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Examining the impact of clinical quality and clinical flexibility on cardiology unit performance—Does experiential quality act as a specialized complementary asset?
Journal of Operations Management
Abstract and Figures
In this study we examine the association of clinical quality and clinical flexibility capabilities on cardiology unit length of stay and cost performance. These relate to the operational performance of cardiology units and capture the timeliness and cost efficiency of cardiac care. We also investigate the complementary role played by the experiential quality in enhancing the impact of clinical quality and clinical flexibility on operational performance measure. Experiential quality relates to patient-centered delivery of care by a hospital. We collect and combine data for 876 U.S. hospitals from four distinct sources and undertake multi-level analyses that consider a hierarchical structure in which the hospital is nested within county and state. To disentangle the effects at the levels of states, counties, and hospitals, we use the mixed-effects modeling approach. The results obtained from econometric analyses indicate that clinical quality and clinical flexibility reduce cardiology unit average length of stay. Clinical flexibility also helps in reducing the average cost of cardiology units. Experiential quality moderates the impact of clinical quality on length of stay and plays a complementary role in the relationship between clinical flexibility and cost. The paper discusses the implications of the findings and presents directions for future research.
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... Researchers argue that flexibility is a competitive weapon to deal with uncertainties and deliver customized services to patients [8,9]. Flexibility provides a mechanism to adjust the medical infrastructure and deliver personalized services to the patients [10]. ...
... Many authors have explored measurement issues, financial and non-financial outcomes of flexibility, and the enablers of flexibility [20,25,26]. A significant number of studies established the linkages between manufacturing and healthcare flexibility while simultaneously indicate the utilization of recent forms of technology like AI to achieve flexibility at various levels [10,21]. However, the Technology Adoption Model (TAM) and theory on customer engagement indicate that service providers exhibit flexibility by utilizing several forms of technology [27,28]. ...
... This support aids medical practitioners' decision-making process, particularly in intricate or quickly changing clinical situations. Thus, AI-enabled clinical flexibility allows a rapid response to the patient's clinical conditions and provides a range of clinical services effectively and efficiently[10]. ...
Artificial Intelligence (AI) has the potential to revolutionize healthcare by enabling the development of more personalized, efficient, and effective medical services. One aspect of AI competence in healthcare that has received significant attention is the ability to respond rapidly to the patients' dynamic needs while injecting more flexibility into the system. This research explores the nexus between AI and service flexibility in healthcare. The qualitative study was carried out to examine the flexibility perspectives of AI-enabled service deliveries in healthcare. The findings contribute to a nuanced understanding of the facets of service flexibility in healthcare that AI could enable. The results would guide better coordination and management of care and the ability to make more informed decisions about treatment options. The nexus between AI and service flexibility in healthcare would sketch the new paradigms of patient value creation and evidence-based practices, which is an immediate need of healthcare organizations across the globe.
... (Chatterjee et al., 2021;Dwivedi et al., 2021) Role of AI in CRM AI-powered CRM systems are tremendously being utilized for a range of services. (Nair et al., 2013;Wimmer et al., 2016) Clinical capability ...
... Many authors argue that clinical capability is the outcome of complex clinical processes that require training and knowledge codification (Zafar & Rehman, 2017). Clinical capability is referred to as diagnostic capacity and treatment skills, which is enabled by the various forms of AI (Nair et al., 2013;Peiffer-Smadja et al., 2020). AI-enabled technologies would improve the clinical skills and competence of healthcare professionals (Wang et al., 2020). ...
... It allows focusing on competitiveness and service performance through several changes in the provision of services (Brozovic et al., 2016). CSF strategy would force healthcare organizations to identify new clinical methods and tools to satisfy their patients (Nair et al., 2013). We argue that CSF plays a significant role in developing the capability of adaptation and is likely to promote healthcare organizations to achieve service innovation. ...
