HBS Theses and Dissertations

In this dissertation, I examine the problem of physician performance evaluation and investigate ways to improve the performance of physicians in the context of an Emergency Department (ED) setting. In the first chapter — co-authored with Soroush Saghafian and Stephen Traub — we use Data Envelopment Analysis (DEA) to develop models for evaluating physician effectiveness and efficiency. We apply our DEA models to a large dataset of care delivered by ED physicians and derive effectiveness and efficiency scores for the physicians in our dataset. Using the generated DEA scores, we then conduct a second-stage analysis in which we use a Tobit framework to identify factors that are associated with higher levels of physician effectiveness and efficiency.

In the second chapter — co-authored with Soroush Saghafian and Stephen Traub — we conduct a large-scale empirical investigation into whether and how physicians who work during the same shift affect each other’s performance. We find strong empirical evidence that physicians affect each other’s speed and quality in our setting. We identify spillover from peers’ utilization of shared resources as the main driver of the observed effects and show that during high-volume shifts, the magnitude of the effects increases. We draw conclusions from our results and discuss how they can be utilized by hospital administrators to improve the overall performance of physicians. In the third chapter — co-authored with Soroush Saghafian and Stephen Traub — we address the question: To which shift should the ED’s high-performing physicians be assigned? Specifically, we empirically examine how assigning a high-performing group of physicians to different shifts of the day affects the daily performance of the ED. Our results demonstrate that assigning a group of high-performing physicians to the first shift of the day has the highest impact on the daily performance of the ED. We further show that physicians’ performance in the earlier shifts of the day has a “domino effect” throughout the rest of the day.

Together these studies provide insights into ED physician performance and shed light on potential ways to improve performance through assigning the right mix of physicians to the right shifts.

The rising levels of ambiguity, uncertainty, and dynamism organizations face today prompt groups and their members to step outside of the boundaries of their formal job descriptions in order to fulfill the shifting demands of their work. This scenario opens up exciting opportunities for them to redefine who they want to become and what they wish to contribute to their organizations. In this dissertation, I explore the process of collective job crafting, which I define as the coordinated action by the members of a group to alter the tasks, relationships, and meanings of the work associated with the group’s formal mandate. Through mechanisms that link the individual and group levels over time, collective job crafting enables the group to progressively enhance its knowledge base, to broaden its sphere of influence, and to define and enact a new identity. My findings are grounded in a longitudinal inductive qualitative study of collective job crafting at Media Solutions, a unit at CLICK, a leading social media company. Through rich interview, observation, and archival data, I trace the collective job crafting trajectory of the unit throughout its 7-year history. What began as an isolated unit in charge of a very simple and specialized task transformed itself into one of the most interconnected groups at the organization, performing complex and impactful work. However, not all areas of the organization supported Media Solutions’ collective job crafting initiatives to the same extent. As time passed, the unit’s view of the world and that of the top managers to whom it reported progressively differed. Questions such as “How should CLICK create and capture value?” “What are our strategic priorities?” “What type of work is considered valuable?” and “Who gets to do that kind of work?” received increasingly different answers. Media Solutions was eventually dissolved during the course of a larger reorganization process. The ebbs and flows of Media Solutions’ trajectory provide the raw materials for my theory of collective job crafting, which I develop from two complementary viewpoints. First, I examine the components of collective job crafting as an informal process, grounded in Media Solutions’ proactive and adaptive behavior. Subsequently, I provide a longitudinal view of collective job crafting and analyze key instances throughout Media Solutions’ self-driven evolution in which the unit negotiated formal ownership of different components of its collectively crafted job, with varying degrees of success. This study contributes to the incipient literature on job crafting by exploring a form of job crafting that occurs at the group level (rather than at the individual or interpersonal levels) and unfolds both within and beyond group boundaries. My findings also provide a glimpse into how emergent organizational designs and strategies arise, gain traction, and are eventually thwarted by inertial forces.

