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A widening gap? Static and dynamic performance differences between specialist and general hospitals

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Abstract

This paper develops and tests a dynamic model of hospital focus. It does so by tracing the performance trajectories of specialist and general hospitals to identify whether a performance gap exists and whether it widens or shrinks over time. Our longitudinal analyses of all hospital organizations within the English National Health Service (NHS) reveal not only a notable performance gap between specialist and general hospitals in particular with regards to patient satisfaction that widens over time, but also the emergence of a gap especially with regards to hospital staff job satisfaction. These findings reflect the considerable potential of specialization as a means to enhance hospital effectiveness. However, they also alert health policy makers to the threat of a widening performance gap between specialist and general hospitals with potential negative repercussions at the patient and health system level.

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Notes

  1. As a robustness check, we used staff productivity computed as the number of admissions per staff member as an alternative indicator of operational performance, which yielded consistent results with regards to our hypotheses.

  2. It is also worth noting that mean and maximum variance inflation factors remain well below the threshold of 10. Multicollinearity is hence unlikely to distort our estimates. As an additional robustness check, we also estimated our four main models using more conventional random effects panel regression analyses using robust standard errors. We chose this approach, because specialist status is time invariant in our study period and would be omitted in any fixed effects panel regression that only exploits within hospital variation over time. Results are broadly consistent with those from our dynamic models even though conventional random effects panel estimates confound the cross-sectional and the longitudinal effects of hospital focus. It is hence not surprising to note that in these additional models the dynamic effect of hospital focus was significant not just with regards to patient satisfaction and job satisfaction as in our mixed effects growth models, but also with regards to return on sales. This is interesting as hospital focus had a positive, but insignificant effect on the return on sales in both our static and dynamic model. When exploiting both types of variances simultaneously, however, a significant effect on financial performance emerged.

References

  1. Smith A (1776) An inquiry into the wealth of nations. Strahan and Cadell, London

    Google Scholar 

  2. Pollitt C, Bouckaert G (2011) Public management reform: a comparative analysis – new public management, governance, and the Neo-Weberian state. Oxford University Press, Oxford

    Google Scholar 

  3. Schneider JE, Miller TR, Ohsfeldt RL, Morrisey MA, Zelner BA, Li P (2008) The economics of specialty hospitals. Med Care Res Rev 65(5):531–553

    Article  Google Scholar 

  4. Davis P, Milne B, Parker K, Hider P, Lay-Yee R, Cumming J, Graham P (2013) Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions. Health Policy 112(1):19–27

    Article  Google Scholar 

  5. De la Maisonneuve C, Oliveira Martins J (2013) Public spending on health and long-term care: a new set of projections. OECD Economic Policy Papers No 6

  6. Hagist C, Kotlikoff L (2005) Who’s going broke? Comparing growth in healthcare costs in ten OECD countries (Working Paper No. 11833). National Bureau of Economic Research, Cambridge

    Book  Google Scholar 

  7. Huckman RS, Zinner DE (2008) Does focus improve operational performance? Lessons from the management of clinical trials. Strateg Manag J 29(2):173–193

    Article  Google Scholar 

  8. Hyer NL, Wemmerlöv U, Morris JA Jr (2009) Performance analysis of a focused hospital unit: the case of an integrated trauma center. J Oper Manag 27(3):203–219

    Article  Google Scholar 

  9. McDermott CM, Stock GN (2011) Focus as emphasis: conceptual and performance implications for hospitals. J Oper Manag 29(6):616–626

    Article  Google Scholar 

  10. Popescu I, Vaughan-Sarrazin MS, Rosenthal GE (2007) Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services. JAMA 297(22):2489–2495

    Article  Google Scholar 

  11. Schneider JE, Ohsfeldt RL, Morrisey MA, Li P, Miller TR, Zelner BA (2007) Effects of specialty hospitals on the financial performance of general hospitals. Inquiry 44:321–344

    Google Scholar 

  12. Poole L, Davis J, Gunby NW (2013) In a niche of time: Do specialty hospitals outperform general services hospitals? Health Care Manag 32(1):13–22

