Agricultural and Biosystems Engineering Publications

Campus Units

Agricultural and Biosystems Engineering, Supply Chain and Information Systems, Information Systems

Document Type


Publication Version

Published Version

Publication Date


Journal or Book Title

Journal of Technology, Management and Applied Engineering





First Page


Last Page


Research Focus Area(s)

Advanced Machinery Engineering and Manufacturing Systems, Biological and Process Engineering and Technology


The healthcare system in the United States is comparatively superior to healthcare systems of other countries in terms of advanced and modern technology, drugs used, services offered, and required care. However, hospital management has to face the challenges in the managing of care and addressing safety issues for its patients due to the multiple stakeholders involved such as medical doctors, residents, nurses, diagnostic tool providers, as well as patients. Every year many people lose their lives due to medical errors caused by new employees in hospitals, errors that can be prevented by “mistake-proofing.” Similarly, teaching hospitals face an increase in medical errors in the month of July due to cohort turnover, which occurs when trained residents graduate and new ones begin their residency, resulting in increased fatalities and mishaps; this phenomenon is called the “July effect.” This sudden changeover of workforce puts the quality of healthcare in teaching hospitals at stake. In this paper, we discuss various reasons behind the July effect and several tools of quality that can be implemented to improve healthcare and increase patients’ safety.


The paper, "Applying Lean Principles to Mitigate the “July Effect”: Addressing Challenges Associated with Cohort Turnover in Teaching Hospitals (Shweta Chopra and Manasa Kondapalli), JTMAE 31/4, July–September 2015" is a copyrighted publication of ATMAE. This paper has been republished with the authorization of ATMAE, and may be accessed directly from the JTMAE website

Copyright Owner




File Format