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Book part

Zo Ramamonjiarivelo, Larry Hearld, Josué Patien Epané, Luceta Mcroy and Robert Weech-Maldonado

Public hospitals have long been major players in the US health care delivery system. However, many public hospitals have privatized during the past few decades. The…

Abstract

Public hospitals have long been major players in the US health care delivery system. However, many public hospitals have privatized during the past few decades. The purpose of this chapter was to investigate the impact of public hospitals' privatization on community orientation (CO). This longitudinal study used a national sample of nonfederal acute-care public hospitals (1997–2010). Negative binomial regression models with hospital-level and year fixed effects were used to estimate the relationships. Our findings suggested that privatization was associated with a 14% increase in the number of CO activities, on average, compared with the number of CO activities prior to privatization. Public hospitals privatizing to for-profit status exhibited a 29% increase in the number of CO activities, relative to an insignificant 9% increase for public hospitals privatizing to not-for-profit status.

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Book part

Lawton R. Burns, Rajiv J. Shah, Frank A. Sloan and Adam C. Powell

Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In…

Abstract

Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In the past, investor-owned hospitals were long suspected of pursuing financial over other goals, culminating in several reviews that found few differences between for-profit and nonprofit forms (Gray, 1986; Sloan, 2000; Sloan, Picone, Taylor, & Chou, 2001). Nevertheless, continuing to the present day, several states prohibit investor-ownership of community hospitals. Conversions to investor-ownership are only one of six types of ownership change, however, with relatively less attention paid to the other types (e.g., for-profit to nonprofit, public to nonprofit). This study has two parts. We first review the literature on the various types of ownership conversion among community hospitals. This review includes the rate at which conversions occur over time, the relative frequency in conversions between specific ownership categories and the observed effects of conversion on hospital operations (e.g., strategic direction and decision-making processes) and performance (e.g., access, quality, and cost). Overall, we find that the impact of ownership conversion on the different measures is mixed, with slightly greater evidence for positive effects on hospital efficiency. As one explanation for these findings, we suggest that the impact of ownership conversion on hospital performance may be mediated by changes in the hospital's strategic content and process. Such a hypothesis has not been proposed or examined in the literature. To address this gap, we next study the role of strategic reorientation following hospital conversion in a field study. We conceptualize ownership conversion within a strategic adaptation framework, and then analyze the changes in strategy content and process across sixteen hospitals that have undergone ownership conversions from nonprofit to for-profit, public to for-profit, public to nonprofit, and for-profit to nonprofit. The field study findings delineate the strategic paths and processes implemented by new owners post-conversion. We find remarkable similarity in the content of strategies undertaken but differences in the process of strategic decision making associated with different types of ownership changes. We also find three main performance effects: hospitals change ownership for financial reasons, experience increases in revenues and capital investment post-conversion, and pursue labor force reductions post-conversion. Membership in a multi-hospital system, however, may be a major determinant of both strategy content and decision-making process that is confounded with ownership change. That is, ownership conversion may mask the impact of system membership on a hospital's strategic actions. These findings may explain the pattern of performance effects observed in the literature on ownership conversions.

Details

Biennial Review of Health Care Management: Meso Perspective
Type: Book
ISBN: 978-1-84855-673-7

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Article

Lior Naamati Schneider

This study aims to map perceptions and changes in public hospitals in response to competition with the private health system, describes solutions adopted by the public

Abstract

Purpose

This study aims to map perceptions and changes in public hospitals in response to competition with the private health system, describes solutions adopted by the public hospitals and considers their implications for the business and strategic management of those hospitals.

Design/methodology/approach

This paper opted for a qualitative study using the open-ended approach of grounded theory, including 40 in-depth interviews with key figures in the health system and administrators at various levels of management.

Findings

Public hospitals are constantly adopting changes because of state-mandated reforms and growing competition with private hospitals. Notable measures include making hospitals customer-oriented and adopting business-oriented behaviors and competitive and marketing strategies. However, because public hospitals are unable to institute radical changes, they typically introduce hybrid services (private services within public services) and other creative solutions such as business-funded research foundations operating alongside them.

Research limitations/implications

The main methodological limitation of this study was the difficulty in obtaining data because of the limited cooperation and lack of transparency of Israel’s health-care system. The interviewees expressed concerns that their department or hospital would appear in a negative light, especially as motivated solely by financial considerations. In anticipation of this difficulty, requests for participation were addressed individually and contained extensive detail regarding the study, the ethics committee’s approval, the data gathering and the strict maintenance of anonymity and confidentiality.

Originality/value

Adopting business-oriented behaviors in public hospitals is somewhat contrary to the principles of public medicine. Their adaptation to the market is partial, and their creative hybrid solutions require state regulation. The absence of controls leads to duplication and waste, causing various problems, including increased social inequality, costs and deficits.

