| This research attempts to address the impact of experiential quality (EQ) and clinical quality (CQ) on hospital performance through the investigation of healthcare quality as two distinct but related dimensions. One relates to their combined magnitude, which is referred to in the literature as the "combined dimension of quality" (CD), while the other pertains to the balance between CQ and EQ, which is referred to in this dissertation as the "balance dimension of quality" (BD). By clearly differentiating between these two dimensions, the purpose of this research is to provide a more precise way to conceptualize and operationalize hospital quality, and establish a basis for investigating theoretically and practically important relationships and contingencies. Drawing a conceptual, operational, and empirical distinction between CD and BD, and examining their interaction, enables this research to provide greater insight into hospital quality. Hypotheses were developed to explore the effects of CD and BD on readmission rate and productivity as well as to test which type of quality, experiential or clinical, has the greatest impact on the outcome variables. This dissertation empirically analyzes how hospitals' CQ and EQ, in terms of the combined magnitude (CQ * EQ) and relative balance (|CQ - EQ|), impact hospital performance through the use of secondary data on approximately 1900 U.S. acute care hospitals. Through the empirical unpacking of the quality construct into distinct dimensions, their main effects and interaction helps to explain previously unaccounted-for variance in hospital performance.;In addition to EQ's and CQ's impact on performance, which is largely due to factors internal to each hospital, organization theory predicts the fate of organizations is contingent on the outcome of interactions between organizations and their environments. While organizations are at the same time embedded in and influencing their environments, it is likely that some environmental conditions pose greater challenges to the survival of the organization than do others. In this study, the organizational environment comprises three dimensions: complexity, munificence, and dynamism. To delve deeper into the uniqueness of CD and BD, as well as to evaluate the theoretical and practical usefulness of drawing a distinction between them, we posit that the relationships among quality (i.e., EQ and CQ) and performance (Readmission Rate and Productivity) are contingent on these three key environmental factors.;This research provides strong empirical evidence that the relative balance of EQ and CQ (|EQ -- CQ|) should be considered along with the combined magnitude (CQ * EQ). First, strong empirical support is provided for the benefit of minimizing the gap between experiential quality (EQ) and clinical quality (CQ). Specifically, allocating the appropriate amount of resources to balance the provision of EQ and CQ is essential in reducing a hospital's readmission rate. Second, the results demonstrate that achieving high overall quality is necessary to both reduce readmissions and increase productivity, and illustrates the importance of achieving both high levels of, and a balance of, EQ and CQ, instead of overcommitting resources to one at the expense of the other. To further demonstrate the value of the aforementioned findings to practice, hospitals were split into two groups: those with EQ ranked higher than CQ (i.e., EQ-dominant), and vice versa (i.e., CQ-dominant). Interestingly, the results suggest that while EQ-dominant hospitals enjoy fewer readmissions, it comes at the cost of lower productivity. On the other hand, CQ-dominant hospitals appear to be more productive, at the cost of higher readmissions. The results suggest that hospitals should focus on increasing both EQ and CQ, while maintaining a close balance between the two. (Abstract shortened by ProQuest.). |
