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Unpacking Quality Ambidexterity: Dimensions, Contingencies, and Synergies

The focus on the quality of health care, both clinical and experiential, is becoming increasingly important to academics and
managers alike as its impact on hospital performance is established. Accordingly, research on the topic is increasing at a rapid pace. The
perspective taken in much of this research focuses predominantly on how both experiential quality (EQ) and clinical quality (CQ) impact
hospital performance. The vast majority of studies, however, have treated EQ and CQ as orthogonal concepts. Recently, researchers have
conceptualized overall quality as a combination of EQ and CQ. However, no studies have conceptualized quality as the balance between EQ
and CQ. As a result, one area that is in need of further investigation is how hospitals' EQ and CQ, in terms of their combined magnitude
(EQ * CQ) and relative balance (|EQ - CQ|) impact hospital readmission rates and productivity. Although there is broad agreement that both
EQ and CQ relate to performance, there is a lack of conceptual clarity about the extent to which hospitals' performance is dependent on
matching the magnitude of EQ and CQ (|EQ - CQ|), or on the combined magnitude of the two (EQ * CQ). This research attempts to address this
lack of clarity about the impact of EQ and CQ on hospital performance through the investigation of healthcare quality as two distinct but
related dimensions. One relates to their combined magnitude, which is referred to in the literature as the "combined dimension of quality"
(CD), while the other pertains to the balance between CQ and EQ, which is referred to in this dissertation as the "balance dimension of
quality" (BD). By clearly differentiating between these two dimensions, the purpose of this research is to provide a more precise way to
conceptualize and operationalize hospital quality, and establish a basis for investigating theoretically and practically important
relationships and contingencies. Drawing a conceptual, operational, and empirical distinction between CD and BD, and examining their
interaction, enables this research to provide greater insight into hospital quality. Hypotheses were developed to explore the effects of
CD and BD on readmission rate and productivity as well as to test which type of quality, experiential or clinical, has the greatest impact
on the outcome variables. This dissertation empirically analyzes how hospitals' CQ and EQ, in terms of the combined magnitude (CQ * EQ)
and relative balance (|CQ - EQ|), impact hospital performance through the use of secondary data on approximately 1900 U.S. acute care
hospitals. Through the empirical unpacking of the quality construct into distinct dimensions, their main effects and interaction helps to
explain previously unaccounted-for variance in hospital performance. In addition to EQ's and CQ's impact on performance, which is largely
due to factors internal to each hospital, organization theory predicts the fate of organizations is contingent on the outcome of
interactions between organizations and their environments. While organizations are at the same time embedded in and influencing their
environments, it is likely that some environmental conditions pose greater challenges to the survival of the organization than do others.
In this study, the organizational environment comprises three dimensions: complexity, munificence, and dynamism. To delve deeper into the
uniqueness of CD and BD, as well as to evaluate the theoretical and practical usefulness of drawing a distinction between them, we posit
that the relationships among quality (i.e., EQ and CQ) and performance (Readmission Rate and Productivity) are contingent on these three
key environmental factors. This research provides strong empirical evidence that the relative balance of EQ and CQ (|EQ – CQ|) should be
considered along with the combined magnitude (CQ * EQ). First, strong empirical support is provided for the benefit of minimizing the gap
between experiential quality (EQ) and clinical quality (CQ). Specifically, allocating the appropriate amount of resources to balance the
provision of EQ and CQ is essential in reducing a hospital's readmission rate. Second, the results demonstrate that achieving high overall
quality is necessary to both reduce readmissions and increase productivity, and illustrates the importance of achieving both high levels
of, and a balance of, EQ and CQ, instead of overcommitting resources to one at the expense of the other. To further demonstrate the value
of the aforementioned findings to practice, hospitals were split into two groups: those with EQ ranked higher than CQ (i.e., EQ-dominant),
and vice versa (i.e., CQ-dominant). Interestingly, the results suggest that while EQ-dominant hospitals enjoy fewer readmissions, it comes
at the cost of lower productivity. On the other hand, CQ-dominant hospitals appear to be more productive, at the cost of higher
readmissions. The results suggest that hospitals should focus on increasing both EQ and CQ, while maintaining a close balance between the
two. / A Dissertation submitted to the Department of Marketing in partial fulfillment of the requirements
for the degree of Doctor of Philosophy. / Spring Semester 2016. / April 7, 2016. / Clinical, Experiential, Performance, Productivity, Quality, Readmissions / Includes bibliographical references. / Jeffery S. Smith, Professor Directing Dissertation; Gerald R. Ferris, University Representative;
Michael K. Brady, Committee Member; Michael J. Brusco, Committee Member; Guangzhi Shang, Committee Member.
ContributorsAnderson, Sidney (authoraut), Smith, Jeffery S. (professor directing dissertation), Ferris, Gerald R. (university representative), Brady, Michael K. (committee member), Brusco, Michael J. (committee member), Shang, Guangzhi (committee member), Florida State University (degree granting institution), College of Business (degree granting college), Department of Marketing (degree granting department)
PublisherFlorida State University
Source SetsFlorida State University
LanguageEnglish, English
Detected LanguageEnglish
TypeText, text
Format1 online resource (92 pages), computer, application/pdf

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