Details

International Journal of Organizational Analysis, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1934-8835

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Article

Stephen Oduro, Kwamena Minta Nyarku and Rotimi A. Gbadeyan

Integrating the social exchange and resource dependency theories, the study aims to comparatively examine the supplier relationship management (SRM) dimensions and…

Abstract

Purpose

Integrating the social exchange and resource dependency theories, the study aims to comparatively examine the supplier relationship management (SRM) dimensions and organizational performance links of private and public hospitals in Ghana.

Design/methodology/approach

Comparative in nature; employing a quantitative approach; and using simple random and convenience sampling techniques, the study tested the proposed hypotheses using structural equation model-partial least square based on 205 usable questionnaires. Partial least square-multigroup analysis (PLS-MGA) was performed to test the significance of the difference in the parameters between the two samples: private and public hospitals in Ghana.

Findings

The dimensions of SRM (communication, cooperation, trust, atmosphere and adaptation) have a significant, positive impact on private hospitals’ performance in Ghana. Similarly, communication and trust were found to be positively and significantly correlated to public hospitals’ performance. In contrast, cooperation, atmosphere and adaptation dimensions showed no significant, positive effect on public hospitals’ performance. PLS-MGA disclosed that these observed differences in the findings between the private and public hospitals in Ghana are statistically significant.

Research limitations/implications

The findings of the study, while limited to hospitals in Ghana, are likely to be relevant in other emerging economies for effective and enhanced supply chain relationship management.

Practical implications

The findings provide pragmatic insights for marketing practitioners and organizational leaders of hospitals about the significance of SRM dimensions in today’s globalized marketplace, and how to nurture them to enhance organizational performance.

Originality/value

The value of the study lies in the examination of the relationship between SRM and organizational performance in the health sector by comparing private and public hospitals in an emerging economy context.

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Article

Andrew Munthopa Lipunga, Betchani M.H. Tchereni and Rhoda Cythia Bakuwa

The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide…

Abstract

Purpose

The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice.

Design/methodology/approach

The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature.

Findings

The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals.

Originality/value

The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.

Details

International Journal of Health Governance, vol. 24 no. 2
Type: Research Article
ISSN: 2059-4631

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Article

Asma Shabbir, Shahab Alam Malik and Saquib Yusaf Janjua

The purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of…

Abstract

Purpose

The purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.

Design/methodology/approach

The study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.

Findings

A cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.

Practical implications

The result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.

Originality/value

The study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

Details

International Journal of Quality & Reliability Management, vol. 34 no. 8
Type: Research Article
ISSN: 0265-671X

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Article

Julie Froud, Colin Haslam, Sukhdev Johal, Jean Shaoul and Karel Williams

Using the example of capital charging in UK hospitals, this paper shows how new public policy initiatives are justified through forms of persuasion without numbers and can…

Abstract

Using the example of capital charging in UK hospitals, this paper shows how new public policy initiatives are justified through forms of persuasion without numbers and can be challenged with empirics. A reading of official and academic texts shows how the official problem definition focuses on poor asset utilisation. Hospital accounts are then reworked to show that, although poor asset utilisation was never a major problem, the introduction of capital charges could disrupt service provision. The conclusion is that the operation of NHS hospitals should be understood in terms of distributive conflict, rather than inefficiency. Through practical demonstration, the authors of this article aim to encourage accounting researchers to use numbers to challenge public policy definitions.

Details

Accounting, Auditing & Accountability Journal, vol. 11 no. 1
Type: Research Article
ISSN: 0951-3574

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Article

Jayesh P. Aagja and Renuka Garg

The purpose of this paper is to develop a scale for measuring perceived service quality for public hospitals from the user's (patient's) perspective. The objective is to…

Abstract

Purpose

The purpose of this paper is to develop a scale for measuring perceived service quality for public hospitals from the user's (patient's) perspective. The objective is to measure perceived service quality of public hospitals.

Design/methodology/approach

Standard scale development research procedure recommended by experts was followed. First, literature review of studies to measure service quality was undertaken. Later, Delphi method (two iterations) was used. Interviews were conducted of experts and customers for understanding and generating items for perceived service quality for public hospitals. A survey was then undertaken first for development of the scale and later for validation purpose.

Findings

A reliable and valid scale called public hospital service quality (PubHosQual) is developed to measure the five dimensions of hospital service quality: admission, medical service, overall service, discharge process, and social responsibility.

Research limitations/implications

Since, this study was conducted in India only, the generalizability of the PubHosQual scale has to be tested in other countries.