Firms spend significant resources on compliance training, but it is often criticized as being cosmetic. Using proprietary records on compliance training and allegations of misconduct from a large multinational firm, I investigate whether compliance training decreases corporate misconduct. I find that in-person training impacts employee behavior but do not find evidence for video training, which indicates that compliance training can be effective when employees are attentive. However, this effect lasts for only two months, suggesting that compliance training only temporarily raises awareness. I also find that the effectiveness of training is curtailed by employees’ economic incentives to misbehave, such as high performance pressure and weak public enforcement. Overall, this study advances our understanding of how and when compliance training can impact employee behavior and describes its limitations.

While multiple literatures suggest that emotion shapes behavior and satisfaction in experiences, there has yet to be a concerted effort to explicitly consider human emotion – whether from customer or employee -- as a source of variability in operations management (Karmarkar, 2015; Dasu and Chase, 2013). Environmental emotions, those that are endemic to the service, or emotions stimulated by operational design choices may each exert influences on service outcomes that providers and scholars alike have yet to consider. As scholarly work to arrive at an agreed upon theoretical foundation for the study of service operations has continued, open empirical questions remain about 1) the magnitude and predictability of emotion’s influence on service outcomes, 2) the opportunity to affect emotional experience through service design and 3) the role that technology plays – particularly in self-service contexts (Berry et al, 2015).
This body of work uses both laboratory and field experimentation to understand the impacts of emotional sources of variability to operational performance and to investigate the potential for more empathic service design to improve customer engagement while preserving sought-after efficiencies. Across three investigations, set in the domains of financial services and ride-sharing, I show that anxiety, whether it is directly related to the decision at hand or not, is a source of variation that exerts a costly influence on choice satisfaction and decision-making that spills over to affect service relationships. I also find that these previously ignored effects can be mitigated through relatively low-cost service design choices.

The management accounting literature investigates the role of control systems in maximizing organizational performance by facilitating managerial decision-making and shaping employee behaviors. Despite the use of diverse management control systems in practice, there is a lack of systematic empirical evidence that examines their effectiveness and (un)intended consequences. In my dissertation, I study the use of different management control systems and their effect on organizational performance by using proprietary data from different organizations. Thereby, my work contributes to the literature on the design of management control systems that can inform corporate leaders and managers on how to deliberately shape organizational outcomes.

As firms increasingly rely on data and algorithms to create value, new strategic management challenges arise which lead to revenue loss and user attrition. My dissertation examines the strategic and managerial puzzles that hinder digital firms’ value creation, from the perspectives of online community design, disintermediation, and platform-based strategies. The first chapter focuses on platform design and user segregation. The second and third chapters focus on disintermediation and its relationship to user trust and technological development. This dissertation aims to direct attention to strategic dilemmas that firms face as they embrace digital business models and provide theoretical and managerial contributions to platform studies in strategic management literature.

How to formulate strategy given the uncertainty of the future is the central question that managers face. The purpose of this dissertation is to investigate one possible answer: the use of strategic foresight, defined not as the ability to predict the future, but rather as the deliberative consideration of multiple plausible futures. In the first essay, I reinterpret Frank Knight’s seminal distinction between “risk” and “uncertainty,” arguing that the absence of analogous circumstance is the defining characteristic of uncertainty. The quest for analogy explains the work of Herman Kahn, the postwar defense intellectual who advocated the use of “ersatz experience,” most notably fictional future scenarios, as a tool for considering strategy amid the uncertainty of the nuclear revolution. In the second essay, I build on the relationship between analogy and uncertainty to construct a theoretical foundation for strategic foresight, which lacks grounding in the management literature. In contrast with the managerial tendency to analogize to past experience, the consideration of multiple imagined futures reduces the danger of prematurely fixating on a focal hypothesis, thereby reducing bias and improving judgment under uncertainty. In the third essay, I report the results of a qualitative study of the U.S. Coast Guard’s “Project Evergreen,” a quadrennial scenario-planning exercise. Project Evergreen has enabled the organization to develop strategy for the long-term future while also facilitating action in the present, easing the tension between exploration and exploitation by promoting a nonlinear conception of time. I introduce the notion of “scrappy foresight” to suggest that imagination is a valuable, but inexpensive, strategic resource. As a whole, this dissertation suggests that strategy, particularly long-term strategy, benefits from efforts that directly engage the uncertainty of the future.

