In a recently published article my co-authors and I examine two effects of the quality penalties on an important determinant of health-care quality, namely, continuity of care for ailments targeted (intra-ailment effects) and ailments not targeted (spillover effects) by the regulation. Continuity of care, broadly defined as enabling appropriate care across patient conditions, settings, and time, is an important part of the health-care delivery continuum that helps patients discharged after intensive hospital-based care to smoothly transition into their communities. Continuity of care can refer to relational continuity, where a patient’s care is managed by the same provider over the entire care cycle; informational continuity, where the patient’s information is transferred over care episodes; continuity of physical location, where the entirety of a patient’s care occurs in the same location; management continuity, which refers to how care is integrated across sites and episodes; or transitional continuity, which occurs when patients are discharged from intensive care to another type of care. We focus on transitional continuity, which encompasses “a broad range of time-limited services designed to ensure health-care continuity, avoid preventable poor out-comes among at-risk populations, and promote the safe and timely transfer of patients from one level of care to another or from one type of setting to another”. Transitional continuity of care can occur in hospital-based step-down or recovery units or in other facilities such as skilled nursing facilities (SNFs), inpatient rehabilitation facilities, long-term care hospitals, and home health agencies.
The findings of this study offer directions for considering routines when developing regulatory policies in the health-care context. Health-care organizations are structured around medical specialties, and the services within these specialties share strong complementarities owing to common knowledge-base, processes, and physical assets. Since it is not practically possible to devise all-encompassing regulations, information about complementarities can help in developing policies that consider potential spillovers due to the underlying complementary processes and assets. Additionally, our findings also shed light on how policymakers can consider spillovers due to these complementarities and the underlying routines to positively influence performance measures that are often difficult to regulate. Post-acute care facilities are scattered, and it is not easy to create policy instrument/regulations to directly improve the quality of transitional continuity of care. We show that current policies that focus on readmissions, bundled care, and accountable care organization can address continuity of care-related quality measures.
For health-care organizations, our study has implications for considering processual and structural routines in quality improvement efforts. Resource allocation decisions can take these routines and complementarities into account. One key criticism of regulatory policies is that they motivate organizations to redirect resources from other activities to respond to the requirement. We show that these regulations can trigger a different sequence of actions whereby organizations develop routines that can aid in not only improving the outcome required by the regulation but also of other related tasks. This finding motivates careful considerations of routines at individual, processual, and structural levels to not only fulfill the requirements of a regulation but to gain operational and strategic benefits. Based on the results of this study, large health-care organizations should invest in acute care facilities to develop necessary routines for improving transitional continuity of care.
Our study has implications beyond healthcare. Manufacturing, merchandise, and service industries can experience quality spillovers from regulatory changes owing to complementarities in production functions. For example, the department of transportation requires the disclosure of on-time performance for domestic flights. Process reengineering to improve ground turnaround times for domestic flights motivated by such focused disclosures can also benefit international flights. Our study speaks to outcomes from other types of regulations, such as environmental regulations.
Source: Deore, A., Krishnan, R., & Nair, A. (2023). Virtuous spillover effects of quality penalties on the continuity of health care. Production and Operations Management, 32(9), 2846-2863.