Practical implications

The proposed scale PubHosQual in this study could be used as a diagnostic tool to identity areas where specific improvements are needed, and to pinpoint aspects of the hospital's services that require modification. The paper is an attempt to develop an instrument to incorporate the “voice of the customer.”

Originality/value

Most relevant studies about perceived service quality for public hospitals either do not have stable factor structure or are relying on generic SERVQUAL scale to measure service quality. The new scale fills the gap of absence of a validated scale to measure perceived service quality for public hospitals.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 4 no. 1
Type: Research Article
ISSN: 1750-6123

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Article

Rocio Rodriguez, Göran Svensson and David Eriksson

The purpose of this paper is to examine the logic and differentiators of organizational positioning and planning of sustainability initiatives between private and public

Abstract

Purpose

The purpose of this paper is to examine the logic and differentiators of organizational positioning and planning of sustainability initiatives between private and public organizations in the healthcare industry. Sustainability initiatives refer to organizations’ economic, social and environmental actions.

Design/methodology/approach

This study is based on an inductive approach judgmental sampling and in-depth interviews of executives at private and public hospitals in Spain have been used. Data were collected from the directors of communication at private hospitals, and from the executive in charge of corporate social responsibility in public hospitals. An empirical discourse analysis is used.

Findings

The positioning and planning of sustainability initiatives differs between private and public hospitals. The former consider sustainability as an option that is required mainly for social reasons, a bottom-up positioning and planning. It emerges merely spontaneously within the organization, while the sustainability initiatives in public hospitals are compulsory. They are imposed by the healthcare system within which the public hospital, operates and constitutes a top-down positioning and planning that is structured to accomplish set sustainability goals.

Research limitations/implications

A limitation of this study is that it is undertaken exclusively in Spanish organizations from one industry. This study differs from previous ones in terms of exploring the positioning and planning of the sustainability initiatives, which focus on the organizational logic of such sustainability initiatives. There are both common denominators and differentiators between private and public hospitals.

Practical implications

The logic of determining the positioning and planning of the sustainability initiatives is mainly about satisfying organizational needs and societal demands. Nowadays, organizations tend to engage in sustainability initiatives, so it is essential to understand the logic of how organizations position and plan such efforts.

Originality/value

This study investigates the path that follows sustainability initiatives in public and private organizations. It reports mainly differentiators between private and public organizations. It also contributes to explaining the organizational reasoning as to why companies make decisions about sustainability initiatives, an issue which has not been addressed sufficiently in existing theory studies.

Details

International Journal of Public Sector Management, vol. 31 no. 7
Type: Research Article
ISSN: 0951-3558

Keywords

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Article

Sineenart Krichanchai and Bart L. MacCarthy

The purpose of this paper is to investigate vendor managed inventory (VMI) for the supply of medicines between distributors and hospitals to identify factors that may…

Abstract

Purpose

The purpose of this paper is to investigate vendor managed inventory (VMI) for the supply of medicines between distributors and hospitals to identify factors that may affect VMI adoption.

Design/methodology/approach

Two contrasting VMI initiatives involving five organizations (three hospitals, one distributor and one manufacturer/supplier) are studied. A case study method with semi-structured interviews is used with triangulation in data collection, site visits and document analysis to enhance reliability and validity. The cases are analyzed and compared with respect to hospital, supplier, product and supply chain integration characteristics.

Findings

A successful public sector VMI initiative and an unsuccessful private sector VMI initiative are identified. The public sector supplier focuses on improving service level while the private sector supplier seeks to strengthen relationships with a key customer. Hospital characteristics, including type of hospital, top management perspectives and the hospital’s willingness to share information, are critical in decisions on VMI initiation or termination. Relatively stable demand products are preferred for a VMI approach. Hospitals may perceive risks in VMI adoption for medicines as it involves relinquishing control of critical supplies and may result in “lock-in” with a particular supplier.

Research limitations/implications

The cases have been conducted in one country, which may affect generalization of the findings. Wider empirical evidence from other countries in both developed and less developed regions will be beneficial.

Practical implications

VMI is advocated as being beneficial in many supply contexts. However, it is challenging to implement. The study identifies factors that affect the adoption of VMI for hospital pharmaceuticals and provides guidance on initiating VMI in a hospital context.

Social implications

The potential for VMI in public health projects to enable greater access to critical medicines is highlighted.

Originality/value

The paper provides supply side and demand side perspectives on VMI adoption in an important sector. It highlights the need for greater understanding of the perceived and actual risks in VMI from the perspective of both the hospital and the supplier and for much clearer advice on which pharmaceutical products are appropriate for VMI control in a hospital context.

Details

The International Journal of Logistics Management, vol. 28 no. 3
Type: Research Article
ISSN: 0957-4093

Keywords

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