Triadic relationships in healthcare

One of the most important goals in healthcare today is reducing costs while maintaining high-quality care. This article focuses on a triadic relationship that is responsible for a significant amount of nonlabor spending in hospitals: physician preference items. The triadic relationship among salespeople, physicians, and hospitals’ supply managers has a direct influence on costs. Regarding some key purchases, the physician-salesperson relationship is closer than the physician-supply manager relationship—even though the latter two entities work for and within the same company and strive for the same mission. This reality creates a type of conflict that is perplexing to solve and costly to ignore. To better understand the sources of friction and opportunities for collaboration in this triad, personnel across hospitals, suppliers, and healthcare consortiums were interviewed. Herein, we introduce strategies to help resolve the conflict. It is essential that hospital supply managers continually negotiate for best solutions that consider both long-run costs and quality of patient care. Yet, salesperson motivations and close salesperson-physician relationships place barriers that prevent negotiations more common to other areas of spending. The strategies offered in this article highlight ways to mute negative and amplify positive effects of the physician-salesperson relationship.     

Performance impacts of interorganizational cooperation: a transaction cost perspective

This study builds on the transaction cost theory to examine the performance effects of interorganizational cooperation and develops an understanding of how different forms of cooperative relationships affect organizational performance within a major service sector, namely the healthcare industry. The authors study, in particular, two cooperative forms applied to hospitals: hospital-based health networks and health systems. An empirical investigation of 382 hospitals in Taiwan shows that interorganizational cooperation exerts positive effects on hospital performance. In addition, health systems have greater positive effects on hospital efficiency than health networks. Furthermore, this study finds that the positive impact of participation in health systems is especially significant for private hospitals, local community hospitals, and hospitals in highly competitive regions. The findings reveal that performance impacts of interorganizational cooperation are contingent on the cooperative arrangements in the healthcare industry.     

Interorganizational relationships and hospital financial performance: a resource-based perspective

This study follows a resource-based theory perspective and aims to analyze the interorganizational relationships between hospitals and outpatient physicians, and hospital financial performance. In the light of increasing interdependence among healthcare providers which has made the coordination of service provision more complex, such relationships could be considered a resource for hospitals that lead to higher performance. In this study, the results from a survey of medical directors were combined with financial performance indicators of their hospitals. The results show that having effective interorganizational relationships is positively associated with the hospital's profitability. This finding emphasizes the importance of an investment in interorganizational relationships from the hospital's point of view.     

Enhancing value creation of device vendors in the medical service industry: a relationship perspective

Around the world, hospitals receiving government funding and insurance payments are under increasing pressure to cut costs. Based on the literature in relationship value and transaction cost economics, long-term relationships between suppliers and customers can be beneficial to cost reduction and value creation. This study explores the value of long-term relationships between medical device vendors and hospitals from the hospital perspective. In-depth interviews were conducted employing a grounded theory approach. The results show that in addition to product benefits/costs and supportive services, vendor reputation and sales personnel specificity are most influential towards the value of their long-term relationships.     

The effects of strategic hospital alliances on hospital efficiency

This study examines the effects of strategic alliances on the efficiency of hospitals controlled by the Department of Health in Taiwan. Overall, it is found that the efficiency of the hospitals improved after they formed strategic hospital alliances (SHAs). The results also indicate that smaller hospitals located in competitive areas are more efficient, as exemplified by shorter patient stays, higher occupancy rates, and lower mortality rates. Based on Taiwan's experience, it is inferred that SHAs do improve the performance of the participating hospitals. It is hoped that the results of this study will encourage health policy officials and healthcare organizations in other countries to consider implementing similar strategies for their hospitals.     

