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The Impact of Combining Conformance and Experiential Quality on Hospitals’ Readmissions and Cost Performance


  • Claire Senot

    () (A.B. Freeman School of Business, Tulane University, New Orleans, Louisiana 70118)

  • Aravind Chandrasekaran

    () (Fisher College of Business, The Ohio State University, Columbus, Ohio 43210)

  • Peter T. Ward

    () (Fisher College of Business, The Ohio State University, Columbus, Ohio 43210)

  • Anita L. Tucker

    () (Brandeis International Business School, Brandeis University, Waltham, Massachusetts 02453)

  • Susan D. Moffatt-Bruce

    () (Wexner Medical Center, The Ohio State University, Columbus, Ohio 43210)


To investigate the opportunity for hospitals to achieve better care at lower cost, we examine two key process quality measures, conformance quality and experiential quality, and two measures of performance, readmission rate and cost per discharge. Conformance quality represents a hospital’s level of adherence to evidence-based standards of care, whereas experiential quality represents the level of interaction between hospital’s caregivers and patients. Analyzing six years of data from 3,474 U.S. acute care hospitals, we find that combining conformance and experiential quality results in lower readmission rates. However, conformance quality and experiential quality each independently increase cost per discharge, which suggests that a readmissions–costs trade-off is unavoidable. To investigate this further, we conduct post hoc analyses by distinguishing between the granular elements of experiential quality (EQ) based on task type: response-focused EQ and communication-focused EQ. Response-focused EQ measures caregivers’ ability to respond to patient’s explicit needs, whereas communication-focused EQ measures caregivers’ ability to engage in meaningful conversations with the patient. We find that combining communication-focused EQ with conformance quality reduces readmission rates. Moreover, as conformance quality increases, the cost of improving communication-focused EQ decreases, indicating complementarity. Response-focused EQ in combination with conformance quality also results in reduced readmission rates. However, as conformance quality increases, the cost of improving response-focused EQ also increases, suggesting that these dimensions might compete for resources. Taken together, our results suggest that hospital administrators can mitigate the trade-off between reducing readmissions and controlling costs by prioritizing communication-focused EQ over response-focused EQ. This paper was accepted by Serguei Netessine, operations management.

Suggested Citation

  • Claire Senot & Aravind Chandrasekaran & Peter T. Ward & Anita L. Tucker & Susan D. Moffatt-Bruce, 2016. "The Impact of Combining Conformance and Experiential Quality on Hospitals’ Readmissions and Cost Performance," Management Science, INFORMS, vol. 62(3), pages 829-848, March.
  • Handle: RePEc:inm:ormnsc:v:62:y:2016:i:3:p:829-848
    DOI: 10.1287/mnsc.2014.2141

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    References listed on IDEAS