    Google Scholar 

  13. Al-Amin M, Zinn J, Rosko MD, Aaronson W (2010) Specialty hospital market proliferation: strategic implications for general hospitals. Health Care Manag Rev 35(4):294–300

    Article  Google Scholar 

  14. Skinner W (1974) The focused factory. Harv Bus Rev 113–120

  15. Hayes RH, Wheelwright SC (1984) Restoring our competitive edge: competing through manufacturing. Wiley, New York

    Google Scholar 

  16. Davidow WH, Uttal B (1988) Service companies: focus or falter. Harv Bus Rev 67(4):77–85

    Google Scholar 

  17. Ferrier GD, Grosskopf S, Hayes KJ, Yaisawarng S (1993) Economies of diversification in the banking industry: a frontier approach. J Monet Econ 31(2):229–249

    Article  Google Scholar 

  18. Heskett JL (1986) Managing in the service economy. Harvard Business Press, Boston

    Google Scholar 

  19. Johnston R (1996) Achieving focus in service organisations. Serv Ind J 16(1):10–20

    Article  Google Scholar 

  20. Laeven L, Levine R (2007) Is there a diversification discount in financial conglomerates? J Financ Econ 85(2):331–367

    Article  Google Scholar 

  21. Heskett JL (1983) Shouldice hospital limited. Harvard Business School Case 9-683-068. Harvard Business School Publishing, Boston

    Google Scholar 

  22. MacStravic RS (1986) Product-line administration in hospitals. Health Care Manag Rev 11(2):35–43

    Article  Google Scholar 

  23. Bowers MR, Taylor JA (1989) Product line management in hospitals: an exploratory study of managing change. Hosp Health Serv Adm 35(3):365–375

    Google Scholar 

  24. Fetter RB, Freeman JL (1986) Diagnosis related groups: product line management within hospitals. Acad Manag Rev 11(1):41–54

    Google Scholar 

  25. Manning MF (1987) Product line management: will it work in health care? Healthc Financ Manage 41(1):23–29

    Google Scholar 

  26. Nackel JG, Kues IW (1985) Product-line management: systems and strategies. Hosp Health Serv Adm 31(2):109–123

    Google Scholar 

  27. Zelman WN, Parham DL (1990) Strategic, operational, and marketing concerns of product-line management in health care. Health Care Manag Rev 15(1):29–35

    Article  Google Scholar 

  28. Herzlinger RE (1997) Market-driven health care. Addison: Wesley, Reading, MA

    Google Scholar 

  29. Ginsburg PB (2000) Are focused factories the wave of the future? Front Health Serv Manag 16(3):41–46

    Article  Google Scholar 

  30. Shactman D (2005) Specialty hospitals, ambulatory surgery centers, and general hospitals: charting a wise public policy course. Health Aff 24(3):868–873

    Article  Google Scholar 

  31. Carey K, Burgess JF, Young GJ (2009) Single specialty hospitals and service competition. Inquiry 46:162–171

    Google Scholar 

  32. Anderson SW (1995) Measuring the impact of product mix heterogeneity on manufacturing overhead cost. Account Rev 70(3):363–387

    Google Scholar 

  33. Brush T, Karnani A (1996) Impact of plant size and focus on productivity: an empirical study. Manag Sci 42(7):1065–1081

    Article  Google Scholar 

  34. Ketokivi M, Jokinen M (2006) Strategy, uncertainty and the focused factory in international process manufacturing. J Oper Manag 24(3):250–270

    Article  Google Scholar 

  35. Lapré MA, Tsikriktsis N (2006) Organizational learning curves for customer dissatisfaction: heterogeneity across airlines. Manag Sci 52(3):352–366

    Article  Google Scholar 

  36. Pesch MJ, Schroeder RG (1996) Measuring factory focus: an empirical study. Prod Oper Manag 5(3):234–254

    Article  Google Scholar 

  37. Tsikriktsis N (2007) The effect of operational performance and focus on profitability: a longitudinal study of the US airline industry. Manuf Serv Oper Manag 9(4):506–517

    Article  Google Scholar 

  38. Vokurka RJ, Davis RA (2000) Focused factories: empirical study of structural and performance differences. Prod Invent Manag J 41(1):44–55

