The effect of location, strategy, and operations technology on hospital performance

Abstract 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.

[1]  Curtis P. McLaughlin,et al.  The Different Operations Strategy Planning Process for Service Operations , 1991 .

[2]  Subhash Sharma,et al.  Identification and Analysis of Moderator Variables , 1981 .

[3]  D. Burda.  Why hospitals close. , 1989, Modern Healthcare.

[4]  J Greene.  Florida 2nd state to issue 'report cards'. , 1996, Modern healthcare.

[5]  Paul S. Calem,et al.  Competition and specialization in the hospital industry: an application of Hotelling's location model , 1995 .

[6]  J. Nunnally.  Psychometric Theory (2nd ed), New York: McGraw-Hill. , 1978 .

[7]  D. Hambrick.  High Profit Strategies in Mature Capital Goods Industries: A Contingency Approach , 1983 .

[8]  Dennis Duchon,et al.  THE NATURE OF INTERNAL COMPLEXITY IN UNUSUAL ORGANIZATIONS: A STUDY OF ENVIRONMENTALLY SENSITIVE AND INSENSITIVE HOSPITALS. , 1996 .

[9]  J. Hoffman,et al.  Porter's generic strategies, discontinuous environments, and performance: a longitudinal study of changing strategies in the hospital industry. , 1993, Health services research.

[10]  PATTERNS OF STRATEGIC CHANGE, ENVIRONMENTAL CHANGE, AND PERFORMANCE: A LONGITUDINAL STUDY OF CALIFORNIA HOSPITALS. , 1990 .

[11]  R E Miles,et al.  Organizational strategy, structure, and process. , 1978, Academy of management review. Academy of Management.

[12]  L. Bourgeois.  STRATEGIC GOALS, PERCEIVED UNCERTAINTY, AND ECONOMIC PERFORMANCE IN VOLATILE ENVIRONMENTS , 1985 .

[13]  W F Henry.  Reinventing rural hospitals. , 1994, Trustee : the journal for hospital governing boards.

[14]  Kenneth K. Boyer,et al.  Unlocking the potential of advanced manufacturing technologies , 1997 .

[15]  A. Hillman,et al.  Hospital adoption of medical technology: an empirical test of alternative models. , 1995, Health services research.

[16]  J Harkey,et al.  Quality of health care and financial performance: Is there a link? , 1992, Health care management review.

[17]  D. Pugh,et al.  Dimensions of Organization Structure , 1968 .

[18]  R. MacCallum,et al.  THE APPLICATION OF EXPLORATORY FACTOR ANALYSIS IN APPLIED PSYCHOLOGY: A CRITICAL REVIEW AND ANALYSIS , 1986 .

[19]  Chee-Chuong Sum,et al.  Business environment, operations strategy, and performance: An empirical study of Singapore manufacturers☆ , 1995 .

[20]  B Japsen.  Another record year for dealmaking. Activity among medium-size companies fuels continued drive toward consolidation. , 1996, Modern healthcare.

[21]  Deepika Nath,et al.  Measuring strategy coherence through patterns of strategic choices , 1994 .

[22]  S. Shortell,et al.  Perceptual and archival measures of Miles and Snow's strategic types: a comprehensive assessment of reliability and validity. , 1990, Academy of Management journal. Academy of Management.

[23]  Cleverley Wo.  Larger urban hospitals increasingly on closed list. , 1991 .

[24]  A. Roth,et al.  Operations as marketing: A competitive service strategy , 1991 .

[25]  I. Moscovice,et al.  Mobile technology in rural hospitals: the case of the CT scanner. , 1996, Health services research.

[26]  P MacPherson.  Live ... and let live. When it comes to organ donations, it takes more than pulling heartstrings to succeed. , 1995, Hospitals & health networks.

[27]  E. O'Connor,et al.  Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. , 1995, Health services research.

[28]  James L. Heskett,et al.  Managing in the service economy , 1986 .

[29]  William I. Gorden.  Service America: Doing business in the new economy , 1988 .

[30]  Barbara B. Flynn,et al.  Empirical research methods in operations management , 1990 .

[31]  H. Harman.  Modern factor analysis , 1961 .

[32]  Rohit Verma,et al.  MULTIPLE RATERS IN SURVEY‐BASED OPERATIONS MANAGEMENT RESEARCH: A REVIEW AND TUTORIAL , 2000 .

[33]  Paul M. Swamidass,et al.  Manufacturing strategy, environmental uncertainty and performance: a path analytic model , 1987 .

[34]  J Morrissey.  'Top 100' hospitals set new success standards. , 1994, Modern healthcare.

[35]  Rajaram Veliyath,et al.  STRATEGIC ORIENTATION, STRATEGIC PLANNING SYSTEM CHARACTERISTICS AND PERFORMANCE* , 1993 .

[36]  James C. Robinson,et al.  The impact of hospital market structure on patient volume, average length of stay, and the cost of care. , 1985, Journal of health economics.

[37]  Henry Wf.  Reinventing rural hospitals. , 1994 .

[38]  S M Shortell,et al.  The etiology and determinants of hospital closure. , 1996, Journal of health care finance.

[39]  J. Kimberly,et al.  Organizational innovation: the influence of individual, organizational, and contextual factors on hospital adoption of technological and administrative innovations. , 1981, Academy of Management journal. Academy of Management.

[40]  W P Welch,et al.  Health care utilization in HMO's. Results from two national samples. , 1985, Journal of health economics.

[41]  L. McMahon,et al.  Measuring outcomes of hospital care using multiple risk-adjusted indexes. , 1991, Health services research.

[42]  Y A Ozcan,et al.  Hospital closure: an efficiency analysis. , 1994, Hospital & health services administration.

[43]  A. Solovy.  Regional forecasts. Predicting the unpredictable. , 1995, Hospitals & health networks.

[44]  Martin Gaynor,et al.  Uncertain Demand, the Structure of Hospital Costs, and the Cost of Emptyhospital Beds , 1993, Journal of health economics.

[45]  C. C. Snow,et al.  Organizational Configurations and Performance: A Comparison of Theoretical Approaches , 1993 .