| Description |
U.S. healthcare costs have shown a marked increase as a percentage of GDP over the past decades. Additionally, the growth of U.S. healthcare spending is outpacing that of other industrialized economies. With this rapid pace of growth and spending, explorations of quality and efficiency within the U.S. healthcare system find a prominent place within the academy. This dissertation adds to extant research via three essays, each exploring unique dimensions of healthcare quality and efficiency. The first essay, Drivers of Quality and Efficiency: A Healthcare Perspective, utilizes regression and stochastic frontier analysis to explore drivers of hospital outcome quality and efficiency. Secondary source data from over 1,800 U.S. hospitals are used to evaluate the degree to which process standardization, service effectiveness and operational focus drive outcome quality and efficiency. In support of hypotheses and extant operations management theory, process standardization is found to relate positively to both outcome quality and efficiency while service effectiveness relates positively to outcome quality but is negatively related to efficiency. Contrary to hypotheses and theory, lower levels of operational focus (i.e., wider breadth of services) are found to positively contribute to outcome quality and efficiency. The second essay, Healthcare Focus and Performance: A Multidimensional Exploration, further explores the unexpected focus / performance relationship of the first essay. Using extant research and the data set from the first essay, multidimensional measures of essay. Using extant research and the data set from the first essay, multidimensional measures of both hospital focus and performance are proposed and evaluated utilizing canonical correlation analysis. This essay provides a contribution by evaluating rigorous multidimensional measures of both focus and performance and confirming that hospitals exhibiting a broader range of services also provide higher levels of overall performance. Additional insights are provided by evaluating individual indicators of focus and exploring their relative contributions to performance. The third essay, Competitive Capabilities: A Healthcare Perspective, examines the acquisition of quality and efficiency capabilities in light of Competitive Progression and Trade-off theoretical frameworks. Panel data from over 140 California hospitals from two time frames (2005-2008, and 2006-2009) and statistical differencing techniques are utilized to find support for the Competitive Progression framework for hospitals residing well off an economic performance frontier. |
