Process Management Impact on Clinical and Experiential Quality: Managing Tensions Between Safe and Patient-Centered Healthcare

Abstract

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.

OM Forum—Causal Inference Models in Operations Management

“…They all use IV estimation to investigate the causal effects of hospital focus, discharge strategies, and admission policies. Other studies include those by Theokary and Ren (2011), who investigate whether hospital volume and teaching status affect service quality, and Chandrasekaran et al (2012), who use a random-effects regression to examine how process management affects the quality of hospital stays. Appendix Table A3) In the area of services management, the main topics that have been empirically examined are (a) the causal relationship between customer satisfaction and various operational metrics and (b) the effects of introducing self-service technology and e-services.…”

Value-Based Purchasing, Efficiency, and Hospital Performance

“…11,12 However, the findings appear to contradict other studies that found that higher hospital spending is related to lower mortality, lower readmissions, and lower cardiac event rates. 21 Larger hospitals may likely have more resources to invest and implement clinically proven process measures as well as to hardwire process of care bundles. Therefore, hospitals should analyze their current clinical process of care measures with proven measures and their clinical process ''bundles.''…”

Building the Case for Quality Improvement in the Health Care Industry

“…27 Physicians, in particular, are more likely to embrace clinical process or outcome improvement efforts rather than ones focused on efficiency gains only. However, setting projectlevel goals in health care can be challenging from a motivational perspective, because of what can appear to be the tradeoff between patient-centered outcomes and cost.…”

“…27,29 Clinical performance refers to the patient medical outcomes, such as mortality, readmission rates, and receipt of recommended treatment protocols. 27,29 Clinical performance refers to the patient medical outcomes, such as mortality, readmission rates, and receipt of recommended treatment protocols.…”