Investigating The Role Of Internal Hospital Factors And The External Environment On Healthcare Quality Outcomes And Patient Choice

The healthcare landscape has been changing rapidly with changes in the reimbursement system, financial incentives for using information technologies, pay for performance programs for quality improvements and increased demand for hospital services from millions of newly insured patients. Understanding the impact of these policy changes in an operations management context has been an understudied area. We contribute to the literature by incorporating research streams from healthcare, economics, marketing and quality management. This dissertation consists of three studies. The first study examines the impact of the mandated use of electronic health records, and finds that such records not only improve the efficiency with which hospitals treat patients, but also that the benefits are higher for patients with greater disease, comorbidity, and coordination complexities. The second study examines the role of process improvement factors in improving processes of care. We find that that operational slack, nursing skill mix and focused strategy improve the quality of care in both more and less competitive markets, with the greatest benefits accruing in less competitive markets. Finally, the third study examines the role of infrastructural and structural investments, patient satisfaction, and hospital reputation generated by third parties in influencing patient demand for hospitals for elective surgeries. Patient choice based on hospital attributes is heterogeneous in nature, and depends on the complexity of comorbidities and type of surgery. Collectively our three studies provide inputs to hospital managers on how to best manage their scarce financial resources in the new pay for performance health care environment