Sara Singer

Adjunct Professor of Health Care Management and Policy

Department of Health Policy and Management

OTHER AFFILIATIONS

• Department of Medicine, Harvard Medical School
• Mongan Institute for Health Policy, Massachusetts General Hospital
• Ariande Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and Harvard T. H. Chan School of Public Health
• Center for Healthcare Organization and Implementation Research, Health Services Research & Development, US Department of Veterans Affairs

RESEARCH

Dr. Singer’s research in the field of health care management and policy addresses the role of organizational leadership and culture in efforts to implement health delivery innovations, integrate patient care, and improve performance of health care organizations. Specific areas of investigation include: (1) patient safety climate, culture, and leadership, (2) integrated patient care, (3) implementation of surgical safety checklists and other health delivery innovations, and (4) organizational learning.

A key feature of this research is the development of survey instruments that measure provider and patient perspectives on key interpersonal and organizational factors. These surveys generate novel information about critical features of organizational behavior, which she has used to conduct research that tests organizational theory and examines the effectiveness of delivery system innovations. In her work, Dr. Singer applies organizational theories and mixed quantitative and qualitative methods to demonstrate not only whether organizational interventions such as surgical checklists and patient-centered medical homes work, but also how and under what conditions they do so. One of her key capabilities is the collaborative design and leadership of large, interdisciplinary, action-oriented research projects, cutting across departments, schools, universities, and organizational partners.

TEACHING & ADMINISTRATION

Dr. Singer developed and teaches Masters level courses at the Harvard T.H. Chan School of Public Health, entitled Health Care Organizations and Organizational Behavior: Leadership and Management for Learning, Innovation, and Performance Improvement and Leadership and Innovation in Health Care.  She also teaches in the Harvard PhD in Health Policy core course and in hospital-based leadership training programs, and she advises Masters, Doctoral, and Postdoctoral students at the Harvard T.H. Chan School of Public Health.

In addition to her research and teaching, Dr. Singer serves as a Co-Chair of the Harvard PhD in Health Policy Program and member of the University Benefits Committee.  She is Implementation Research Director for the Safe Surgery 2015 initiative and Evaluation Co-Chair for Massachusetts’ Proactive Reduction in Outpatient Malpractice: Improving Safety Efficiency and Satisfaction (PROMISES) program. She has published more than 70 articles in academic journals and books on healthcare management, health policy, and health system reform. Her publications have won numerous awards, including best paper awards from the Academy of Management’s Health Care Division in three consecutive years 2009, 2010, and 2011. She was also the recipient of the 2013 Avedis Donabedian Healthcare Quality Award from the American Public Health Association.

Previously Dr. Singer co-founded and served as Executive Director for the Center for Health Policy at Stanford, where she was also a Senior Research Scholar and Lecturer (1993-2003).  She also served as Staff Director for the California Managed Care Improvement Task Force (1997-98), a Senior Legislative Assistant for Health Policy in the US House of Representative (1994), and Health Policy Analyst at the Office of Management and Budget (1992).

EDUCATION

2007, Ph.D., Harvard University, Program in Health Policy/Management.

1993, M.B.A, Stanford University, Graduate School of Business.

1986, A.B., Princeton University, English and European Cultural Studies.

SELECTED PUBLICATIONS

Tucker A and Singer S, “The Effectiveness of Management-By-Walking-Around: A Randomized Field Study,” Production and Operations Management, in press.

Huang LC, Conley D, Lipsitz S, Wright CC, Diller TW, Edmondson L, Berry W, Singer S,  “The Surgical Safety Checklist and Teamwork Coaching Tools: A Study of Inter-rater Reliability” BMJ Quality and Safety, online ahead of print Feb 4, 2014.

Alidina S, Schneider EC, Singer SJ, Rosenthal MB, “Structural Capabilities in Small and Medium-Sized Patient-Centered Medical Homes,” American Journal of Managed Care, in press.

Austin JM, D’Andrea BG, Birkmeyer J, Leape L, Milstein A, Pronovost P, Romano P, Singer S, Vogus T, Wachter R, “Safety in Numbers: The Development of Leapfrog’s Composite Patient Safety Score for U.S. Hospitals,” Journal of Patient Safety, 10(1): online ahead of print Sep 27, 2013.