Although AI-enabled customer relationship management (CRM) systems have gained momentum in healthcare to enhance performance, there is a striking dearth of knowledge on how such capabilities are formed and affect service innovation. The study adopted a mixed-method approach to investigate the underlying phenomena. This research infused resource-based theory, dynamic capability theory, and theory of productivity paradox to investigate how healthcare in India acquires AI-enabled CRM capabilities and enhances service innovation. We identified the facets of AI-enabled CRM capabilities using a case study and developed a framework for AI-enabled CRM capability and service innovation. This study noticed that customer service flexibility (CSF) is a missing link in this relationship. The findings of the quantitative study employing PLS-SEM reveal the linear relationships between AI-enabled CRM capability, CSF, and service innovation. This study explains the formation of AI-enabled CRM capabilities to fill the research gap and direct innovative performance in healthcare, which is an immediate need to sustain in a volatile environment. This study provides theoretical implications to enhance the research stream and practical implications for decision-makers.
... Currie et al. (2016) find that hospitals offering the most aggressive and clinically responsive practice styles were staffed by younger doctors who had graduated from "top-20" medical schools (p.72). These hospitals may also offer greater clinical flexibility in their treatment options, which has been shown to benefit cardiac patients positively (Nair et al. 2013). These hospitals may also just be more effective at optimizing their internal resources. ...
Improving emergency department (ED) care coordination requires analytics-based models that can integrate large patient-level and hospital databases to help formulate better transfer processes and policies across different hospital settings. This study develops a new empirical model to analyze over one million heart attack emergency department (ED) encounters between 2006-2014 to understand the factors that drive the need for inter-facility transfers (IFT) in different hospital settings. The resulting model has proven helpful for deriving public policy insights from this information. For instance, while we find that while healthcare IFT inequities and inconsistencies persist with ED discharge decisions because of some specific patient and hospital resource factors, these have been reduced significantly in the more recent post-reform period. We conclude by discussing the implications of using this empirical modeling approach for developing smarter policies and procedures for managing and benchmarking downstream healthcare operations practices in this disease area.
The erosion of professional ethics in medicine has severe consequences for patients and society. Existing approaches often rely on retrospective analysis and lack the precision and timeliness needed to effectively identify and mitigate risks. Although patient online reviews offer a unique opportunity to proactively detect ethical issues by providing candid, unsolicited feedback on healthcare experiences, few studies have empirically established the link between patient reviews and ethical breaches in medicine. This research introduces a novel machine learning framework to derive text-based indicators of physicians’ professional ethics using online patient reviews. Our approach leverages large language models to extract ethics-related comments and employs few-shot contrastive learning to train multi-label classifiers. Empirical validation studies suggest that the ethical indicators can help predict a wide range of adverse outcomes including drug-related deaths, disciplinary actions, malpractice claims, and rent-seeking behaviors. Our framework offers promising avenues for proactively managing ethical risks in healthcare and other professional services.
Purpose
This study aims to explore the constituents of artificial intelligence (AI)-augmented knowledge management (AIKM) capability and its impact on clinical performance (CP) in the health-care sector. It further examines the mediating role of absorptive capacity (Abs Cap) and discusses the implications of these findings for marketing strategies, highlighting how enhanced CP through AIKM can lead to more effective and patient-centered marketing approaches.
Design/methodology/approach
This research uses a mixed-method design. A qualitative study through semi-structured interviews was conducted to explore the facets of AIKM. The synthesis of qualitative findings infused with the relevant literature to develop a hypothesized model of AKM, Abs cap and CP metrics (e.g. diagnostic accuracy, patient satisfaction and treatment effectiveness). A survey of health-care professional in India was conducted to assess the proposed model by using structural equation modeling (PLS-SEM).
Findings
The results demonstrate a significant positive relationship between AIKM and CP. Moreover, Abs Cap mediates this relationship partially, highlighting its crucial role in translating improved knowledge access and analysis enabled by AI into enhanced clinical outcomes.
Research limitations/implications
The findings suggest that health-care organizations should invest in developing AIKM alongside strengthening Abs cap to maximize the positive impact of AI on CP and ultimately improve patient care. Future research can explore specific AIKM components and Abs cap facets influencing different aspects of CP.
