Cohort Turnover and Operational Performance: The July Phenomenon in Teaching Hospitals

Abstract

We consider the impact of cohort turnover on operational performance in the context of teaching hospitals. Using 12 years of data from a sample of U.S. hospitals, we show that the annual July turnover of residents results in longer lengths of stay, though not a significant change in mortality rates. In major teaching hospitals, we find evidence of an anticipation effect that presents as a gradual decrease in operational performance beginning several months before the actual cohort turnover. We also identify managerial levers for mitigating the decrease in hospital operational performance both at the time of and in the months leading up to the cohort turnover.