Impact of operational innovations on customer loyalty in the healthcare sector

This study investigates the effects of operational innovations, such as application of advanced information technology (IT) systems and supported knowledge and skills (SKSs), on care quality and customer loyalty in the healthcare industry. A research model is proposed based on previous studies and examined the relationships among the constructs using the structural equation modeling approach. Research data were collected through a survey of patients and employees of participating hospitals in Korea, with a patient and an employee as one set. The results of the study indicate that operational innovations result in improved customer closeness, which is associated with IT systems usage and SKSs for delivery of quality care, which have a positive impact on patient satisfaction and customer loyalty. Thus, hospital managers should encourage employees to generate new ideas for work efficiency, care quality, customer loyalty, and organizational performance.     

我国公立医院审计委员会制度构想

在建立以理事会为核心的公立医院法人治理改革框架下, 加强医疗卫生综合监督体系的顶层设计至关重要. 本文因循国外医疗机构审计委员会近40年的治理现实和我国上市公司引入审计委员会制度10多年的成功经验, 提出应在公立医院试行并推广审计委员会制度的设想. 论文构建了一个新医改前后公立医院审计供需均衡的基本经济学模型, 据此进一步分析了我国公立医院设立审计委员会的现实需求和可行供给, 并就我国公立医院施行审计委员会制度提出了相关建议.     

Hospital Positioning and Integrated Hospital Marketing Communications: State-of-the-Art Review,Conceptual Framework,and Research Agenda

In the light of patient empowerment and channel fragmentation, hospitals struggle to target patients in their new role as active, knowledgeable consumers. As market differentiation via traditional marketing mix variables such as price is hardly achievable in healthcare, superior communication grounded on sound positioning is a more promising lever for competitive advantage. Yet, research on marketing-driven communication from provider to patient lacks synthesis and critical reflection. Drawing upon evidence from previous research, this article unites 62 articles from medical and social sciences covering aspects of hospital marketing communications. Derived from qualitative content analysis, findings on the effectiveness of specific communication channels and contents are portrayed. This article further uncovers the characteristics of four evolving archetypes for hospital positioning and illustrates the implementation of integrated hospital marketing communication strategy. The elaborated conceptual framework can be used as a managerial tool for tailoring hospital communications. The article closes by highlighting future research directives.     

医院营销的现状与发展对策

医院营销是医院改革和发展的重要组成部分,是提高医院声誉,扩大医院业务的重要途径,是保持医院“两个效益”的重要环节,是在市场经济条件下医院求生存、求发展的重要手段。因此,必须高度重视医院营销,建立具有高素质的专业营销队伍,确立适合医院发展的营销战略,把医院营销推向一个崭新的阶段。     

The Impact of Relational Supplier Exchange on Financial Performance: A Study of the Hospital Sector

In the hospital context, when responsiveness is high, relational exchange with suppliers associates with better financial performance. But when a hospital’s responsiveness is low, relational exchange has no effect on performance—the hospital’s inability to adopt “things that are new” and extirpate “things that are old” eclipses the potential financial benefits of long‐term, relational exchange with suppliers. Furthermore, the quality orientation of the hospital and supplier uncertainty associate with relational supplier exchange—these effects are not moderated by hospital responsiveness. The net effect is that a quality orientation in a hospital impacts financial performance only when hospital responsiveness is high.     

A Case Study to Determine the Impact of Offering Selective Menus on Customer Satisfaction in a Health-Care Foodservice Operation

Abstract

In an effort to improve patients' satisfaction with healthcare foodservice, many hospitals are implementing a selective menu program. The purpose of this study was to identify the impact of a selective menu program on customer satisfaction in a health-care foodservice setting in Korea. The results of this study indicate that patients' perceptions of food and service dimensions are significant predictors of overall satisfaction with hospital foodservices. Patients who opted for a selective menu program at high levels of frequency showed more satisfaction with the selective menu program than those in the low-user group. “Food variety,” “taste,” and “offering nutritional information about menu items” are the key drivers of overall satisfaction.     