    Google Scholar 

  39. Ding DX (2014) The effect of experience, ownership and focus on productive efficiency: a longitudinal study of US hospitals. J Oper Manag 32(1):1–14

    Article  Google Scholar 

  40. Eastaugh SR (2001) Hospital costs and specialization: benefits of trimming product lines. J Health Care Finance 28(1):61–71

    Google Scholar 

  41. Capkun V, Messner M, Rissbacher C (2012) Service specialization and operational performance in hospitals. Int J Oper Prod Manag 32(4):468–495

    Article  Google Scholar 

  42. Clark JR, Huckman RS (2012) Broadening focus: spillovers, complementarities, and specialization in the hospital industry. Manag Sci 58(4):708–722

    Article  Google Scholar 

  43. Hagen TP, Vaughan-Sarrazin MS, Cram P (2010) Relation between hospital orthopaedic specialisation and outcomes in patients aged 65 and older: retrospective analysis of US Medicare data. Br Med J 340:1–8

    Article  Google Scholar 

  44. Bredenhoff E, van Lent WA, van Harten WH (2010) Exploring types of focused factories in hospital care: a multiple case study. BMC Health Serv Res 10(1):154

    Article  Google Scholar 

  45. Greenwald L, Cromwell J, Adamache W, Bernard S, Drozd E, Root E, Devers K (2006) Specialty versus community hospitals: referrals, quality, and community benefits. Health Aff 25(1):106–118

    Article  Google Scholar 

  46. Barro JR, Huckman RS, Kessler DP (2006) The effects of cardiac specialty hospitals on the cost and quality of medical care. J Health Econ 25(4):702–721

    Article  Google Scholar 

  47. Cram P, Rosenthal GE, Vaughan-Sarrazin MS (2005) Cardiac revascularization in specialty and general hospitals. N Engl J Med 352(14):1454–1462

    Article  Google Scholar 

  48. KC DS, Terwiesch C (2011) The effects of focus on performance: evidence from California hospitals. Manag Sci 57(11):1897–1912

  49. Burns LR, David G, Helmchen LA (2011) Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics. Popul Health Manag 14(2):69–77

    Article  Google Scholar 

  50. Herzlinger RE (2004) Specialization and its discontents the pernicious impact of regulations against specialization and physician ownership on the US healthcare system. Circulation 109(20):2376–2378

    Article  Google Scholar 

  51. Iglehart JK (2005) The uncertain future of specialty hospitals. N Engl J Med 352(14):1405–1407

    Article  Google Scholar 

  52. Postrel S (2002) Islands of shared knowledge: specialization and mutual understanding in problem-solving teams. Organ Sci 13(3):303–320

    Article  Google Scholar 

  53. Salge TO (2012) The temporal trajectories of innovative search: insights from public hospital services. Res Policy 41(4):720–733

    Article  Google Scholar 

  54. Medicare Payment Advisory Commission (2006) Physician-Owned Specialty Hospitals Revisited. Medicare Payment Advisory Commission: Washington, DC. https://asipp.org/documents/PhysicianOwnedSpecialtyHospitals.pdf. Accessed 15 Dec 2014

  55. Badlani N, Boden S, Phillips F (2012) Orthopedic specialty hospitals: centers of excellence or greed machines? Orthopedics 35(3):201

    Google Scholar 

  56. Popescu I, Nallamothu BK, Vaughan-Sarrazin MS, Cram P (2008) Do specialty cardiac hospitals have greater adherence to acute myocardial infarction and heart failure process measures? An empirical assessment using Medicare quality measures: quality of care in cardiac specialty hospitals. Am Heart J 156(1):155–160

    Article  Google Scholar 

  57. Nallamothu BK, Rogers MA, Chernew ME, Krumholz HM, Eagle KA, Birkmeyer JD (2007) Opening of specialty cardiac hospitals and use of coronary revascularization in Medicare beneficiaries. JAMA 297(9):962–968

    Article  Google Scholar 

  58. Casalino LP, Devers KJ, Brewster LR (2003) Focused factories? Physician-owned specialty facilities. Health Aff 22(6):56–67

