Abstract
This paper develops and tests a dynamic model of hospital focus. It does so by tracing the performance trajectories of specialist and general hospitals to identify whether a performance gap exists and whether it widens or shrinks over time. Our longitudinal analyses of all hospital organizations within the English National Health Service (NHS) reveal not only a notable performance gap between specialist and general hospitals in particular with regards to patient satisfaction that widens over time, but also the emergence of a gap especially with regards to hospital staff job satisfaction. These findings reflect the considerable potential of specialization as a means to enhance hospital effectiveness. However, they also alert health policy makers to the threat of a widening performance gap between specialist and general hospitals with potential negative repercussions at the patient and health system level.
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Notes
As a robustness check, we used staff productivity computed as the number of admissions per staff member as an alternative indicator of operational performance, which yielded consistent results with regards to our hypotheses.
It is also worth noting that mean and maximum variance inflation factors remain well below the threshold of 10. Multicollinearity is hence unlikely to distort our estimates. As an additional robustness check, we also estimated our four main models using more conventional random effects panel regression analyses using robust standard errors. We chose this approach, because specialist status is time invariant in our study period and would be omitted in any fixed effects panel regression that only exploits within hospital variation over time. Results are broadly consistent with those from our dynamic models even though conventional random effects panel estimates confound the cross-sectional and the longitudinal effects of hospital focus. It is hence not surprising to note that in these additional models the dynamic effect of hospital focus was significant not just with regards to patient satisfaction and job satisfaction as in our mixed effects growth models, but also with regards to return on sales. This is interesting as hospital focus had a positive, but insignificant effect on the return on sales in both our static and dynamic model. When exploiting both types of variances simultaneously, however, a significant effect on financial performance emerged.
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Vera, A., Petratos, P. & Salge, T.O. A widening gap? Static and dynamic performance differences between specialist and general hospitals. Health Care Manag Sci 21, 25–36 (2018). https://doi.org/10.1007/s10729-016-9376-0
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DOI: https://doi.org/10.1007/s10729-016-9376-0