Role of Bottom‐Up Decision Processes in Improving the Quality of Health Care Delivery: A Contingency Perspective

Abstract

Recent 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.

Keywords

conformance and experiential quality Magnet status administrative intensity bottom‐up and top‐down decision processes contingency theory

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References

Abernethy

M. A.

Lillis

A. M.

. 1995. The impact of manufacturing flexibility on management control system design. Account. Organ. Soc. 20(4): 241–258.

Abraham

Jerome‐D'Emilia

, and Begun

J. W.

. 2011. The diffusion of Magnet hospital recognition. Health Care Manag. Rev. 36(4): 306–314.

Adler

P. S.

Borys

. 1996. Two types of bureaucracy: Enabling and coercive. Admin. Sci. Q. 41(1): 61–89.

Adler

P. S.

Goldoftas

Levine

D. I.

. 1999. Flexibility versus efficiency? A case study of model changeovers in the Toyota production system. Organ. Sci. 10(1): 43–68.

Aiken

L. S.

West

S. G.

. 1991. Multiple Regression: Testing and Interpreting Interactions. Sage Publications, Inc, Thousand Oaks, CA.

American Hospital Association . 2001. Patients Or Paperwork?: The Regulatory Burden Facing America's Hospitals. Available at www.aha.org (accessed date February 10, 2015).

Avolio

B. J.

Zhu

Koh

Bhatia

. 2004. Transformational leadership and organizational commitment: Mediating role of psychological empowerment and moderating role of structural distance. J. Organ. Behav. 25(8): 951–968.

Blau

P. M.

Schoenherr

R. A.

. 1971. The Structure of Organisations. Basic Books, New York.

Boulding

Glickman

S. W.

Manary

M. P.

Schulman

K. A.

Staelin

. 2011. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am. J. Manag. Care 17(1): 41–48.

10.

Bower

J. L.

1974. Planning and control ‐ bottom up or top down? J. Gen. Manag. 1(3): 20–31.

11.

Burgelman

R. A.

2002. Strategy as vector and the inertia of coevolutionary lock‐in. Admin. Sci. Q. 47(2): 325–357.

12.

Burns

Stalker

G. M.

. 1961. The Management of Innovations. Tavistock Publications, London.

13.

Carling

Fung

Killion

Terrin

Barza

. 2003. Favorable impact of a multidisciplinary antibiotic management program conducted during seven years. Infect. Control Hosp. Epidemiol. 24(9): 699–706.

14.

Chandrasekaran

Senot

Boyer

K. K.

. 2012. Process management impact on clinical and experiential quality: Managing tensions between safe and patient‐centered health care. Manuf. Serv. Oper. Manag. 14(4): 548–566.

15.

Cheng

T. C. E.

Choi

T.‐M.

Zhao

. 2012. Call for papers: Special issue of Production and Operations Management – multi‐methodological research in production and operations management. Prod. Oper. Manag. 21(6): 1119.

16.

Child

1973. Predicting and understanding organization structure. Admin. Sci. Q. 18(2): 168–185.

17.

Cosgrove

. 2014. The Cleveland Clinic Way: Lessons in Excellence from One of the World's Leading Health Care Organizations. McGraw‐Hill, McGraw‐Hill Education, New York, NY.

18.

Damanpour

1987. The adoption of technological, administrative, and ancillary innovations: Impact of organizational factors. J. Manag. 13(4): 675–688.

19.

Donabedian

1988. The quality of care. JAMA 260(12): 1743–1748.

20.

Friese

C. R.

2005. Nurse practice environments and outcomes: Implications for oncology nursing. Oncol. Nurs. Forum 32(4): 765–772.

21.

Gibson

C. B.

Birkinshaw

. 2004. The antecedents, consequences, and mediating role of organizational ambidexterity. Acad. Manag. J. 47(2): 209–226.

22.

Glaser

Strauss

. 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine Transaction, Chicago, IL.

23.

Gupta

A. K.

Smith

K. G.

Shalley

C. E.

. 2006. The interplay between exploration and exploitation. Acad. Manag. J. 49(4): 693–706.

24.

Hagle

T. M.

Mitchell

G. E.

. 1992. Goodness‐of‐fit measures for probit and logit. Am. J. Politi. Sci. 36(3): 762–784.

25.

Hair

J. F.

Black

W. C.

Babin

B. J.

Anderson

R. E.

. 2010. Multivariate Data Analysis. Prentice‐Hall, Upper Saddle River, NJ.

26.

Hayes

Pisano

Upton

Wheelwright

S. C.

. 2004. Operations, Strategy and Technology: Pursuing the Competitive Advantage. John Wiley & Sons, Inc., Hoboken, NJ.

27.

Hosmer

D. W.

Jr , and Lemeshow

. 2004. Applied Logistic Regression. John Wiley & Sons, Wiley and Sons, Inc., Hoboken, NJ.

28.

Hutchison‐Krupat

Kavadias

. 2015. Strategic resource allocation: Top‐down, bottom‐up, and the value of strategic buckets. Manage. Sci. 61(2): 391–412.

29.

Inkpen

A. C.

Tsang

E. W. K.

. 2005. Social capital, networks, and knowledge transfer. Acad. Manag. Rev. 30(1): 146–165.

30.

Jansen

J. J. P.

Tempelaar

M. P.

Van denBosch

F. A. J.

Volberda

H. W.

. 2009. Structural differentiation and ambidexterity: The mediating role of integration mechanisms. Organ. Sci. 20(4): 797–811.

