Essays in healthcare operations management : investigating the relationship between operational factors and healthcare outcomes

Abstract

My dissertation explores the relationship between operational factors and healthcare outcomes. The dissertation consists of three empirical research chapters. The first one studies family engagement. Family engagement is an ongoing partnership between health professionals and families to enhance healthcare quality, safety, and delivery. While family engagement is increasingly considered an essential component of patient-centered care, its importance in influencing healthcare delivery outcomes is unclear. This paper studies how family engagement acts as a moderator in the relationship between healthcare metrics such as length of stay and severity of illness and healthcare delivery outcomes such as patient satisfaction (subjective) and readmission (objective). We test these relationships using regressions after coarsened exact matching on 5,915 observations of patients in Korean acute care hospitals from 2011 through 2015. We find that family engagement relieves the negative relationships between severity of illness and patient satisfaction. In addition, family engagement alleviates the positive relationships both between length of stay & readmission and between severity of illness & readmission. In post-hoc analyses, we examine whether the benefits of family engagement are dependent on the type of family member engaged in the care delivery process and explore the empirical effects of a professional caregiver compared to family engagement. Overall, our study shows the importance of family engagement as an operational lever in influencing the relationship between difficult-to-change healthcare metrics and healthcare delivery outcomes.The second one is about the relationship between healthcare costs and patient satisfaction. Although both healthcare costs and patient satisfaction are important to hospital operations, the association between the two variables remains unclear. Using secondary data from Korean acute care hospitals from 2011 to 2015, we develop an integrated framework to understand the interrelationships between healthcare costs and patient satisfaction through mediators—perceptions of overtreatment and recovery. We discover that healthcare costs increase the perception of overtreatment, reducing patient satisfaction. Additionally, healthcare costs decrease the perception of recovery, which in turn lowers patient satisfaction. We also run mediated moderation models to test the moderation effects of severity of illness between healthcare costs, perceptions of overtreatment and recovery, and patient satisfaction. We learn that higher severity of illness causes healthcare costs to worsen patient satisfaction, and the negative mediation effect of perception of overtreatment is stronger when patients' health status is more severe. Our findings show that perceptions of overtreatment and recovery as well as severity of illness are critical elements in the relationship between healthcare costs and patient satisfaction. These findings have meaningful theoretical and managerial implications. The last one is regarding multihospital systems. We document how healthcare organizational focus (physicians and nurses) could affect the quality of care and efficiency depending on the influence of the multihospital system. In other words, if hospitals invest in their physicians and nurses more, they might expect performance improvements. Our research examines this relationship and how it is affected by the impact of multihospital systems. We collected cardiology services datasets across hospital service areas in California acute care hospitals from 2011 through 2014 and conducted panel data analyses to alleviate endogeneity concerns. We discovered that higher multihospital systems could ease the positive relationship between physician integration and patient care cost ratio, while for nurse integration, higher multihospital systems could relieve the relationship with net revenue ratio. Furthermore, lower multihospital systems could improve conformance quality and readmission rate only in the case of nurse integration. The moderation effects of multihospital systems are still unclear and are needed to investigate more from both theoretical and managerial perspectives.