In a recently published article my co-authors and I 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 research model is as shown below:
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 findings of this study present implications for structuring processes and allocating resources in hospitals. It is important to ensure that hospitals supplement their clinical quality and flexibility capabilities with personalized attention to patient needs. Facets such as empathy and consideration for patients’ situation, and room environment play important role in providing patient-centered care. The results highlight the complementary role of these facets, referred to as experiential quality capability, in enhancing the impact of clinical quality and flexibility capabilities on cardiology unit operational performance. Hospitals are operating in a very different environment compared to the 1990s. During these earlier times a significant portion of hospital costs were fixed. There was sufficient capacity and the per-diem revenue earned by increasing patients’ length of stay was higher than the variable costs to provide healthcare. In today’s environment, many hospitals are facing capacity constraints since the decline in managed care utilization management and aging demographics have increased demand. Furthermore, the fixed per diem contracts are also much less prevalent in many markets. Our results show that a holistic management of clinical quality, clinical flexibility, and experiential quality capabilities can make cardiology units better equipped to cope with these changed circumstances by reducing length of stay and costs.
The results of our study present implications for setting up multidisciplinary clinical business units comprised of various services and different functional representatives such as the physician, the nurse, the pharmacist, the radiologist, and the manager. This enables gaining complementary benefits of clinical quality, clinical flexibility, and experiential quality capabilities. Multiple services within a clinical unit help in effectively managing co-morbidities, such that a patient can be moved to different sub-divisions within the clinical unit depending upon their prevailing conditions. Team members with varying perspectives on healthcare could jointly review clinical condition of patients, patient and staff satisfaction data, and operational performance measures within the unit. This team approach results in improved communication among various members, which in turn provides ongoing interdisciplinary education, better coordination of care for patients, and concurrent data feedback. The team-based efforts and open lines of communication with patients could also aid in incorporating evidence-based best practices, which enables audit with feedback such that a summary of the clinical performance of healthcare over a time interval is maintained and is then communicated back to practitioners.
Recognizing the importance of healthcare quality and to facilitate a broader understanding among healthcare providers, consumers and policy makers, the Institute of Medicine offered the following definition: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” The definition proposed by the Institute of Medicine clarifies the meaning of healthcare quality, yet several of the aspects referred in the definition could vary considerably depending on whether one considers the point of view of the healthcare providers or that of the patients. For instance, “desired health outcomes” refers to the accuracy of diagnoses and the effectiveness of treatments in producing health, but providers and patients could have varying perspectives regarding this aspect of healthcare. While providers would consider the clinical aspect of healthcare quality (i.e., type of medical equipment used, the use of healthcare techniques, etc.), patients would form opinions based on overall perception of the healthcare experience. Similarly, the aspect of “current professional knowledge” could vary substantially since healthcare service providers differ in their level and type of training. This difference could intensify depending on the range of related services, type of medical equipment, and techniques that providers use for healthcare. The national debate about healthcare often emphasizes inefficient processes, rising costs, and variations in quality. The necessity of satisfying the needs of various stakeholders (healthcare providers and patients) makes it obligatory to look more carefully into the key factors that influence healthcare operational performance. A holistic consideration of quality and flexibility capabilities is important in order to deliver on the promise of improving healthcare. In this study we establish the distinct role played by cardiology unit clinical quality and clinical flexibility in improving adjusted average length of stay and adjusted average cost performance. The results of this study shed important light into distinguishing these capabilities and highlighting how these capabilities improve operational performance.
Disparities in cardiovascular health across geographic locations are well documented. These disparities manifest in the form of healthcare challenges and access barriers, and pose one of the most serious public health problems. Socio-economic factors, such as unemployment, poverty, low educational level, and income inequality, also vary across geographic locations and contribute towards cardiovascular health disparities. Although there have been remarkable declines in cardiovascular mortality observed nationally over the last three decades, the disparities across population subgroups and geography are widening. In fact, Healthy People 2020 national public health agenda8 includes the elimination of these disparities as one of its goals. Our multi-level investigation in which the effects of state and county manifest at different levels accounts for disparities associated with complex environmental conditions within which hospitals operate.
Source: Nair, A., Nicolae, M., Narasimhan, R. (2013). “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, 31(7-8), 505-522.