alleviate that,” Moffatt-Bruce said.

“We asked patients, ‘What went right, what went wrong?’ ”

The researchers assessed the consistency of patient education using a five-item test that measured the ease of getting information and the level of understanding of symptoms and procedures. To evaluate empathy, they used a three-item scale that asked patients about their comfort level when they interacted with caregivers.

The researchers worked closely with the entire transplant team at Ohio State’s medical center, including 24 nurses and several physicians.

They found a strong association between anxiety levels a week after discharge and readmission within a month. They also found that the odds of getting readmitted increase by 110 percent for a one-unit increase in anxiety levels.

They did not find a direct link between consistency and empathy measured in the surveys and readmissions. But they did find that those elements appeared to play a clear role in raising anxiety, which was linked to readmissions.

The researchers took into account factors that could skew their findings – including age, ethnicity, preexisting health conditions and the function of the transplanted organ upon discharge.

Since conducting this work, the researchers and transplant staff designed interventions to improve pre-discharge care and attempt to reduce preventable readmissions.

The discharge nurses, in particular, played a key role in the changes, which have cut the number of individual instructions given to patients from about 80 to 25, Moffatt-Bruce said.

“When you go home you’re going to be more confident, you’re going to be safer and you’re going to be less likely to come back to the hospital,” she said.

Overcoming barriers to distributed innovation


There was a time not long ago when design teams for products ranging from computer hardware to aircraft carriers were housed within the same four walls of a company. Within the last decade or so, firms began moving away from a centralized design approach to innovation in favor of specialized strategic partners — oftentimes scattered in different locations across the globe.

But with the shift away from centralized design to what is known as the distributed innovation model, what challenges do companies face in the product-design process?

That was the question posed by Dr. Aravind Chandrasekaran, associate professor of operations in the Department of Management Sciences at The Ohio State University Max M. Fisher College of Business, and colleagues Professor Edward G. Anderson Jr., of the University of Texas McCombs School of Business; Professor Alison Davis-Blake, of the University of Michigan’s Ross School of Business; and Geoffrey G. Parker, of Tulane University’s Freeman School of Business.

The researchers’ findings appear in the journal Information Systems Research in a new paper titled Managing Distributed Product Development Projects: Integration Strategies for Time Zone and Language Barriers.

The shift to distributed project teams began in the software development field, but it quickly spread to other industries, including a wide range of physical product manufacturers. To achieve design efficiencies and cost savings, today’s companies often seek out strategic partners with the expertise they need, which typically means working with partners on the other side of the world from various cultures who speak different languages.

The researchers examined some of the challenges inherent among these distributed teams. The main obstacles they discovered were time zone differences, which typically lead to delays in email response times, and language differences, especially with non-native English speakers understanding jargon-heavy engineering concepts.

“We wanted to study what can be done to minimize these barriers within the design process,” Chandrasekaran said.

The research team studied 20 multinational firms that span a variety of industries including aerospace, IT, medical device, commercial goods and food processing. The researchers analyzed some of the tactics these firms employed to overcome the challenges inherent with distributed innovation.

Some common methods firms use include co-locating workers, whereby members from strategic partner teams spend time with teams from the focal company; modularization of product design, which involves producing components in modules and then bringing the respective parts together later for assembly; and IT solutions, such as video conferencing. The researchers’ findings validate what many managers have discovered, which is that these solutions often do little to minimize the challenges of distributed product development.

What does work?

Two tactics stood out to the researchers. First, they found that firms using standardized design-specific IT systems have greater success in their product development projects. For example, firms that use a design structure matrix process to capture the interactions between distributed development teams fared better than those that did not.

The second, often more successful strategy was having a designated person or an entity within the organization serve as the single point of contact between two geographically separated teams. Known as a supply chain integrator, this entity serves as a pivot point between the two locations, even if there are multiple teams within each country. This strategy minimized coordination challenges, the researchers found.

