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• Healthcare systems face challenges globally, such as overcrowding and underfunding in the UK and high costs in the US.  
• Researchers from some of the world’s top business schools are looking into how we can improve healthcare around the world, offering practical solutions to some of the biggest problems.  
• In this research roundup, we dive into some of this academic research around this, including improving employee health, offering greater support for carers and reducing overcrowding in emergency services. 

Healthcare systems are facing countless challenges all around the world.  

The NHS in the UK is overcrowded, understaffed, and underfunded. Healthcare costs in the US are some of the highest in the world, making it difficult for many to afford insurance, treatments, or medications, with some people risking their lives by going without. 

And as life expectancy increases whilst younger generations decide not to have as many children, if any at all, countries around the world are struggling to plan for how to care for an aging population. 

It might not be the most obvious avenue for business school research, but many academics in business education focus their research on discovering ways in which to improve the healthcare sector. Whether it’s useful leadership skills for healthcare managers, how to improve waiting times, or the impact of various lifestyle factors on individual health. 

Here are some examples of health and healthcare related research from business schools hoping to have real-world impact: 

Healthy company, healthy employees 

More productive firms don’t just produce healthy profits, but also healthier employees, according to research from Corvinus University of Budapest and HUN-REN Centre for Economic and Regional Studies.  
 
Researchers Anikó Bíró and Peter Elek analysed employee healthcare use before and after moving to a new firm. Firm productivity was assessed using data on revenue, costs, and capital value. 

They demonstrated that moving to a more productive firm leads to a higher consumption of drugs for cardiovascular conditions and more physician visits, without evidence of deteriorating physical health. This is because moving to a more productive firm is accompanied by a higher awareness of diagnostic services and a higher probability of the diagnosis and treatment of existing cardiovascular diseases, such as hypertension and high cholesterol. 

In Hungary, by law, each worker entering a new firm has to undergo a health check-up provided by the new employer. Therefore, the researchers’ finding that an employee is more likely to be treated for cardiovascular diseases after starting at a more productive firm could be explained by: 

• More productive firms taking the health check-up for new workers more seriously. 
• More productive firms being able to afford, or more willing to provide, regular health check-ups for workers. 
• People moving to more productive firms taking the recommendations of the occupational physician more seriously, partly because they are more motivated to maintain their capacity to work. 

Amongst older workers working in productive companies, there was also a lower consumption of medications for mental health conditions. As outpatient care use increases whilst specialist psychiatric service use does not, the researchers conclude that mental health improves with firm productivity amongst older workers, potentially due to better working conditions. 

These findings suggest productive firms have a beneficial effect on the identification of undiagnosed chronic illnesses and on the mental health of employees.  

Carers need care too 

It’s not just employees we need to keep healthy, however, but also the individuals providing the care . The most vulnerable in our society often rely on unpaid carers to help support them and improve their quality of life. As people continue to live longer, as a society, we might come to rely on carers even more. 
 
In providing support, carers may not only be having a profound impact on care recipients’ lives, but also on their own quality of life. 
 
Using data from the Survey of Adult Carers in England, researchers from Nottingham Business School investigated how carers’ tasks impact carer quality of life. They find that all the carer tasks they have information for are statistically significant predictors of quality of life. 

Specifically, male carers and carers who also do paid work report higher levels of quality of life, as do carers who take their recipient out as part of their care duties.  
 
However, physical help, such as giving medicine to care recipients and emotional support, are all associated with negative health outcomes for carers – feeling tired or depressed, reporting disturbed sleep, stress, physical strain, and needing to see the GP more. In fact, the physical help task is one of the most important predictors of carer quality of life.  

To reduce the negative impact on carers, local government services that support carers should be aware of the impact these different tasks have, the researchers suggest. These findings could be used to better understand where carers need more help or support themselves to carry out the tasks that are negatively impacting their own quality of life. 

How care processes influence cost 

The clinical care processes employed when providing healthcare can have an impact on overall costs, according to research on patients with cystic fibrosis (CF). 

CF is a genetic condition that affects multiple systems in the body, causing mucus to build up. Over time, this can lead to reduced function of the lungs, digestive system, and other organs.

Due to multidisciplinary care models alongside advancements in pharmacotherapy innovations, survival rates and quality of life have vastly improved in recent years. However, costs involved in the care and treatment of CF remain substantial. 
 
Professor Gerardine Doyle from UCD Michael Smurfit Graduate Business School, alongside colleagues from Maynooth University, Children’s Health Ireland at Temple Street, Harvard Business School, Harvard Medical School, and Boston Children’s Hospital, investigated how CF processes of care influence costs. 
 
Focusing on two large specialist CF centres providing care for children in the US and Ireland, cost was measured using time-driven activity-based costing, a bottom up costing approach. This looked at how much time healthcare professionals spent with each patient and the activities they performed for those patients to calculate the cost of care by multiplying the time by the dollar-per-minute cost of each healthcare professional. 

Physicians were found to be the most expensive professionals in the care process in both sites. In the US, physicians and dietitians spent the most time with patients, whilst Clinical Nurse Specialists and dietitians did so in Ireland. The greatest cost differential was for children in the age cohort 6-17 years, where there was a 28% cost difference between the two sites. 