Originality/value
This study represents a pioneering effort to conceptualize AIKM within the health-care context and empirically establish it as a higher-order factor. The inclusion of marketing strategies underscores the potential of AIKM not only in improving clinical outcomes but also in transforming health-care marketing. The mediating role of Abs Cap emphasizes the importance of organizational structures and processes that facilitate the absorption and utilization of knowledge, thereby contributing to both clinical and marketing excellence.
Hospital-physician integration has been increasingly considered a potential solution for the underlying challenges hospitals face as they are adapting to value-based healthcare services. We adopt an activity-based measure of integration (ABI) to investigate the relationship between integration and care outcomes, namely in-hospital mortality risk, length of stay (LOS), and 30-day readmission risk. ABI is measured based on a group of physicians who handle a specific procedure, coronary artery bypass graft (CABG), that is, CABG physicians, and is operationalized as the proportion of cases handled by the CABG physicians who single-site (or concentrate all their activity) at a focal hospital. To test hypotheses that posit a U-shaped relationship between ABI and patient care outcomes, we utilize patient-visit level information for Florida patients who underwent cardiac surgery performed by CABG physicians during 2011–2014. We find that ABI has a U-shaped relationship with both mortality risk and LOS, such that patient mortality risk and LOS are minimized at ABI tipping points of about 55%. In contrast, 30-day readmission risk continues to decrease as ABI increases. We also find that hospital teaching status and bed utilization moderate the relationship between ABI and LOS, such that the U-shaped relationship is flatter, basically linear in teaching and/or high-utilization hospitals. Our results suggest that a medium level of integration could be desirable, since a strategy of high integration trades off potentially higher patient volumes and revenues for suboptimal care outcomes. Overall, this study offers new insights for theory and practice, as the non-linear association between integration and care outcomes has not been investigated previously.
There has been a resurgence of interest in the role of operational focus in the healthcare operations literature in the backdrop of increasing demand for efficient and effective care. However, the evidence on the benefits of focus in healthcare is mixed. Our study proposes that a key piece of this puzzle that is been largely missing is an explicit consideration of the complexity of patient care needs. Specifically, our study serves to answer the questions: How does the complexity of care requirements affect care delivery operations? How does focus across the hierarchical levels of care affect care delivery outcomes across complexity regimes? The empirical analysis in the study is based on a large generalizable dataset of 246,663 patient discharges across 26 categories at 154 hospitals. We develop a multi‐factor measure of complexity of care requirements. The study results point to the deleterious impact of complexity on the costs of care. Next, our findings highlight the differential impact of focus across hierarchical levels (task‐level focus, category‐level focus, and selective focus in related areas) on the costs of care. Third, our study findings highlight the role of focus in mitigating the effects of complexity on costs in a healthcare setting. We discuss the implications of the study findings for theory and practice, and the directions for future research.
Problem definition: Hospital-acquired conditions (HACs) represent undesirable complications that occur during a hospital stay. HACs can compromise patient safety and care outcomes and result in unnecessary socio-economic costs. Although hospitals are expected to reduce the incidence of HACs, few studies have examined the implications of HACs on other clinical outcomes and measures of hospital performance. This study contributes to the literature by exploring the relationship between exposure to a set of target HACs, length of stay (LOS) performance, and 30-day readmission risk. Methodology/results: To estimate the effects of HACs, we conduct econometric analyses using patient-visit-level data for heart attack, heart failure, and pneumonia patients hospitalized in the U.S. state of Florida during 2010–2014. We define LOS performance as the deviation of LOS from the Geometric Mean LOS (GMLOS), a standard LOS set by the Centers for Medicare and Medicaid Services. First, we find that exposure to HACs leads to a 37% increase in the odds of readmission and a 79% increase in LOS. Second, an increase in LOS is associated with a decrease in readmission risk, and this decrease is stronger for patients exposed to HACs. Third, LOS performance mediates the HACs-readmission risk relationship, such that the increase in the readmission risk of a HAC patient can be fully suppressed by the patient’s LOS. Fourth, we find that for patients exposed to HACs, the benefits of a longer LOS are almost entirely capitalized when the LOS becomes 65% longer than the GMLOS. Managerial implications: We demonstrate that, when addressing the consequences of HACs, clinicians also face indirectly a trade-off between reducing readmissions and controlling costs. We proffer LOS as a potential mechanism under hospitals’ control for mitigating the adverse effects of HACs on readmission risk. Thus, this study offers guidance to clinicians having to decide when to discharge patients with exposure to HACs.
Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0088 .
This study aims to investigate the constituents of customer relationship management (CRM) capability that allows to exhibit customer service flexibility (CSF) and affects innovation in healthcare. In doing so, it qualitatively develops and identify the dimensions of CRM capability through a case study in a public healthcare setting in India and provides a framework of CRM, CSF, and service innovation. The findings of the study suggest that CSF is a mediating mechanism between CRM capability and service innovation which is long ignored in the healthcare literature. The study contributes to theory and practice-oriented knowledge on how the CRM capabilities can improve the public healthcare and facilitates key strategies for flexible deliveries and innovative services.
Healthcare providers often implement quality improvement (QI) practices to improve clinical quality, which may be measured as the extent to which healthcare workers (HCWs) comply with standardized procedures designed for ensuring patient safety. Unfortunately, the effectiveness of QI practices to improve clinical quality varies from facility to facility because of healthcare delivery complexity. In this paper, we consider the contextual complexity and the provider complexity arising from healthcare delivery processes, and we propose an exploratory study based on discrete choice experiments to examine their roles in the relationship between QI practices and clinical quality. By collecting and analyzing data from 320 HCWs at a university hospital in Taiwan, we found that healthcare delivery complexity significantly moderated the effectiveness of QI practices and how they improved clinical quality. We found that the contextual complexity influenced the level of effectiveness of the QI practices, whereas the provider complexity influenced whether a QI practice may be effective or not. We also studied the effect of implementing multiple QI practices simultaneously to counter the provider complexity. We found that implementing more QI practices does not necessarily lead to better outcomes, but implementing the right ones would. Our findings provide healthcare facilities with ex ante insights for designing QI practices to improve clinical quality.
Funding: W. Chen was supported by the National Natural Science Foundation of China [Grant 71902017], and C.-L. Tseng was supported by the University of New South Wales UNOVA Knowledge Hub.
Supplemental Material: The online appendix is available at https://doi.org/10.1287/serv.2023.0323 .
Intense international competition in the 1980s has focused increasing attention in both the academic and popular press on fundamental sources of superior performance in manufacturing. Sizable gaps in productivity and quality between U.S. manufacturers and their Japanese and European competitors in a wide range of industries led to new perspectives on the role of inventory in production, the impact of statistics on process control, and the central role of committed, capable people in solving problems and achieving continuous improvement.
Design management and process management are two important elements of total quality management (TQM) implementation. They are drastically different in their targets of improvement, visibility, and techniques. In this paper, we establish a framework for identifying the synergistic linkages of design and process management to the operational quality outcomes during the manufacturing process (internal quality) and upon the field usage of the products (external quality). Through a study of quality practices in 418 manufacturing plants from multiple industries, we empirically demonstrate that both design and process management efforts have an equal positive impact on internal quality outcomes such as scrap, rework, defects, performance, and external quality outcomes such as complaints, warranty, litigation, market share. A detailed contingency analysis shows that the proposed model of synergies between design and process management holds true for large and small firms; for firms with different levels of TQM experience; and in different industries with varying levels of competition, logistical complexity of production, or production process characteristics. Finally, the results also suggest that organizational learning enables mature TQM firms to implement both design and process efforts more rigorously and their synergy helps these firms to attain better quality outcomes. These findings indicate that, to attain superior quality outcomes, firms need to balance their design and process management efforts and persevere with long‐term implementation of these efforts. Because the study spans all of the manufacturing sectors (SIC 20 through 39), these conclusions should help firms in any industry revisit their priorities in terms of the relative efforts in design management and process management.