Rosenthal MB, Friedberg MW, Singer SJ, Eastman D, Zhonghe L, Schneider EC, “Impact of the Pilot of the Rhode Island Multi-Payer Patient-Centered Medical Home on Health Care Utilization and Quality,” JAMA Internal Medicine, 2013, online ahead of print Sep 9, 2013.

Clark J, Murphy C, Singer S, “How Much Do Leaders Matter? Organizational Identity as a Constraint on Leader Discretion,” Leadership Quarterly, 2013, 38(3): 211-293.

Singer SJ, Rivard P, Shokeen P, Hayes J, Gaba D, Rosen A, “Improving Patient Care through Leadership Engagement with Frontline Staff: A VA Case Study,” Joint Commission Journal on Quality and Patient Safety, 2013, 39(8): 349-360.

Singer SJ, Friedberg M, Kiang M, Rathgeb T, Kuhn D, “Development and Preliminary Validation of the Patient Perceptions of Integrated Care Survey,” Medical Care Research and Review, 2013, 70(2): 143-164.

Clark J, Singer S, Kane N, Valentine M, “From striving to thriving: Systems thinking, strategy, and the performance of safety net hospitals,” Health Care Management Review, 2013; 38(3): 211-223.

Singer SJ and Vogus T, “Reducing Hospital Errors: Interventions that Build Safety Culture,” Annual Review of Public Health, 2013; 34(21): 373-396.

Singer SJ and Vogus T, “Safety climate research: taking stock and looking forward” BMJ Quality and Safety, 2013; 22(1):1-4.

Liu SW, Chang Y, Camargo CA, Weissman JS, Walsh K, Schuur JD, Deal J, Singer SJ, “A mixed-methods study of the quality of care provided to patients boarding in the emergency department: comparing emergency department and inpatient responsibility models” Medical Care Research and Review, 2012; 69(6): 679-698.

Singer S, Kitch BT, Rao S, Bonner A, Bates D, Gaudet-Meagher J, Field T, Gurwitz J, Keohane C, Campbell E, Patient Safety across the Care Continuum: An Exploration of Safety Climate in Nursing Homes, Journal of Patient Safety, 2012; 8(3): 104-124.

Singer SJ, Moore SC, Meterko M, and Williams S. “Development of a Short Form Learning Organization Survey: the LOS-27.” Medical Care Research and Review, 2012; 69(4): 432–459.

Kane NM, Singer SJ, Clark JR, Eeckloo K, Valentine M, “Strained local and state government finances among current realities that threaten public hospitals’ profitability,” Health Affairs, 2012; 31(8): 1680–1689. Also, letter: Kane NM, Singer SJ, Clark JR, “Variations among public hospitals: the authors reply,” Health Affairs, 2012; 31(10): 2354.

*Nembhard IM, *Singer SJ, Shortell S, Rittenhouse D, Casalino L. The Cultural Complexity of Medical Groups. Health Care Management Review, 2012; 37(3): 200–13  *Joint lead authorship.

Singer SJ and Shortell SM. Implementing Accountable Care Organizations: Ten Potential Mistakes and How to Learn from Them.” JAMA, 2011; 306(7): 758-9.

Singer SJ and Clark JC. “Entrepreneurship, Culture, Knowledge, and Learning: A Multispective View of Patient Safety Improvement.” Health Care Management Review, 2011; 36(4): 299-300.

Cooper JB, Singer SJ, Hayes J, Sales M, Vogt J, Raemer D, and Meyer GS. “Design and evaluation of simulation scenarios for a program introducing patient safety, teamwork, safety leadership and simulation to healthcare leaders and managers.” Simulation in Healthcare, 2011; 6(4): 231-238.

Liu S, Chang Y, Weissman J, Griffey R, Thomas J, Hamedani A, Camargo C, and Singer S. “An empirical assessment of boarding and quality of care: delays in care among chest pain, pneumonia, and cellulitis patients.” Academic Emergency Medicine, 2011; 18(12): 1339-1348.

Conley DM, Singer S, Edmondson L, Berry W, and Gawande A. “Effective Surgical Safety Checklist Implementation.” J Am Coll Surg, 2011; 212(5): 873-9.