The amount of time spent with patients had a significant effect; more time was spent with patients in Ireland than the US. Different types of clinicians providing care was also a factor, as the US had a different mix of and higher-cost providers. Furthermore, clinicians were paid 31% more in the US than in Ireland. 

The team in Ireland has greater diversity in skill mix, for example inclusion of Clinical Nurse Specialists and pharmacists, allowing tasks to be delegated more efficiently. Ireland’s approach also integrates routine clinical tests into the patient visit, which allows for more efficient resource use, reducing the need for additional appointments for the patient. In the US, tests are often scheduled separately, resulting in higher health system costs and higher patient borne costs. 

Understanding these differences can help reduce costs and improve efficiency of CF care where different health systems treat the same medical condition. The methodology used in this study could be applied to other medical conditions to improve patient care efficiency, streamline testing, enhance patient experience and optimise patient outcomes, particularly for chronic diseases requiring frequent visits.  

How to fight overcrowded emergency departments 

Overcrowded emergency departments are an often-reported issue plaguing healthcare.  

Overcrowding doesn’t only lead to four hour long waits in Accident & Emergency (A&E), but can also be life threatening. In 2020-21, more than 4500 deaths in England were found to be caused by overcrowding and extensive wait times. 

And any attempts to improve waiting times don’t seem to be doing much good. There has been an upward trend in A&E waiting times longer than four hours throughout the UK: In England, the percentage of patients waiting longer than four hours increased from 8.1% in January 2013 to 42.4% in September 2023! 

Current strategies to make improvements are based primarily on the following ratio: the number of patients expected/the number of healthcare staff required. However, it’s hard to predict the number of patients expected in an emergency department as patient numbers can fluctuate drastically from hour to hour and day to day. 

Researchers from NEOMA Business School, University of Winnipeg, and City University of Hong Kong may have found a solution. They argue that patient flow is influenced more by the effective management of unpredictable events than the simple number of patients admitted. They used a data set of 145,000 emergency department visits in a Canadian hospital to investigate this. 

They measured two categories of unpredictable event: time-related (the interval between successive patient arrivals and the length of treatment for each patient) and case-diversity (age, symptoms, level of acuity, etc.). 

The researchers found that “time complexity” and “case complexity” metrics are much more effective than the number of admissions for predicting the average wait time and total time spent in emergency departments. 

The greater the time complexity, the higher the risk of overcrowding. High time complexity could result from grouped and sporadic patient admissions rather than spaced out and steady admissions, or from an influx of cases needing long-term care rather than patients who can be treated quickly. 

On the other hand, the greater the case complexity, the lower the risk of overcrowding. High case complexity occurs when patients attend the emergency department with very diverse pathologies and are therefore assigned to different staff with varying expertise.  

These measures use patient data that the emergency services already collect so would not require any extra work. But how can these findings be applied in real-life? 

Solutions suggested by the researchers include: 

1. Prioritise patients based on predicted wait time. For patients with conditions of similar severity, the one who can be treated quickly should be seen before a patient requiring more time, even if the latter arrived first. This would free up staff to see others patients sooner. 

2. Integrate complexity measures into a decision-making tool connected to the registration system for admitting patients on arrival. This tool would trigger alerts when complexity levels approach critical thresholds that indicate potential overcrowding. The emergency department supervisor could then reallocate resources before wait times increase too much. 

Don’t forget about long COVID 

The days of strict lockdowns, one walk per day, and socially-distanced gatherings might be behind us now, but the lasting impact of the pandemic is still felt by many. Particularly when it comes to long COVID; persisting and often debilitating symptoms after a COVID-19 infection. 

The pandemic already had a devastating impact on economies by triggering a global recession and stock market crash, but by also leaving some with chronic COVID-related symptoms, will there be continued economic effects?  

Afschin Gandjour, Professor of Health Management from Frankfurt School of Finance & Management, explored economic, healthcare, and pension costs due to long COVID in Germany.  

Economic costs were calculated based on wage rates and the loss of gross value-added. Pension payments were determined based on the incidence, duration, and amount of disability pensions. Healthcare expenditure was calculated based on rehabilitation expenses.  
 
The analysis estimated a production loss of 3.4 billion euros, the gross value-added loss was calculated to be 5.7 billion euros, and the estimated financial burden on healthcare and pension systems due to COVID-19 infection was approximately 1.7 billion euros.  
 
This demonstrates the massive costs of long COVID for the German economy, and a similar impact has been observed in other countries, particularly as over 400 million people worldwide are estimated to have had long COVID.  

As “keep 2m apart” signs fade from public walkways, it might seem like we are leaving the pandemic far behind us. However, research such as Professor Gandjour’s is vital for highlighting the long-lasting effects of the pandemic and the impacted areas we need to address, whether economic, health-related, or both. 

Improving the future 

Healthcare remains one of the most pressing global concerns, but innovative research from business schools is helping to address these problems and improve patient care.  

By applying these practical insights, companies, individuals and governments can help to shape the future of healthcare, leading to tangible improvements in both the cost and the quality of care. 

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