    1. Wu, De-Min, 1973. "Alternative Tests of Independence Between Stochastic Regressors and Disturbances," Econometrica, Econometric Society, vol. 41(4), pages 733-750, July.
    2. Hansen, Lars Peter, 1982. "Large Sample Properties of Generalized Method of Moments Estimators," Econometrica, Econometric Society, vol. 50(4), pages 1029-1054, July.
    3. Arellano, Manuel & Bover, Olympia, 1995. "Another look at the instrumental variable estimation of error-components models," Journal of Econometrics, Elsevier, vol. 68(1), pages 29-51, July.
    4. Wesley David Sine & Scott Shane & Dante Di Gregorio, 2003. "The Halo Effect and Technology Licensing: The Influence of Institutional Prestige on the Licensing of University Inventions," Management Science, INFORMS, vol. 49(4), pages 478-496, April.
    5. David Roodman, 2009. "How to do xtabond2: An introduction to difference and system GMM in Stata," Stata Journal, StataCorp LP, vol. 9(1), pages 86-136, March.
    6. Kevin B. Hendricks & Vinod R. Singhal, 2001. "The Long-Run Stock Price Performance of Firms with Effective TQM Programs," Management Science, INFORMS, vol. 47(3), pages 359-368, March.
    7. Hausman, Jerry, 2015. "Specification tests in econometrics," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 38(2), pages 112-134.
    8. M. S. Krishnan & C. H. Kriebel & Sunder Kekre & Tridas Mukhopadhyay, 2000. "An Empirical Analysis of Productivity and Quality in Software Products," Management Science, INFORMS, vol. 46(6), pages 745-759, June.
    9. Dimitrios A. Andritsos & Christopher S. Tang, 2014. "Linking Process Quality and Resource Usage: An Empirical Analysis," Production and Operations Management, Production and Operations Management Society, vol. 23(12), pages 2163-2177, December.
    10. Stephen R. Bond, 2002. "Dynamic panel data models: a guide to micro data methods and practice," Portuguese Economic Journal, Springer;Instituto Superior de Economia e Gestao, vol. 1(2), pages 141-162, August.
    11. Sloan, Frank A. & Picone, Gabriel A. & TaylorJr., Donald H. & Chou, Shin-Yi, 2001. "Hospital ownership and cost and quality of care: is there a dime's worth of difference?," Journal of Health Economics, Elsevier, vol. 20(1), pages 1-21, January.
    12. Blundell, Richard & Bond, Stephen, 1998. "Initial conditions and moment restrictions in dynamic panel data models," Journal of Econometrics, Elsevier, vol. 87(1), pages 115-143, August.
    13. Justin J. P. Jansen & Michiel P. Tempelaar & Frans A. J. van den Bosch & Henk W. Volberda, 2009. "Structural Differentiation and Ambidexterity: The Mediating Role of Integration Mechanisms," Organization Science, INFORMS, vol. 20(4), pages 797-811, August.
    14. Christopher D. Ittner & Venky Nagar & Madhav V. Rajan, 2001. "An Empirical Examination of Dynamic Quality-Based Learning Models," Management Science, INFORMS, vol. 47(4), pages 563-578, April.
    15. Stephen Bond, 2002. "Dynamic panel data models: a guide to microdata methods and practice," CeMMAP working papers CWP09/02, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.
    16. Davidson, Russell & MacKinnon, James G., 1993. "Estimation and Inference in Econometrics," OUP Catalogue, Oxford University Press, number 9780195060119.
    17. Gary P. Pisano & Richard M.J. Bohmer & Amy C. Edmondson, 2001. "Organizational Differences in Rates of Learning: Evidence from the Adoption of Minimally Invasive Cardiac Surgery," Management Science, INFORMS, vol. 47(6), pages 752-768, June.
    18. Venky Nagar & Madhav V. Rajan, 2005. "Measuring Customer Relationships: The Case of the Retail Banking Industry," Management Science, INFORMS, vol. 51(6), pages 904-919, June.
    19. Deborah L. Kellogg & Richard B. Chase, 1995. "Constructing an Empirically Derived Measure for Customer Contact," Management Science, INFORMS, vol. 41(11), pages 1734-1749, November.
    20. Dimitrios Andritsos & Christopher S. Tang, 2014. "Linking Process Quality and Resource Usage: An Empirical Analysis," Post-Print hal-01099628, HAL.
    21. Daniel Levinthal & Claus Rerup, 2006. "Crossing an Apparent Chasm: Bridging Mindful and Less-Mindful Perspectives on Organizational Learning," Organization Science, INFORMS, vol. 17(4), pages 502-513, August.
    22. Christopher D. Ittner & David F. Larcker, 1997. "The Performance Effects of Process Management Techniques," Management Science, INFORMS, vol. 43(4), pages 522-534, April.
    23. Rogelio Oliva & John D. Sterman, 2001. "Cutting Corners and Working Overtime: Quality Erosion in the Service Industry," Management Science, INFORMS, vol. 47(7), pages 894-914, July.
    24. Manuel Arellano & Stephen Bond, 1991. "Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations," Review of Economic Studies, Oxford University Press, vol. 58(2), pages 277-297.
    25. Anderson, T. W. & Hsiao, Cheng, 1982. "Formulation and estimation of dynamic models using panel data," Journal of Econometrics, Elsevier, vol. 18(1), pages 47-82, January.
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    Blog mentions

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    1. Thesis Thursday: Sarah Zheng
      by Chris Sampson in The Academic Health Economists' Blog on 2018-03-15 07:00:19


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    Cited by:

    1. Bichescu, Bogdan C. & Bradley, Randy V. & Smith, Antoinette L. & Wei, Wu, 2018. "Benefits and implications of competing on process excellence: Evidence from California hospitals," International Journal of Production Economics, Elsevier, vol. 202(C), pages 59-68.
    2. Ferreira, D.C. & Marques, R.C. & Nunes, A.M. & Figueira, J.R., 2018. "Patients’ satisfaction: The medical appointments valence in Portuguese public hospitals," Omega, Elsevier, vol. 80(C), pages 58-76.


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