Examining Public Hospital Service Failure: The Influence of Service Failure Type,Service Expectations,and Attribution on Consumer Response

This study investigates three independent variables; types of service failure, service expectations, and attribution on postfailure responses in healthcare. A between-subjects 3?×?2?×?2 experimental design using written scenarios was used. The findings demonstrate that customer responses to service failures in hospitals are extensively influenced by the type of service failure, the level of service expectation of the provider, and, to a lesser extent, the controllability of the cause of the failure. Core service failures lead to greater increases in negative responses for satisfaction, emotional, and behavioral responses than supplementary service failure with high service expectations protecting the provider against overall dissatisfaction, negative word-of-mouth, and switching behaviors. Interestingly, perceived high controllability leads to greater dissatisfaction but not to increased negative emotional or behavioral responses. The study applies attribution theory to explain the results. The article concludes with managerial implications.     

A New Internet Driven Internationalisation Framework

This paper aims to offer a new Internet driven theoretical framework that explains how a successful internationalisation process may be developed and identifies the strategic dimensions that influence the key decisions in an interrelated, performance-associated way. The extant literature is examined in international marketing, international entrepreneurship and Internet marketing and a comprehensive strategic analysis is conducted of a successful individual services business: ING Direct. It is shown how strategic constructs and risk constructs drive the internationalisation process in an interrelated and performance-associated way. In the framework, the firm's target is to take advantage of an opportunity by obtaining a sustainable competitive advantage while attenuating international risk. Entry mode and country selection are strategic decisions interrelated mutually and with other strategic choices and with performance; this is why an analysis with ceteris paribus statements or episodic analysis may lead to the wrong conclusions.     

A conceptual framework to analyse hospital competitiveness

This article proposes a conceptual framework to analyse hospital competitiveness at the organisational level. Hospital competitiveness, defined as the capacity a hospital has to develop a superior performance that leads it to a position of competitive advantage, may be analysed in three dimensions: organisation, strategic behaviour, and performance. Based on previous studies and on the current structural adjustment in the Portuguese public hospital sector, this article suggests the following categories: legal status, organisational complexity, and resources for the organisation dimension; stakeholders, services and inter-organisational relationships for the strategic behaviour dimension; and type of indicators, efficiency and effectiveness, and benchmarking for the performance dimension. This framework seems to be particularly useful in evaluating Portuguese hospital competitiveness and providing insights for hospitals' managers and public decision makers both from Portugal and other countries.     

Healthier for whom? Technological service improvement in the healthcare industry

This study tackles the dilemma of a technology-based service improvement wherein an organization performs a technology change to improve its service process, while its customers do not necessarily perceive the new service as an improvement. The empirical research follows a healthcare provider that changed its primary care provider appointment scheduling using a new call centre technology. The methodology involves three processes reflecting the entire change: personal interviews, focus groups, and surveys. To facilitate adoption of a technology-based service, it is recommended that there be a focus on customers’ experience with similar service industries’ image, and organizational policies on contracting service representatives.     

Measuring the Perceived Quality of Professional Business Services

Professional firms serving business clients are recognizing the need for improved quality services. Unfortunately, measures of professional service quality have proven difficult to develop. This paper reports on the use of SERVQUAL, an instrument commonly used to assess consumer perceptions of service quality. This instrument was employed with a sample of business owners who were asked to rate the quality of service received from their accounting firm. Although several dimensions of the scale proved useful, additional quality related factors emerged from the analysis.     

