Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals
AbstractThe impact of labor turnover on productivity has received a great deal of attention in the literature on organizations. 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 the ability of the most-intensive teaching hospitals to reduce turnover's negative effect on performance.
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Date of creation: Mar 2005
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This paper has been announced in the following NEP Reports:
- NEP-ALL-2005-03-20 (All new papers)
- NEP-HEA-2005-03-20 (Health Economics)
- NEP-LAB-2005-03-20 (Labour Economics)
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- James L. Medoff & Katharine G. Abraham, 1981.
"Experience, Performance, and Earnings,"
NBER Working Papers
0278, National Bureau of Economic Research, Inc.
- Brown, Charles & Medoff, James, 1978. "Trade Unions in the Production Process," Journal of Political Economy, University of Chicago Press, vol. 86(3), pages 355-78, June.
- Kim B. Clark, 1980. "The impact of unionization on productivity: A case study," Industrial and Labor Relations Review, ILR Review, Cornell University, ILR School, vol. 33(4), pages 451-469, July.
- Rachel M. Hayes & Paul Oyer & Scott Schaefer, 2004.
"Co-Worker Complemetarity and the Stability of Top Management Teams,"
NBER Working Papers
10350, National Bureau of Economic Research, Inc.
- Rachel M. Hayes & Paul Oyer & Scott Schaefer, 2006. "Coworker Complementarity and the Stability of Top-Management Teams," Journal of Law, Economics and Organization, Oxford University Press, vol. 22(1), pages 184-212, April.
- Hayes, Rachel M. & Oyer, Paul & Schaefer, Scott, 2005. "Co-worker Complementarity and the Stability of Top Management Teams," Research Papers 1846r, Stanford University, Graduate School of Business.
- Levhari, David & Sheshinski, Eytan, 1973. "Experience and Productivity in the Israel Diamond Industry," Econometrica, Econometric Society, vol. 41(2), pages 239-53, March.
- Alan B. Krueger & Alexandre Mas, 2003.
"Strikes, Scabs and Tread Separations: Labor Strife and the Production of Defective Bridgestone/Firestone Tires,"
NBER Working Papers
9524, National Bureau of Economic Research, Inc.
- Alan B. Krueger & Alexandre Mas, 2004. "Strikes, Scabs, and Tread Separations: Labor Strife and the Production of Defective Bridgestone/Firestone Tires," Journal of Political Economy, University of Chicago Press, vol. 112(2), pages 253-289, April.
- Krueger, Alan B. & Mas, Alexandre, 2003. "Strikes, Scabs and Tread Separations: Labor Strife and the Production of Defective Bridgestone/Firestone Tires," IZA Discussion Papers 869, Institute for the Study of Labor (IZA).
- Judith K. Hellerstein & David Neumark, 1995. "Are Earnings Profiles Steeper Than Productivity Profiles? Evidence from Israeli Firm-Level Data," Journal of Human Resources, University of Wisconsin Press, vol. 30(1), pages 89-112.
- Cheryl L. Maranto & Robert C. Rodgers, 1984. "Does Work Experience Increase Productivity? A Test of the On-The-Job Training Hypothesis," Journal of Human Resources, University of Wisconsin Press, vol. 19(3), pages 341-357.
- Boylan, Richard T, 2004. "Salaries, Turnover, and Performance in the Federal Criminal Justice System," Journal of Law and Economics, University of Chicago Press, vol. 47(1), pages 75-92, April.
- Argote, L. & Epple, D., 1990. "Learning Curves In Manufacturing," GSIA Working Papers 89-90-02, Carnegie Mellon University, Tepper School of Business.
- Fee, C. Edward & Hadlock, Charles J., 2004. "Management turnover across the corporate hierarchy," Journal of Accounting and Economics, Elsevier, vol. 37(1), pages 3-38, February.
- Jovanovic, Boyan, 1979.
"Job Matching and the Theory of Turnover,"
Journal of Political Economy,
University of Chicago Press, vol. 87(5), pages 972-90, October.
- Joseph J. Doyle, Jr. & Steven M. Ewer & Todd H. Wagner, 2008. "Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams," NBER Working Papers 14174, National Bureau of Economic Research, Inc.
- Doyle Jr., Joseph J. & Ewer, Steven M. & Wagner, Todd H., 2010. "Returns to physician human capital: Evidence from patients randomized to physician teams," Journal of Health Economics, Elsevier, vol. 29(6), pages 866-882, December.
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