here - Action Learning

MIT Sloan Healthcare Lab
Fall 2015 Host Application
Submission Deadline: Monday, August 10, 2015
Organization Information (* = required information)
1. Organization Name *
2. City and State
3. Street address
4. Zip Code
5. Website
Primary Contact
This should be the person whom the team can contact initially to discuss the project and with whom they
will have most of their communication during the project.
6. Full name *
7. Job title
8. Primary Phone Number
9. Secondary Phone Number
10. Email address *
11. Skype account
Secondary Contact
This should be the person whom the team can contact if the primary contact is unavailable.
12. Full name
13. Job title
14. Phone number
15. Email address
16. Skype account
Organization Profile
17. Describe which health or healthcare segment your organization is in (for
example, hospital, pharma, technology, services, etc.).
18. When was your organization established? What stage is your company in:
startup, expansion, established, or something else?
19. How many employees do you have?
20. Please describe the function of your unit, division, department. (For example,
surgical services, medical records, product development, etc.)
21. How does your company fund its operations? (For example: self-funding from
operations, angel funding or venture capital investment, etc.)
22. Do you have any links to H-Lab or MIT? Have you hosted an MIT Action
Learning Lab team previously (welcome back!)? Do you have MIT Alumni
working with you?
In framing your project, please think of the H-Lab team as working on a short but intensive internship
with your organization. The team will undertake significant initial research on campus from October
through December. They will work onsite at your organization during the fall semester, 1 week in
October and/or up to 3 weeks in January. They will formally present their conclusions to you at the end of
their engagement, together with any specific deliverables you agreed on.
23. What type of project would you like the H-Lab team to work on for your
organization? Please select one or more categories that you would like the H-Lab
team to work on for you. You and your team will agree to the final project scope.
Operations Management
Organizational change or development
Other Management related Project (please specify):
24. Please describe what challenge or opportunity you would like your H-Lab team
to work on for your organization, i.e., what problem are you trying to solve?
Please provide relevant background and details about the project. Please also help
us understand why this project is important to your firm. (H-Lab projects are
most successful when they are strategic or mission-critical to their host
25. What work should the team focus on during the fall semester? How can your
team best leverage the rich resources available at MIT to prepare for and begin
work on your project? Background research? Initial interviews with local sources?
Something else?
26. What is the key deliverable that the team should provide to you at the
conclusion of their project? In addition to the standard presentation or written
report to senior management, please consider if there are concrete deliverables
such as spreadsheet tools, organizational dashboard templates, roadmaps for
marketing, process improvement diagrams, etc., that would be particularly useful
to your organization.
27. OPTIONAL: Please provide any additional information you believe is
important. Please give additional organizational background, links, etc. that you
believe will help teams understand your organization, your project, and the
opportunity to work with you.
Project Logistics
Students usually will work in teams of 4. If your project is in the Boston area, the team will visit your
location during the semester and/or for an intensive week in October. If your project is out of the Boston
area, your team will visit you for an intensive work session during January.
We ask that H-Lab organizations pay modest travel and lodging expenses (economy airfare and modest
accommodations), if travel is required outside of the Boston area. There are no other costs involved for
host organizations.
28. What skills and experience are most valuable for the team to bring to the
project? Please indicate which abilities would be required and which are preferred.
29. Please confirm that you will pay round-trip economy airfare to and from onsite
work, if applicable (outside the greater Boston area). *
__Not Applicable
30. Please confirm that you will provide safe, appropriate accommodations during
the onsite work, if applicable (outside the greater Boston area). *
__Not Applicable
31. Please confirm that you will provide appropriate workspace during the onsite
work (e.g., desk, internet access, general office supplies, etc.). *
32. Non-Disclosure Agreements (NDAs): Occasionally, organizations request teams
to sign NDAs, depending on the scope of their project. Do you expect to request an
NDA? If so, we will connect you with our legal advisor for the appropriate
33. Do you require any medical tests or vaccines from our student teams in order
for them to be onsite at your organization? Some hospitals require TB, flu
vaccines, etc. If so, we will contact you as soon as possible with student
information. *
__ Yes
__ No
__Not Applicable
Supporting Documents
Please add any supporting documents that might be helpful for the student team to better understand your
project or your organization (structure, culture, product(s)/service(s)).