Singer S., Hayes J, Cooper J, Vogt J, Sales M, Aristidou A, Gray G, Kiang M, and Meyer G. “A Case for Safety Leadership Team Training of Hospital Managers.” Health Care Management Review, 2010; 36(2): 1-13.

Hansen L, Williams M, Singer S. “Perceptions of Hospital Safety Climate and Incidence of Readmission,” Health Services Research, 2010; 42(2): 596-616.

Singer SJ, Burgers J, Friedberg M, et al. Defining and Measuring Integrated Patient Care: Promoting the Next Frontier in Health Care Delivery. Med Care Res Rev 2010; 68(1): 112-127.

Singer SJ, Rosen A, Zhao S, Ciaverelli A, Gaba D. Comparing safety climate in naval aviation and hospitals:  Implications for improving patient safety.  Health Care Management Review, 2010; 35(2): 134-146.

Singer SJ, Falwell A, Gaba D, Meterko M, Rosen A, Hartmann C, Baker L.  Identifying Organizational Cultures that Promote Patient Safety.  Health Care Management Review, 2009; 34(4): 300-11.

Singer SJ, Hartmann, CW, Hanchate A, Zhao S, Meterko M, Shokeen P, Lin S, Gaba D, Rosen AK. Comparing safety climate between two populations of hospitals in the US. Health Services Research, 2009; 44(5, Part I): 1563-84.

Singer SJ, Falwell A, Lin S, Gaba G, Baker L. “Relationship of Safety Climate and Safety Performance in Hospitals,” Health Services Research, 2009; 44(2, Part 1): 399-421.

Singer SJ, Gaba D, Falwell A, Lin S, Hayes J, Baker L. Patient Safety Climate in 92 US Hospitals: Differences by Work Area and Discipline. Medical Care. 2009 Jan; 47(1):23-31.

Singer SJ, Falwell A, Gaba G, Baker L. Patient Safety Climate in US Hospitals: Variation by Management Level. Medical Care. 2008 Nov; 46(11):1149-56.

Tucker A, Singer S, Hayes J, Falwell A. Front-line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems, Health Services Research, 2008 Oct; 43(5 Pt 2):1807-29.

Shortell S and Singer SJ. Improving Patient Safety by Taking Systems Seriously, JAMA, 2008; 299(4):445-447.

Singer SJ, Meterko M, Baker L, Gaba G, Falwell A, and Rosen A, “Workforce perceptions of hospital safety culture: Development and validation of the Patient Safety Climate in Healthcare Organizations survey,” Health Services Research, 2007 October, 42(5) 1999-2021.

Tucker A, Singer S, Hayes J, Falwell A, “Front-line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems,” Harvard Business School Working Paper No. 08-015.

Bundorf MK, Wagner TH, Singer SJ, Baker LC, “Who Searches the Internet for Health Information?” Health Services Research, 2006 June, 41(3) 819-836.

Wagner TH, Bundorf MK, Singer SJ, and Baker LC, “Free Internet Access, The Digital Divide and Health Information,” Medical Care, 2005 April, 43(4): 415-420.

Bundorf MK, Singer SJ, Wagner TH, Baker LC, “Consumers’ Use of the Internet for Health Insurance,” American Journal of Managed Care, 2004 Sep, 10(9): 609-616.

Gaba D, Singer S, Sinaiko S, Bowen J, “Differences in Safety Climate Between Hospital Personnel and Navy Aviators,” Human Factors, 2003 Summer, 45(2): 173-185.

Baker LC, Wagner TH, Singer SJ, and Bundorf MK, “Use of the Internet and E-Mail for Health Care Information: Results from a National Survey,” JAMA, 2003 May 14, 289(18): 2400-2406.

Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC, “The Culture of Safety in California Hospitals,” Quality and Safety in Healthcare, 2003 Apr, 12:112-8.

Singer SJ and Bergthold L, “Prospects for Improved Decision Making About Medical Necessity,” Health Affairs, 2001 Jan-Feb, 20(1): 200-206.

Singer SJ and Enthoven AC, “Structural Problems in Managed Care in California and Some Options for Ameliorating Them,” California Management Review, 2000 Fall, 43(1): 50-65.

