a b s t r a c tHigh tech organizations confront dual demands of exploring new products/processes and exploiting existing products/processes. Research shows that ambidextrous organizations can better manage these dual demands, but our understanding of the antecedents that lead to ambidexterity is still emerging. In addition, previous research has taken a piecemeal approach to understand ambidexterity and does not fully consider its multilevel nature. This research takes a multilevel perspective and argues that a competency in ambidexterity involves three capabilities at different organizational levels: decision risk (strategic level), structural differentiation (project level), and contextual alignment (meso level). After correcting for endogeneity we empirically examine the relationship between these antecedents and ambidexterity competency by collecting multi-level data from 34 high tech business units and 110 exploration and exploitation R&D projects. The results indicate that decision risk and contextual alignment affect ambidexterity competency for high tech organizations. Structural differentiation does not affect ambidexterity competency but has mixed effects on R&D project performance.

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To investigate the opportunity for hospitals to achieve better care at lower cost, we examine two key process quality measures, conformance quality and experiential quality, and two measures of performance, readmission rate and cost per discharge. Conformance quality represents a hospital’s level of adherence to evidence-based standards of care, whereas experiential quality represents the level of interaction between hospital’s caregivers and patients. Analyzing six years of data from 3,474 U.S. acute care hospitals, we find that combining conformance and experiential quality results in lower readmission rates. However, conformance quality and experiential quality each independently increase cost per discharge, which suggests that a readmissions–costs trade-off is unavoidable. To investigate this further, we conduct post hoc analyses by distinguishing between the granular elements of experiential quality (EQ) based on task type: response-focused EQ and communication-focused EQ. Response-focused EQ measures caregivers’ ability to respond to patient’s explicit needs, whereas communication-focused EQ measures caregivers’ ability to engage in meaningful conversations with the patient. We find that combining communication-focused EQ with conformance quality reduces readmission rates. Moreover, as conformance quality increases, the cost of improving communication-focused EQ decreases, indicating complementarity. Response-focused EQ in combination with conformance quality also results in reduced readmission rates. However, as conformance quality increases, the cost of improving response-focused EQ also increases, suggesting that these dimensions might compete for resources. Taken together, our results suggest that hospital administrators can mitigate the trade-off between reducing readmissions and controlling costs by prioritizing communication-focused EQ over response-focused EQ. This paper was accepted by Serguei Netessine, operations management.

This research investigates the effect of process management on clinical and experiential quality. Clinical quality measures hospitals' performance on patient safety, i.e., adherence to standards, whereas experiential quality relates to patient centeredness, i.e., responsiveness to the needs and preferences of the patient. Drawing from the organizational learning literature, we argue for a trade-off between clinical and experiential quality as hospitals emphasize process management. We also study how external and internal forces, i.e., state legislation and hospital leadership, influence this relationship. A combination of primary data and secondary data collected at various time intervals is employed to test our hypotheses. Four important implications emerge from this work. First, we find that hospitals' emphasis on process management is associated with an increase in clinical quality but a decrease in experiential quality. Second, we find that state legislation initially reinforces this trade-off but, overtime, facilitates a positive impact of process management on both quality outcomes. Third, a post hoc analysis suggests that a specific type of hospital leadership, namely, patient-centered leadership, helps mitigate the negative association between process management and experiential quality. Finally, our research provides preliminary evidence regarding the relationship between clinical quality and patient satisfaction contingent on experiential quality. Implications for theory and practice are discussed.