31.

Jha

A. K.

Orav

E. J.

Dobson

Book

R. A.

Epstein

A. M.

. 2009. Measuring efficiency: The association of hospital costs and quality of care. Health Aff. 28(3): 897–906.

32.

Keizers

J. M.

Bertrand

Wessels

. 2003. Diagnosing order planning performance at a navy maintenance and repair organization, using logistic regression. Prod. Oper. Manag. 12(4): 445–463.

33.

Kelly

L. A.

McHugh

M. D.

Aiken

L. H.

. 2011. Nurse outcomes in Magnet^® and Non‐Magnet Hospitals. J. Nurs. Adm. 41(10): 428–433.

34.

Langley

1999. Strategies for theorizing from process data. Acad. Manag. Rev. 24(4): 691–710.

35.

March

J. G.

1991. Exploration and exploitation in organizational learning. Organ. Sci. 2(1): 71–87.

36.

March

J. G.

Simon

H. A.

. 1958. Organizations. Wiley, New York.

37.

McClure

M. L.

2005. Magnet Hospitals: Insights and issues. Nurs. Admin. Q. 29(3): 198–201.

38.

McFadden

1974. Conditional logit analysis of qualitative choice behaviour. Zarembka

, ed. Frontiers in Econometrics. Academic Press, New York, 105–142.

39.

Mintzberg

1979. The Structuring of Organizations. Prentice‐Hall, Englewood Cliffs.

40.

Nair

Nicolae

Narasimhan

. 2013. Examining the impact of clinical quality and clinical flexibility on cardiology unit performance—Does experiential quality act as a specialized complementary asset? J. Oper. Manag. 31(7): 505–522.

41.

Narayanan

Swaminathan

J. M.

Talluri

. 2014. Knowledge Diversity, Turnover, and Organizational‐Unit Productivity: An Empirical Analysis in a Knowledge‐Intensive Context. Prod. Oper. Manag. 23(8): 1332–1351.

42.

Nembhard

I. M.

Edmondson

A. C.

. 2006. Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. J. Organ. Behav. 27(7): 941–966.

43.

Nembhard

I. M.

Alexander

J. A.

Hoff

T. J.

Ramanujam

. 2009. Why does the quality of health care continue to lag? Insights from management research. Acad. Manag. Perspect. 23(1): 24–42.

44.

O'Reilly

C. A.

Tushman

M. L.

. 2004. The ambidextrous organization. Harv. Bus. Rev. 82(4): 74–83.

45.

Pronovost

P. J.

Vohr

. 2010. Safe Patients, Smart Hospitals. How One Doctor's Checklist Can Help Us Change Health Care From the Inside Out. Hudson Street Press, New York, NY.

46.

Senot

Chandrasekaran

Ward

P.T.

Tucker

A.L.

Moffatt‐Bruce

S. D.

. 2015. The impact of combining conformance and experiential quality on hospitals' readmissions and cost performance. Manage. Sci., doi: 10.1287/mnsc.2014.2141 Forthcoming.

47.

Shortell

S. M.

Gillies

R. R.

Devers

K. J.

. 1995. Reinventing the American hospital. The Milbank Quarterly 73(2): 131–160.

48.

Singhal

. 2012a. Imperatives of the science of operations and supply‐chain management. J. Oper. Manag. 30(3): 237–244.

49.

Singhal

. 2012b. Opportunities for developing the science of operations and supply‐chain management. J. Oper. Manag. 30(3): 245–252.

50.

Sloan

F. A.

Picone

G. A.

Taylor

D. H.

Chou

S. Y.

. 2001. Hospital ownership and cost and quality of care: Is there a dime's worth of difference? J. Health Econ. 20(1): 1–21.

51.

Sodhi

M. S.

Tang

C. S.

. 2014. Guiding the next generation of doctoral students in operations management. Int. J. Prod. Econ. 150: 28–36.

52.

Staggs

V. S.

Dunton

. 2012. Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: An observational cross‐sectional study. Int. J. Nurs. Stud. 49(9): 1138–1145.

53.

Stene

E. O.

1940. An approach to a science of administration. Am. Politi. Sci. Rev. 34(6): 1124–1137.

54.

Suddaby

2006. From the editors: What grounded theory is not. Acad. Manag. J. 49(4): 633–642.

55.

Theokary

Ren

. 2011. An empirical study of the relations between hospital volume, teaching status, and service quality. Prod. Oper. Manag. 20(3): 303–318.

56.

Tucker

A. L.

Edmondson

A. C.

. 2003. Why hospitals don't learn from failures. Ca. Manag. Rev. 45(2): 55–72.

57.

Weiner

B. J.

Alexander

J. A.

Shortell

S. M.

Baker

L. C.

Becker

Geppert

J. J.

. 2006. Quality improvement implementation and hospital performance on quality indicators. Health Serv. Res. 41(2): 307–334.

58.

Whitley

1999. Firms, institutions and management control: The comparative analysis of coordination and control systems. Accoun. Organ. Soc. 24(5): 507–524.

59.

Woolhandler

Himmelstein

D. U.

Lewontin

J. P.

. 1993. Administrative costs in US hospitals. N. Engl. J. Med. 329(6): 400–403.

60.

Yin

R. K

. 1994. Case Study Research: Design and Methods. Sage Publications, Thousands Oaks, CA.

61.

Yin

R. K.

2003. Case Study Research: Design and Methods (3rd edn.). Sage Publications, Inc., Thousand Oaks, CA.