With funding from the National Science Foundation, the team interviewed supply chain integrators and discovered common traits, including an understanding of cause and effect, an ability to coordinate the work, systems thinking ability, and bilingual or multilingual skills.

“They do more than span the geographical boundaries; they have a macro or systems view of the world,” Chandrasekaran said. “They understand that if they’re making a small change to one aspect of the project, they know how that change will affect other teams. That skill of helping people coordinate the work was very unique to these individuals.”

However, the researchers are quick to acknowledge that there is no silver bullet for overcoming the challenges of distributed projects, noting that firms must anticipate the tradeoffs when using distributed product development.

Citing previous research by Professor Kim Clark, former dean of Harvard Business School, Chandrasekaran said his team’s research also found that “heavy weight project managers” have an edge in distributed workforces because they tend to have access to high levels of their organizations’ management and can use that access to resolve issues efficiently.

For firms considering the use of supply chain integrators, Chandrasekaran notes some things to consider. Supply chain integrators are typically employed by the product manufacturing companies, rather than being third parties. In addition to systems knowledge, they often have design and procedural knowledge, as well as an understanding of procurement.

Most importantly, the researchers found that supply chain integrators need to understand that when they’re working with their counterparts, it’s not just that they’re working on a particular aspect of the project, they have to understand how that project actually affects the bigger picture.

“If your firm works on distributed projects, you’re bound to have a lot of coordination issues,” Chandrasekaran said. “The common mechanisms that managers might already be employing may not be effective. Firms will likely have to invest in people with these types of specialized supply chain skills.”

Grand Challenges…Here we come!

What comes to your mind when we say “grand challenge”? People think about big issues such as ending world hunger and curing cancer.  These are certainly big problems that takes several thousand people working every minute for the betterment of the society. We all want to be part of these grand challenges, but either have limited capabilities or the time, given our day-to-day schedule. What if we use these grand challenges as learning opportunities? Perhaps this may allow us to make some incremental contributions and also learn at the same time.

This was the main idea when we started our conversations with the Mid-Ohio Food Bank regarding a “learning lab” for our MBOE students. Mid-Ohio Food Bank is one the largest food bank in the United States primarily catering to the 20 counties surrounding the Columbus region. They are an amazing organization with great talent yet have really complex challenges in serving the community. Think about this for a statistic:

“There are over 400,000 people in Franklin community who live under 200% of the poverty line and miss over 15% of their meals. In other words, over 400,000 people are going without food for an entire day each week.”

This is not because Mid-Ohio Food Bank or their agencies have a shortage of food. It is because as Mark Mollenkopf – Strategic Solutions Developer – so eloquently puts – “Our problem is to get the right food to the right people at the right place and the right time”  

This is a perfect learning opportunity for our incoming MBOE students to scope down this larger complex problem into manageable problems in distribution, access, population health, nutrition and consumer behaviors. Our incoming class of students will spend time at the Mid-Ohio Food bank understanding and solving this problem over 5 months beginning November 2019.  They will first learn to break the complexity down to workable “chunks”, where to make impactful changes, how to measure and sustain these changes over 4 different learning sessions. Our students won’t be able to eradicate human hunger in 5 months, but they can certainly make a difference and make substantive improvements in this given time.

Our MBOE and Fisher Management Science team are really excited to use this amazing learning opportunity and help our community along the way!

Come and see what we do in our MBOE program at:

Operational Excellence Systems – How to Create a Perpetual Learning Organization?

Have you ever worked for an organization that is always successful in its mission whose employees are highly committed to its purpose? Anyone reading this article would question the existence of such an organization. Through our research, teaching and outreach, we found that managers from various industries such as healthcare, information technology, manufacturing and hospitality services are constantly searching for the answer to the question on how to create a perpetual learning organization where everyone continuously learns, improve and remain committed to its purpose every day (similar to the perpetual moving machine shown below).



Think about the following example of a healthcare system that personifies such a learning organization where a small problem faced by one unit becomes a great learning opportunity for the entire system.