An application of health-portals to improve electronic listening

Electronic listening (eListening) is an innovation that potentially provides patients and other users with the right answer in the right place at the right time. Thus, eListening can potentially improve service flexibility, adaptability and quality. The main purpose of this paper is to investigate the extent to which new web-based service delivery channels, which we refer to as health-portals (he-portals), facilitate eListening in the Spanish public healthcare sector. In this paper, we investigate the relative importance and significance of hospital size and three different types of information and communications technologies (Internet, groupware and collective systems) on the use of eListening through an empirical investigation of 300 Spanish public he-portals. Our main conclusion is that the implementation of Internet systems alone does not guarantee the development of effective eListening. In addition, we demonstrate that hospital size does not affect the level of eListening achieved by hospitals.     

基于DEA的汽车行业供应商权变选择方法研究

从汽车制造企业的实际情况出发,以汽车制造整车厂的角度研究供应商选择问题,根据对汽车零部件供应商的不同需求和战略定位差异,来对零部件供应商进行细分,从输入、自身情况、输出、合作情况四个方面综合考虑供应商的各项指标,在此基础上应用权变选择的思想,建立各自多层次指标评价体系,并且建立基于DEA-C2WH模型的多层次指标选择方法进行评估。     

Organizational Misbehavior and Management Control in China’s Public Hospitals: Doctors’ Red Packets

This paper investigates Chinese doctors’ informal payment, known as red packets, with reference to the debate on organizational misbehavior, fiddles and control. It aims to examine the internal and external factors that have contributed to the emergence of red packets in health services and the strategies of hospital management in dealing with informal payment. Analysis on the data collected from two hospitals shows that doctors’ misbehavior is influenced by health services’ funding mechanism, payment systems and corruption. More importantly, the study demonstrates the rationality of employee fiddles and management responses. Findings indicate that doctors are mainly responsible for this fiddling, unethical and illegal activity because of the financial gains acquired from patient bribery. However, doctor misbehavior remains under management’s latent control as long as hospital income generation and reputation are not severely threatened. The study contributes to the analysis of informal payment in the field of organizational studies and employment relations, with a fresh perspective offered to extend our understanding of red packets in the context of healthcare marketization reform.     

Average out-of-pocket healthcare and work-loss costs of traffic injuries in Karachi, Pakistan

The objective of this study was to assess the average out-of-pocket healthcare and work-loss costs of road traffic injuries (RTI) in Karachi. In this cross-sectional study, RTI patients presenting to the five trauma centres in Karachi were contacted using stratified sampling to report their inpatient and outpatient expenses, the time spent in hospital and their average monthly income. These costs were compared among different categories of patient-related variables using analysis of variance test. Out of 341 RTI victims, two wheelers accounted for the majority of injuries (77.2%, N?=?256) followed by pedestrians (14.2%, N?=?48). Almost half of the sample patients were breadwinners (N?=?135, 45.2%), with 87.4% (N?=?118) earning less than US$ 248. Average out-of-pocket healthcare costs were US$ 271 (SD?=?440.9), which were significantly higher (P ≤ 0.026) for pedestrians (US$ 442), moderate (US$ 341.7) or severe (US$ 553.8) injury, and treatment in private hospitals (US$ 451.7). Similarly, average work loss was US$ 67.1 (SD?=?132.1), which were significantly higher (P?=?0.001) for breadwinners (US$ 99.1), moderate (US$ 130.0) or severe (US$ 157.1) injury, and treatment in private hospitals (US$ 150.0). Study results clearly showed the need to advocate RTI prevention measures in Pakistan as any such event could lead to a difficult economic situation for those involved and their family.     

Coping with national health insurance: Strategic behaviours of Taiwan’s hospitals

The primary goals of this study are to profile the strategic behaviours of Taiwan’s hospitals under the National Health Insurance programme, identify the related factors for such behaviours, and assess the influences of hospitals’ strategic behaviours on their performance. Findings indicate that the most prevalent strategy adopted by hospitals is strategic alliance. The results demonstrate that hospital level is a predictor of strategies employed by hospitals. Furthermore, findings also reveal that although the most embraced strategy by hospitals is strategic alliance, hospital executives perceive that the strategies of focus and differentiation are the ones that exert significantly positive influences on hospital performance.     

