Relating focus to quality and cost in a healthcare setting

Exploring characteristics of specialization as moderators of the link between specialization and patient experience of care

BACKGROUND

Hospitals are increasingly pursuing specialization as a strategy to operate efficiently while delivering high-quality care. To date, however, evidence is lacking on whether hospital specialization has a consistent effect on patients' experience of care or whether different specialization characteristics influence how specialization works.

PURPOSE

This study investigates whether specialization characteristics, that is, the within-specialty concentration and the within-specialty urgency score, moderate the link between hospital specialization and patient experience of care.

METHODOLOGY

We use patient-reported and administrative data from German hospitals between 2014 and 2017, with orthopedic and trauma care as the research setting. Our sample consists of 157,458 patient observations nested within 483 hospitals. We apply random-intercept multilevel modeling.

RESULTS

Our results indicate that the effect of specialization on patient experience of care (a) decreases as the within-specialty concentration increases and (b) increases as the within-specialty urgency score increases.

CONCLUSION

This study provides novel insights into the specialization characteristics that make hospital specialization in orthopedic and trauma care particularly effective at improving patient experiences.

PRACTICE IMPLICATIONS

Although specialization is gaining popularity as a strategy for pooling scarce resources and facilitating high-quality health care, hospital managers and policymakers should consider that certain characteristics of specialization can influence the way that specialization works and how effective it is in improving patient experiences. Within the scope of orthopedic and trauma care, our study suggests that a low concentration of diagnoses within a service area and a high average level of medical urgency make specialization particularly effective at improving patient experiences.

Five focus strategies to organize health care delivery

PURPOSE

The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations.

DESIGN/METHODOLOGY/APPROACH

First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies.

FINDINGS

The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes.

RESEARCH LIMITATIONS/IMPLICATIONS

Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination.

PRACTICAL IMPLICATIONS

Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization's strategy and key performance indicators.

ORIGINALITY/VALUE

Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.

Quantitative comparisons of urgent care service providers

Purpose

– The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices.

Design/methodology/approach

– This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality.

Findings

– Primary care physicians’ offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions.

Research limitations/implications

– The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings.

Practical implications

– The patient’s choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape.

Social implications

– This work contributes to the understanding of how to provide cost effective and efficient UC services.

Originality/value

– This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.