This dissertation examines the psychological consequences of firms’ financial and prosocial strategies and practices pertaining to how firms define value and performance. Firms typically measure value and performance financially. However, we know little about how this affects the zero-sum perceptions and satisfaction of firms’ stakeholders, such as employees. In contrast, firms are increasingly considering social value in their strategic management of firm performance and including prosocial practices in their evaluations of employee performance, such as including CSR work in employees’ performance appraisals. Yet, we know little about how these strategies and practices affect workers’ satisfaction with the firm and other firm-stakeholder outcomes. I examine these questions through a mixed methods set of studies using field data from real firms. First, through seven field experiments, I find that reporting financial performance measures increases employees’ zero-sum perceptions and ultimately decreases workers' satisfaction with the firm. In contrast, through a unique dataset of survey responses from architecture firms engaged in pro bono work, I find that incorporating CSR into employee performance appraisals increases employee satisfaction. This suggests that a pluralistic orientation toward firm value may mitigate the zero-sum pitfalls of financial performance for employees and other stakeholders. Through exploring a unique combination of datasets, including parsed word counts of financial value and social value words from firms’ annual reports, and firm-level outcome data for employees, customers, shareholders, and the community, I find a preliminary positive relationship between collective stakeholder outcomes, particularly employee satisfaction and community impact ratings, and firms’ described activities toward both financial and social value; however, this relationship holds only in more recent years, possibly due to a potential shift in the institutional logics of firm value supporting firms’ consideration of social value. The research contributes to theories of strategic management, performance measurement, financial psychology, and employee satisfaction.

Consumers attitudes towards products and brands are rapidly changing. The democratization of luxury has made products of quality more available and the internet has facilitated access to information that was previously not in hand. How do consumers react to these changes? And, in what effective ways should brands respond to consumers’ shifting values and behaviors? This dissertation attempts to answer these questions in three essays by investigating some paradoxical effects of luxury consumption, social comparison, and brand secrecy in the new world on consumers symbolic consumption and behavior. The first essay highlights a tension between consumers’ desire for an aspirational lifestyle and the growing demand for authentic living. I suggest that aspirational luxury products may conflict with consumers self-views, making them feel inauthentic. The second essay demonstrates an unexpected effect of upward social comparison on compensatory consumption. Thanks to online social media, consumers constantly encounter displays of others’ success. I find that upward comparisons in one domain may lead consumers to prefer status enhancing items in an alternative identity domain, in which they fare more favorably. I investigate the domains consumers pivot to, and compare the prevalence and appeal of the “status pivoting” behavior. Lastly, the third essay explores an emerging phenomenon of brand’s pseudo-secrecy. I suggest that when brands offer consumers an opportunity to attain seemingly secret information about publicly available products, such as secret menus or hidden stores, they increase their subjective experience of social centrality, which in turn positively impacts word-of-mouth and purchase behavior in the marketplace. I use a mixed-methods approach, combining field studies, lab experiments, a netnographic analysis, observational studies, and qualitative interviews with consumers, to gain a comprehensive understanding of these phenomena, and examine their prevalence and impact in real-world settings.

This dissertation explores themes surrounding digital innovation and its effects on industries and firm- and employee-level productivity. Using novel and often proprietary sources of data, I take an empirical approach to asking how digital technology has transformed entire industries (e.g. medical devices and medical care), as well as how employees interact with tasks (e.g. technology-enabled remote work and telemedical care), with a focus on unpacking mechanisms driving each result. In each of these chapters, I focus on phenomena with large-scale impacts, from the digital transformation of a 150 billion US dollar medical device industry in the US, to increased productivity at the US Patent and Trademark Office that could lead to 1.3 billion US dollar in value as a result of new patent approvals, to potentially saving 70,000 lives a year as a result of telemedical intervention in the intensive care sector in the US