The Effects of Focus on Performance: Evidence from California Hospitals

40 Pages Posted: 21 Apr 2011

See all articles by Diwas Singh KC

Diwas Singh KC

Emory University - Goizueta Business School

Christian Terwiesch

University of Pennsylvania - Operations & Information Management Department

Date Written: April 15, 2011

Abstract

We use hospital level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization – at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply “cherry-picking” easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm-level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g. operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects.

Keywords: Specialization, Productivity, Quality, Healthcare, Service Operations

Suggested Citation

KC, Diwas Singh and Terwiesch, Christian, The Effects of Focus on Performance: Evidence from California Hospitals (April 15, 2011). Available at SSRN: https://ssrn.com/abstract=1815529 or http://dx.doi.org/10.2139/ssrn.1815529

Diwas Singh KC (Contact Author)

Emory University - Goizueta Business School ( email )

1300 Clifton Road
Atlanta, GA 30322-2722
United States

Christian Terwiesch

University of Pennsylvania - Operations & Information Management Department ( email )

Philadelphia, PA 19104
United States

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