中国农业居民医疗保险需求及其影响因素分析

本文基于2006年的微观横截面数据,运用似不相关二维probit模型与工具变量,分析了我国农业居民医疗保险需求及其影响因素,并着重考察了新型农村合作医疗保险与商业医疗保险之间的关系。研究的主要结论:一是参加新型农村合作医疗对乡村农业居民购买商业医疗保险有较显著的刺激作用;二是教育水平、年龄、居住省份、职业对乡村农业居民是否参加新型农村合作医疗有显著影响;职业、家庭规模和地区经济发展水平对乡村农业居民是否购买商业医疗保险有显著影响;三是在乡村农业居民是否参加新型农村合作医疗的决策中观测到逆向选择的行为。     

Regulatory incentives and financial reporting quality in public healthcare organisations

English National Health Service Foundation Trusts are subject to a regulatory regime in which the level of monitoring and intervention is determined by performance against two key performance metrics: a ‘financial risk rating’, based on a number of performance metrics, such as the reported surplus margin and return on assets, and a ‘prudential borrowing limit’. In this paper, we investigate the variation in financial reporting quality, proxied by discretionary accruals, with the incentives introduced by this regime. We find: first, that discretionary accruals are managed to report small surpluses; second, that, consistent with the avoidance of regulatory intervention in both the short and medium term, discretionary accruals are more positive when pre-managed performance is below intervention triggering thresholds and more negative when well above threshold; third, that, despite a move away from financial breakeven as the primary performance objective, there remains an aversion to small loss reporting. We further find that the level of discretionary accruals is driven by two metrics of strategic significance: the surplus margin (a measure of retained earnings) and the prudential borrowing limit (a measure of borrowing capacity).     

Healthcare resource utilization by patients with treatment-refractory myasthenia gravis in England

Aims: To examine healthcare resource utilization associated with refractory myasthenia gravis (MG) in England.

Materials and methods: This was a retrospective cohort study of linked data from the Clinical Practice Research Datalink and the Hospital Episode Statistics database collected between 1997 and 2016. Included patients were ≥18?years of age at the index MG diagnosis. Patients with refractory MG were identified using an algorithm based on treatments received. Healthcare resource utilization since the index date was compared between refractory and non-refractory cohorts.

Results: The study included 1149 patients with MG, of whom 66 (5.7%) were refractory. Sex and age at diagnosis did not significantly differ between the refractory and non-refractory cohorts. Rates of healthcare resource utilization per person-year were significantly higher (p?healthcare professionals, outpatient visits and inpatient hospitalization. Patients in the refractory cohort spent more total days hospitalized since the index visit than patients in the non-refractory cohort (median, 33 vs. 16?days [p?Limitations: The algorithm for identifying refractory patients did not include clinical criteria. Also, treatments administered in hospitals or by specialists were not available in the databases.

Conclusions: Patients in England with refractory MG more often visit healthcare providers, are hospitalized and visit an emergency room than patients with non-refractory MG.     

Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study

Aims: To assess incremental charges of patients experiencing venous thromboembolisms (VTE) across various types of elective inpatient surgical procedures with administration of general anesthesia in the US.

Methods: The authors performed a retrospective study utilizing data from a nationwide hospital operational records database from July 2014 through June 2015 to compare a group of inpatients experiencing a VTE event post-operatively to a propensity score matched group of inpatients who did not experience a VTE. Patients included in the analysis had a hospital admission for an elective inpatient surgical procedure with the use of general anesthesia. Procedures of the heart, brain, lungs, and obstetrical procedures were excluded, as these procedures often require a scheduled ICU stay post-operatively. Outcomes examined included VTE events during hospitalization, length of stay, unscheduled ICU transfers, number of days spent in the ICU if transferred, 3- and 30-day re-admissions, and total hospital charges incurred.

Results: The study included 17,727 patients undergoing elective inpatient surgical procedures. Of these, 36 patients who experienced a VTE event were matched to 108 patients who did not. VTE events occurred in 0.2% of the study population, with most events occurring for patients undergoing total knee replacement. VTE patients had a mean total hospital charge of $60,814 vs $48,325 for non-VTE patients, resulting in a mean incremental charge of $11,979 (p?<?.05). Compared to non-VTE patients, VTE patients had longer length of stay (5.9 days vs 3.7 days, p?<?.001), experienced a higher rate of 3-day re-admissions (3 vs 0 patients) and 30-day re-admissions (7 vs 2 patients).

Conclusions: Patients undergoing elective inpatient surgical procedures with general anesthesia who had a VTE event during their primary hospitalization had a significantly longer length of stay and significantly higher total hospital charges than comparable patients without a VTE event.