Duration of the effects of hiring rates in the
system. Systematic reactions stemming from inflows are less intuitive than those related to outflows.
Concurrently, there is a dearth of research about the outcomes associated with hiring rates
(Siebert & Zubanov, 2009). Our dynamic approach can help explain the relationship between inflows
and patient satisfaction. External hiring rates and transfer-in rates differ in their effect on patient satisfaction (both in the short and long term), as well as on other system variables. We expect that hiring rate effects are
likely to increase patient satisfaction over a longer duration than will changes in transfer-in rates. One
reason is that new workers are likely to generate more innovative ideas about improving processes
and capabilities than incumbents (who have a tendency to resist changes proposed by newcomers).
Given that the ideas generated by outside newcomers are likely to be less incremental than the ideas
from inside workers (Carpenter & Wade, 2002), we expect that external hiring of nurses will bring a
greater variance of ideas than transfers-in. The ideas may not get implemented (Cohen &
Levinthal, 1990), but when they do, we expect them to have a longer-lasting impact than ideas
from transferred-in nurses. Further, the duration of effects of human capital additions will be partly
determined by the reaction of the other system elements. For example, hiring from the outside may
create a positive labor market reputation, making future hiring easier and thus more likely.