Enthoven AC and Singer SJ, “Unrealistic Expectations Born of Defective Institutions,” Journal of Health Politics, Policy and Law, 1999 Oct, 24(5): 931-940.

Enthoven AC and Singer SJ, “The Managed Care Backlash and the Task Force in California,” Health Affairs, 1998 Aug, 17(4): 95-110.

Enthoven AC and Singer SJ, “Markets and Collective Action in the Regulation of Managed Care,” Health Affairs, 1997 Nov-Dec, 16(6): 26-32.

Hunt KA, Singer SJ, Gable J, Liston D, and Enthoven AC, “Paying More Twice: When Employers Subsidize Higher Cost Health Plans,” Health Affairs, 1997 Nov-Dec, 16(6): 150-156.

Enthoven AC Singer SJ, “Managed Competition and the California Health Care Economy,” Health Affairs, 1996 Spring, 15(1): 39-57.

Enthoven AC and Singer SJ, “Increasing Cost-Consciousness for Managed Care: Reforming the Tax Treatment of Health Insurance Expenditures, Health Care Management, 1995 Oct, 2(1): 109-114.

Enthoven AC and Singer SJ, “Market-Based Reform: What to Regulate and By Whom,” Health Affairs, 1995 Spring, 14(1): 105-119.

Enthoven AC and Singer SJ, “Choosing Among Health Plans,” Health Care Management, 1994 Aug, 1(1): 45-56.

Enthoven AC and Singer SJ, “Incentives for a Better Health Care System,” Journal of Health Care Benefits, 1994 Jul-Aug, 3(6): 4-7.

Enthoven AC and Singer SJ, “A Single Payer System in Jackson Hole Clothing,” Health Affairs, 1994 Spring, 13(1): 81-95.

Singer SJ, “Problems in Gaining Access to Hospital Information,” Health Affairs, 1991 Summer, 10(2): 148-151.

BOOK CHAPTERS

Singer SJ and Edmondson AC, “When Learning and Performance are at Odds: Confronting the Tension,” in Learning and Performance Matter, Kumar P and Ramsey P, eds., (New Jersey: World Scientific Books) 2008 (also available as HBS Working Paper No. 07-032).

Singer SJ, Enthoven AC, and Garber AM, “Healthcare Financing and Information Technology: A Historical Perspective,” in Biomedical Informatics: Computer Applications in Health Care and Biomedicine, Third Edition, Shortliffe EH, Cimino JJ, eds., (New York: Springer-Verlag) 2006, 791-828.

Singer SJ, Dunham KM, Bowen JD, Geppert JJ, Gaba DM, McDonald KM and Baker LC, “Lessons in Safety Climate and Safety Practices from a California Hospital Consortium,” in: Henriksen K, Battles JB, Lewin DI, Marks E, eds., Advances in patient safety: From research to implementation. (Rockville, MD: Agency for Healthcare Research and Quality) 2005 May, 3:411-423.

Geppert JJ, Singer SJ, Buechner J, Ranbom L, Suarez W, Xu W, “State Race and Ethnicity Data Collection,” in Melnick D and Perrin E, eds., Improving Racial and Ethnic Data on Health: Report of a Workshop (Washington, DC: National Academies Press), 2003.

Singer SJ, Garber AM, Enthoven AC, “Near-Universal Coverage Through Health Plan Competition: An Insurance Exchange Approach,” in Covering America: Real Remedies for the Uninsured, JA Meyer and EK Wicks, eds. (Washington, DC: Economic and Social Research Institute) 2001 Jun, 155-172.

Singer SJ, Enthoven AC, and Garber AM, “Health Care and Information Technology: Growing Up Together,” in Medical Informatics, Computer Application in Health Care, Second Edition, Shortliffe EH, Perreault LE, Wiederhold G, Fagan LM, eds., (New York: Springer-Verlag) 2000, 663-696.

Singer SJ and Enthoven AC, “California’s Struggle with Regulation,” in Regulating Managed Care: Theory, Practice, and Future Options, Altman S, Reinhardt U, and Schactman D, eds., (Menlo Park: Jossey-Bass) 1999, 312-330.