Trends in rural healthcare delivery in the United States, 1990-1999

This article describes the results of a literature search of pertinent professional literature written on issues important to rural healthcare delivery in the United States. The purpose of the literature review was to provide journal articles to practicing rural healthcare leaders who, because of time and economic constraints, claimed they were unable to research their own relevant journal articles. The authoring team is composed of individuals who work as full-time faculty members at institutions that offer courses in health administration. Because the nature of their professional work and research dictates that they focus on areas of rural health, the authoring team offered to share their findings with rural administrators as a means to assist them. The intent was to form a working collaboration between health services management professionals in academia, representatives of the state's healthcare organizational affiliate associations, and professionals practicing in the industry. This ten-year collaboration resulted in a unique wedding of resources that helped both in the delivery of rural healthcare services in a western state and in the advancement of the field of health services administration through original research. Thus, the product of this literature search is a comprehensive study of the trends in rural healthcare delivery. The variety of topics discussed were gleaned from over 500 articles found in and summarized from 70 professional healthcare journals published between 1990 and 1999.     

On the internationalization of Turkish hospital chains: A dynamic capabilities perspective

How do professional service firms build the capabilities required for effective international operations? Although the internationalization of manufacturing firms is a widely studied topic, the literature on the internationalization of service firms remains scant. The problem is even more acute when it comes to studies of professional services such as healthcare organizations and hospitals. Yet, we encounter remarkable examples of international market expansion by professional service firms. In this paper, we report on a study of large privately-owned hospital operators from the emerging economy of Turkey, based on in-depth interviews with senior executives. Taking advantage of Turkey’s strategic location in the region, these firms have shown extraordinary entrepreneurial initiative expanding their operations beyond the home market over the past two decades. Even more impressive is the creative strategies these firms have been deploying in terms of market entry modes. These range from medical tourism to setting up diagnostic clinics abroad, operating full-service hospitals in key markets, management contracts, and attracting equity capital from international investment firms. We draw from the theory of dynamic capabilities in order to explain the success these firms have had in cultivating international market opportunities. We contend that it takes a variety of organizational capabilities for traditionally domestic-market focused firms to expand into international markets. We provide an integrative discussion and offer implications for advancing knowledge and managerial practice.     

Hospital demand for physicians

This article develops a derived demand for physicians that is general enough to encompass physician control, simple profit maximization and hospital utility maximization models of the hospital. The analysis focuses on three special aspects of physician affiliations: the price of adding a physician to the staff is unobserved; the physician holds appointments at multiple hospitals, and physicians are not homogeneous. Using 1983 American Hospital Association data, a system of specialty-specific demand equations is estimated. The results are consistent with the model and suggest that physicians should be concerned about reduced access to hospitals, particularly as the stock of hospitals declines.     

Reconstituting lean in healthcare: From waste elimination toward ‘queue-less’ patient-focused care

With ultra-short sightlines to its patient-customers, healthcare should pursue lean in its own way rather than follow the often wayward lean practices of manufacturing, a sector in which few people ever see real customers. Because of the distance in manufacturing from end customers, this sector’s lean practices usually focus inward on operational efficiency through waste elimination. The nature of healthcare—with customers up close and immediate—calls for elevating its lean efforts toward customer-focused lean effectiveness: flexibly quick response along the multiple flow paths leading to and involving patients. This article illustrates that approach to lean by drawing from a case study in which widely scattered heart attack patients were transported to a central treatment hospital in a system-wide, highly coordinated program of quick response. This article shows that the keys to success—including high rates of saving lives and lean healthcare in general—boil down to just five lean methodologies, each focused on quick response. Lean healthcare, when practiced in this way, becomes deserving of status as a fixture in strategic management of the enterprise.