Robert Huckman has spent a good portion of his career working to improve medical care in the US. As a consultant in the private sector, he advised healthcare companies on their merger and acquisition strategies. And as an academic, he has done groundbreaking work on the efficacy of surgeons and surgical teams.
“There’s a lot we can do in terms of thinking about improving medical care that doesn’t have to do with adding technology,” says Prof Huckman. “We can organise existing practices more efficiently and more productively.”
But, says Prof Huckman, who teaches at Harvard Business School, some of the most rewarding moments of his professional life so far have nothing to do with improving surgical results. Rather, they have come from his students.
“I remember my first semester teaching at HBS,” he recalls. “I’d heard stories about how it is such a tough environment to teach in because the students are so skilled and so ambitious. But I found right away that it was an incredibly supportive environment. So much of the outcome is based on student enthusiasm, and the students here want you to do well. I felt they were really pulling for me.”
Prof Huckman was not born an academic, but he was destined to go into the healthcare industry. He grew up in Evanston, Illinois, just outside Chicago, and his parents both worked in the medical field: his father as a neuroradiologist, and his mother as an administrator of a medical centre.
“I went to college assuming I’d get my MD afterwards,” he says.
That plan soon changed. As an undergraduate at Princeton, he endured a painful year of organic chemistry that left him with the distinct impression that he was not quite cut out for medical school. But more importantly, he was introduced to the study of economics. “I got to see healthcare from an economic and public policy perspective, not just the clinical practice side,” he recalls.
He was hooked. Prof Huckman wrote his thesis on the Orphan Drug Act, a law meant to provide incentives for pharmaceutical companies to manufacture drugs for rare diseases. He says that his thesis adviser, Uwe Reinhardt, recognised as one of the leading authorities on healthcare economics in the US, had a great influence on the direction of his research. “Everyone wants to create his own niches, but there are certain people who have a major impact on your work,” he says.
After graduating with highest honours, Prof Huckman took a job with Booz Allen & Hamilton. “I decided I was going to go into healthcare consulting, and approach the issue from the firm’s perspective. At the time these companies were experiencing a lot of change, a lot of consolidation.”
In 1994, a senior colleague at Booz Allen left to start Stamos Associates, a boutique healthcare consulting group that would advise hospitals and healthcare organisations on mergers and acquisitions. The opportunity was too good to pass up, and so Prof Huckman went with him. “It was a wonderful experience,” he says. “It gave me a chance to work on current issues, and it also gave me a chance to be part of a start-up and see first-hand the dynamics of smaller organisations.”
After working at Stamos for two years, Prof Huckman – who plays guitar in his spare time – took a leave of absence from the firm to go to graduate school at Harvard. One year into his studies, however, he received word that Stamos was being bought by Perot Systems, a consulting company based in Plano, Texas. He was asked to return for a year to help with the transition.
While the interruption to his graduate work was not ideal, the move turned out to be fortuitous: the project he was assigned to introduced him to a series of databases – state-collected figures on the outcomes of cardiac surgeons – that has since figured prominently in his research.
For the past few years, Prof Huckman – who earned his PhD from Harvard in the spring of 2001 and got a job teaching at the business school that autumn – has pored through these databases in order to draw conclusions about the portability of a surgeon’s skill, and whether the quality of medical care is impacted by the organisational setting in which it is delivered.
“This type of information is very important to get out in the public but a great deal of effort needs to be taken to explain how this information is collected and measured, and it by no means should be used as the sole tool in someone’s decision-making process,” he says.
“It’s important for people to understand the methodology for developing it. For instance, the data only looks at mortality, not the quality of life following the surgery.”
Perhaps Prof Huckman’s most important finding – about the importance of teamwork in the operating room – came in a paper he wrote with a Harvard colleague, Gary Pisano.
The two professors analysed the work of heart surgeons in Pennsylvania who practice at more than one hospital. They found that the death rates from comparable procedures performed by the same surgeon can differ as much as fivefold at different hospitals. The majority of the time, patients did better in the hospital where their surgeon performed more operations.
He says the results indicate that the surgeon's interactions with his or her team of nurses, profusionists, anaesthetists and technicians are critical to the outcome of the surgery.
“The information is useful to patients but it could also be helpful to hospital administrators who are thinking about how they ought to go about recruiting star talent,” he says.
Prof Huckman, who is also a research fellow in the health care programme of the National Bureau of Economic Research, says he likes the fact that his work blends the theoretical aspect of academic inquiry with the practical application to healthcare management.
“I got into healthcare in some sense because it was in my family, but professionally it’s fortuitous to be working in this now,” he says. “There is so much work to be done.”