“In a Tier 6 daily huddle using visual management, the senior leaders (including the CEO, Chief Medical Officer, Chief Nursing Officer, Chief Financial Officer and Chief Quality & Safety Officer) of Apollo Hospital systems were informed on a “near-miss” caregiver fall injury that had happened in one of their regional surgical units previous day, 60 miles from their main hospital. The attending nurse almost tripped on a wire from a new computer terminal recently installed due a system wide rollout of electronic medical records. After a quick discussion, it was decided to prioritize this issue and offer support to the care team at the surgical unit to solve this problem. The next week, the CEO attended their tier 1 huddle at the regional hospital listening to how the team was planning on solving this issue. Thirty days later, the countermeasure developed and vetted by the team in the surgical unit was spreading all across the 24 hospital systems involving more than 30,000 caregivers to avoid similar near miss injuries. What is fascinating is that every unit in Apollo is adapting the solution to their appropriate unit needs, tracking them and improving them on a daily basis. Six months later, Apollo continues to maintains a zero-fall injury rate for both their caregivers and patients”

  • Information about a close-encounter from a regional unit within the hospital system percolates all the way up to the C-suite within 24 hours. It is important to note that action follows immediately after the reporting process.
  • The hospital system tracks caregiver outcomes (e.g. near-miss accident) and prioritizes them along with patient (customer) outcomes.
  • The CEO of the hospital system makes time to travel 60-miles to offer her support to the team in the unit the next week.
  • There are no specialists solving the problem at Apollo. Rather, the team who encountered this problem is tasked to come up with a countermeasure and report on the efficacy of this measure after experimentation.
  • The countermeasure developed in this unit (i.e. process of problem solving and not the solution) is rolled out across all 24 hospitals within 30-days. This process of problem solving results in customized solutions across other units adapted to their needs (i.e. there is no single silver bullet for problems).
  • The entire organization is learning every day and improving from smaller experiments that are happening throughout the system. These lessons are made available to those facing similar problems in a way that same problems do not get solved over and over.

Our research with several organizations, including Toyota, Mayo Clinic, Nationwide, Cleveland Clinic, Thedacare Systems, IBM, General Electric and 3M etc. reveals that creating a perpetual learning organization such as the one described in Apollo requires creating four distinct learning systems. They include Alignment & Adaptability Systems, People Development Systems, Problem Solving Systems, and Daily Management Systems. We refer to them collectively as Operational Excellence Systems.  See Figure 1 that describes these systems.

Figure 1: Operational Excellence Systems

Dimensions of the Operational Excellence Systems

  • Alignment & Adaptability Systems – Systems that allow everyone in the organization to understand the value and purpose of the work they do and how it relates to the higher level strategy. This allows them to guide their actions as well develop adaptive skills to change for the future.
  • People Development Systems – Extent to which the firm invest in practices that add skills and capabilities to employees at all levels that allows them to continuously experiment, reflect, learn and innovate and become change agents.
  • Problem Framing & Solving Systems – The approaches taken by everyone when a problem arises in way the problem framing and solving processes are standardized across all levels of the organization and the learning permeate through the entire organization.
  • Daily Management Systems – The practices leaders at all levels use every day to identify potential issues and ensure all activities are on track and create accountability and cadence to the functioning of their units.

It is important to note that these systems are leader independent and sustains even after the departure of the architect responsible for creating them. They are also independent of the processes and business functions and has to exist at every level within the organization.

Our findings are not only informed through our research but also through our experience developing 300+ change leaders through the Master of Business of Operational Excellence (MBOE) program at the Fisher College of Business. In this program, executives from various industries develop their own operational excellence systems over a year. Through this journey, they document some of their challenges and opportunities when creating these systems back in their organizations.

What became evident to us through this learning journey is that even exemplar organizations don’t have all four systems at all levels within their organizations. The answer to creating a perpetual learning system may involve creating “isomorphic” structures of these systems at all areas in your organization.

Interested in knowing how to develop these systems in your organizations? See how our students and organizations partnering in MBOE program do by visiting