Hospitals are characterized by high levels of technical expertise as well as patient interactions. In an attempt to improve their performance along these dimensions, hospitals are making significant investments in health information technologies (HIT). However, the performance benefits from these investments are largely unknown. This study employs a portfolio approach to study HIT adoption using a large longitudinal panel data for 3615 US hospitals from 2007 to 2012. Insights from the Advanced Manufacturing Technology (AMT) and existing HIT literature are used to categorize 76 HITs into 3 distinct bundles based on their extent of patient centered integration, and the extent of caregiver interaction. We then examine how two key HIT bundles: Clinical HIT (defined as HIT systems primarily used for patient data collection, diagnosis and treatment) and Augmented Clinical HIT (defined as HIT systems primarily used for integrating patient information and augmenting decision making capability of caregivers) jointly impact cost and process quality outcomes. Cost is measured in terms of total hospital operating expenses per bed while process quality is assessed along two dimensions: conformance quality or the ability to adhere to technical standards and experiential quality or the ability to cater to preferences of the patient. Results suggest complementarities between Clinical and Augmented Clinical HIT with respect to process quality but not cost outcomes. A follow-up post-hoc analysis which divides Augmented Clinical HIT into Electronic Medical Record (EMR) and Non-EMR technologies offers additional explanation to the lack of association with cost. We discuss these implications to both theory and practice of HIT adoption.

a b s t r a c tThe new Design Science department at the Journal of Operations Management invites submissions using a design science research strategy for operations management (OM) issues. The objective of this strategy is to develop knowledge that can be used in a direct and specific way to design and implement actions, processes or systems aimed at achieving desired outcomes. This knowledge is developed by engaging with real-life OM problems or opportunities. Manuscripts submitted to this department will be evaluated on pragmatic validity and practical relevance. Because design science research (DSR) differs in some important aspects from other OM research strategies, this essay examines in some depth its challenges and possible solutions.

High technology organizations need to develop new products or processes that address the dual goals of exploration and exploitation. The competing viewpoints and the asymmetric nature of market returns associated with these goals in R&D projects can heighten stress levels among project team members and reduce their psychological safety. While current research calls for greater focus on task design for improving psychological safety, we know little about how team contextual factors affect this relationship. This study develops and tests a conceptual framework that examines the moderating role of R&D team contextual factors, namely, relative exploration and project‐organization metric alignment on the relationship between a key task design variable, namely, team autonomy, and psychological safety. Relative exploration captures the extent to which exploration goals are emphasized over exploitation goals in an R&D project, while project‐organization metric alignment measures the extent to which project metrics are aligned with broader organizational metrics. Furthermore, we examine the performance consequences of psychological safety in R&D projects. The empirical analysis is conducted using primary data collected from multiple informants across 110 R&D projects in 34 high technology business units. Our results indicate that relative exploration and project‐organization metric alignment have contrasting moderating effects. Furthermore, the effect of psychological safety on project performance is found to be indirect and mediated through team turnover. Implications of the study findings, limitations, and directions for future research are discussed.

R ecent changes to health care reimbursements policy mandate hospitals to improve simultaneously on conformance and experiential quality. Conformance quality measures the level of caregivers' adherence to evidence-based standards of care while experiential quality measures the level of interaction between caregivers and patients. Hospitals operate in regulated environments characterized by heavy top-down control mechanisms that are conducible for improving conformance quality. However, mechanisms that propel experiential quality, which emerges from the operational-level interactions between caregivers and patients, remain unclear. This study employs a two-phase multi-method research to investigate this issue. The first phase uses qualitative data from five U.S. acute care hospitals involving 49 semi-structured interviews and develops hypotheses on the effect of bottom-up and top-down decision processes on hospitals' ability to simultaneously improve on conformance and experiential quality. These hypotheses are then tested and refined using secondary data for a sample of 3,124 U.S. acute care hospitals between the years of 2006 and 2012. Results from the case analyses suggest that Magnet status, a sign of bottom-up decision processes, is associated with hospitals' ability to improve on both conformance and experiential quality. However, hospitals' administrative intensity, which relates to top-down decision processes, appears to mitigate the effect of Magnet status on simultaneous improvement. Testing this framework using large-scale secondary data supports the positive effect of Magnet status on simultaneous improvement. However, we do not find support for a negative moderating effect of administrative intensity. A follow-up analysis reveals that this moderation is in fact curvilinear (inverted U-shape), which indicates that a moderate level of administrative intensity is most beneficial to the relationship between Magnet status and simultaneous improvement. Taken together, our results provide new insights into the complementary between top-down and bottom-up decision processes in hospitals.