    Article  Google Scholar 

  59. McCracken MJ, McIlwain TF, Fottler MD (2001) Measuring organizational performance in the hospital industry: an exploratory comparison of objective and subjective methods. Health Serv Manag Res 14(4):211–219

    Article  Google Scholar 

  60. Fottler MD (1987) Health care organizational performance: present and future research. J Manag 13(2):367–391

    Google Scholar 

  61. Breidbach C, Antons D, Salge TO (2016) Seamless service? On the role and impact of service orchestrators in human-centered service systems. J Serv Res (forthcoming)

  62. Cleverley WO (1993) The almanac of hospital financial and operating indicators. The Center for Healthcare Industry Performance Studies (CHIPS), Columbus

    Google Scholar 

  63. Li LX, Benton WC (1996) Performance measurement criteria in health care organizations: review and future research directions. Eur J Oper Res 93(3):449–468

    Article  Google Scholar 

  64. Rapoport J, Teres D, Zhao Y, Lemeshow S (2003) Length of stay data as a guide to hospital economic performance for ICU patients. Med Care 41(3):386–397

    Google Scholar 

  65. Chadwick C, Hunter LW, Walston SL (2004) Effects of downsizing practices on the performance of hospitals. Strateg Manag J 25(5):405–427

    Article  Google Scholar 

  66. Ayanian JZ, Weissman JS (2002) Teaching hospitals and quality of care: a review of the literature. Milbank Q 80(3):569–593

    Article  Google Scholar 

  67. Bliese PD, Ployhart RE (2002) Growth modeling using random coefficient models: model building, testing, and illustrations. Organ Res Methods 5(4):362–387

    Article  Google Scholar 

  68. Chen G, Ployhart RE, Thomas HC, Anderson N, Bliese PD (2011) The power of momentum: a new model of dynamic relationships between job satisfaction change and turnover intentions. Acad Manag J 54(1):159–181

    Article  Google Scholar 

  69. Orszag PR, Ellis P (2007) Addressing rising health care costs—a view from the Congressional Budget Office. N Engl J Med 357(19):1885–1887

    Article  Google Scholar 

  70. Przywara B (2010) Projecting future health care expenditure at European level: drivers, methodology and main results (Economic Papers 417). Directorate General Economic and Monetary Affairs, European Commission

  71. Erlandsen E (2008) Improving the efficiency of health care spending: what can be learnt from partial and selected analyses of hospital performance? OECD Econ Stud 44(1):1–33

    Google Scholar 

  72. Cook D, Thompson JE, Habermann EB, Visscher SL, Dearani JA, Roger VL, Borah BJ (2014) From ‘solution shop’ model to ‘focused factory’ in hospital surgery: increasing care value and predictability. Health Aff 33(5):746–755

    Article  Google Scholar 

  73. NHS England (2013) The NHS belongs to the people: a call to action. NHS England, London. http://www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/. Accessed 31 Oct 2014

  74. Roberts A, Marshall L, Charlesworth A (2012) A decade of austerity? The funding pressures facing the NHS from 2010/11 to 2021/22. Nuffield Trust, London

    Google Scholar 

  75. Monitor (2013) Closing the NHS funding gap: how to get better value healthcare for patients. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284044/ClosingTheGap091013.pdf. Accessed 31 Oct 2014

  76. Devers KJ, Brewster LR, Ginsburg PB (2003) Specialty hospitals: focused factories or cream skimmers? Issue Brief (Cent Stud Health Syst Change) 62:1–4

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Authors and Affiliations

  1. Organization and HR Management Group, German Police University, Zum Roten Berge 18-24, 48165, Muenster, Germany

    Antonio Vera

  2. Saïd Business School, Oxford University, Park End Street, Oxford, OX1 1HP, UK

    Pythagoras Petratos

  3. Innovation, Strategy and Organisation Group (ISO), TIME Research Area, RWTH Aachen University, Kackertstrasse 7, 52072, Aachen, Germany

    Torsten Oliver Salge

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  1. Antonio Vera
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Correspondence to Antonio Vera.

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Vera, A., Petratos, P. & Salge, T.O. A widening gap? Static and dynamic performance differences between specialist and general hospitals. Health Care Manag Sci 21, 25–36 (2018). https://doi.org/10.1007/s10729-016-9376-0

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