Quality management (QM) has often been advocated as being universally applicable to organizations. This is in contrast with the manufacturing strategy contingency approach of operations management (OM) which advocates internal and external consistency between manufacturing strategy choices. This article investigates, using the case‐study method, whether customer focus practices—a distinctive subset of the whole set of QM practices—are contingent on a plant’s manufacturing strategy context. The study strongly suggests that customer focus practices are contingent on a plant’s manufacturing strategy and identifies mechanisms by which this takes place. The findings inform the implementation of QM programs.
Over the past decade, 10% of community hospitals have closed. In this challenging time, our study presents hospital administrators with some valuable information that can help improve community hospitals’ performance. The purpose of this paper is to develop a strategic operations management model that links long‐term service choices, intermediate operations decisions, and hospital performance given the structural constraints of location, size, and medical teaching status. Data collected from 151 community hospitals are used to test the model. The research identifies strategic operations management decisions in the US community hospitals, shows their causal relationships, and identifies their effects on hospital performance. Specifically, we find that intermediate infrastructural operations decisions affect a community hospital’s cost, quality, and financial performance after the structural decisions of location and size have set the stage. Our study also reveals that community hospitals have adopted new staff and demand management decisions in response to the market needs.
Although there is a wealth of research on operations management and strategic planning in hospitals, there has been little if any research on the integration of these two issues. Hospital administrators are being pressured to improve the quality of services and to curb costs ‐ two primary themes within the field of operations management. This leads us to wonder to what extent operations are considered within the strategic planning process and what impact it may have. By surveying the literature, we identify a pattern in hospital management research, and identify articles which address the operations capabilities of quality, flexibility, delivery and cost control. These articles can serve as a springboard for research in hospital operations strategy, an area that is largely neglected in the literature. We also provide examples of how hospitals are addressing operations capabilities, and conclude with implications for hospital administrators and a research agenda for researchers.
This paper addresses the relationship between environmental uncertainty and operational flexibility through research that utilized a mail survey of North American manufacturers, and structured field interviews of users of advanced manufacturing technologies (AMT). Results from these efforts include: (1) no relationship was found between the measures of environmental uncertainty and operational flexibility, (2) no relationship was found between a firm's performance and its effort to align the level of operational flexibility with its external environment, and (3) the sample of AMT users reported more certain external environments than the random survey sample of manufacturers. The qualitative data gathered during the structured interviews is used to help explain these results, which redefine the boundaries of existing theory on these relationships and provide direction for future research.
Hospitals in the US are faced with challenges in how to compete and remain viable in an increasingly competitive environment. Using data from a primary survey of hospitals and from various secondary sources, we investigate the incremental effects on hospital performance of location, strategy, and technology. We find that hospital location is significantly related to performance, but that a hospital’s choice of strategy can moderate the effect of location. Additionally, we find hospitals that invest more extensively in clinical technologies tend to be better performers regardless of location. Hospital size, measured as number of beds, captures the effects of location and technology investment in accounting for a major portion of hospital performance. While we cannot argue that larger is always better for hospitals, mergers, partnerships, and other forms of consolidation currently observed in the marketplace indicate that managers in the hospital industry understand the advantage of size.
Modular product architectures are being adopted as the basis for new product designs in a growing number of markets. In this article, the author explains how adoption of modular product architectures makes possible new kinds of processes for creating and realizing products, as well as new approaches to identifying and managing organizational knowledge used in product creation and realization. When managed strategically, modular product, process, and knowledge architectures enable firms to create greater product variety, introduce technologically improved products more rapidly, bring new products to market more quickly, and lower costs of product creation and realization. This article investigates the ways in which the strategic use of modular architectures can affect the marketing process. It explains ways in which modular architectures change the technologically determined possibilities for product creation and realization in the marketing process, create new market dynamics, and lead to new objectives and methods for the marketing process.
Purchasing arrangements for repetitively used industrial supplies assume many different forms. Drawing on transaction cost analysis, the authors advance a conceptual framework that organizes these arrangements along a continuum of relationships. They use data from a survey of 140 OEM purchasers of bearings to demonstrate that performance in terms of acquisition costs is enhanced when, under conditions of uncertainty, firms introduce more relational elements into their purchasing arrangements. Possession cost performance improved when larger volumes of bearings were purchased. Implications for theory and practice are discussed.