ارتباط درک مزیت رقابتی در مدیریت بیمارستان: یک تجزیه و تحلیل چند سطحی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|293||2012||5 صفحه PDF||سفارش دهید||3610 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Experimental & Clinical Medicine, Volume 4, Issue 3, June 2012, Pages 170–174
Purpose: As the hospital industry continues to undergo significant change and becomes an increasingly competitive environment, the concept of competitive advantage has received a considerable degree of attention in the healthcare literature. Using a multilevel modeling approach, this study evaluated the contributions of hospital characteristics and market competition on perceived competitive advantage of hospital managers in Taiwan. Methods: Data for this study were mainly collected using a questionnaire that was mailed to the top executives of 432 accredited hospitals in Taiwan in 2009. Valid responses were obtained from182 hospitals for an effective response rate of 42.1%. Results: Respondents indicated relatively moderate assessment of perceived competitive advantage (mean = 3.5, standard deviation = 0.72, on a five-point Likert scale). There were no significant correlations between the group-level predictor (competition of local healthcare market) and the individual-level ones. Results of multilevel analysis to simultaneously examine the effects of individual-level (hospital characteristics; level 1) and group-level (competition of local healthcare market; level 2) predictors on perceived competitive advantage indicated that the predictors at hospital level had a statistically significant effect on respondents' perception of competitive advantage of their hospitals. Nonetheless, there was insignificant market competition variation in perceived competitive advantage among respondents. Conclusion: We conducted a multilevel analysis that reflected the hierarchical structure of our data, where hospitals were nested within healthcare markets of different intensities of competition. Our results join a body of healthcare literature suggesting that hospital level is a significant predictor of hospital performance. However, we found no evidence of a strong relationship between the degree of local market competition and perceived competitive advantage of respondents. Taken together, the results of our empirical study shed light on some interesting issues regarding competitive advantage.
As the hospital industry continues to undergo significant change and becomes an increasingly competitive environment, the concept of competitive advantage has received a considerable degree of attention in the healthcare literature.1 Briefly, competitive advantage occurs when an organization acquires or develops attributes and resources that allow it to outperform its competitors by offering customers greater value.2 The ability of a hospital in a local market to develop strategic competencies which are relatively superior to its competing hospitals, and thus result in competitive advantage, is increasingly critical for its survival and growth in today's extremely turbulent healthcare environment. The theme of sustainable competitive advantage of organizations has been the primary focus of the strategic management literature over the past few decades. For example, Barney3 and Wernerfelt4 propose the resource-based view; Hunt5 offers the resource advantage theory; while there is the market orientation discourse as well.6 and 7 In addition, Porter2 proposes three generic strategies with which a firm can defend against external competing forces and gain a competitive advantage: (1) low cost; (2) differentiation; and (3) focus. Indeed, the increase in external environmental challenges has forced not only for-profit companies, but not-for-profit organizations (e.g., hospitals) to adopt a variety of strategies aimed at achieving competitive advantage to build viable and sustainable organizations.8, 9, 10, 11, 12 and 13 Although numerous scholars have empirically scrutinized the topic of competitive advantage of hospitals, the impact of a nested data structure is relatively seldom tackled. It is quite reasonable that the perceived competitive advantage of hospital executives in the same healthcare market (i.e., encountering the same degree of rival intensity) is likely to be more closely correlated than that of their counterparts in different healthcare markets. Multiple observations of perceived competitive advantage are nested within a single healthcare market. The problem with such a nested data structure is that it violates the assumption of independent responses required by traditional statistical techniques such as ordinary least-squares multiple analysis, and it will lead to an inflation of the probability of a Type I error.14 Multilevel analysis (also termed multilevel modeling or hierarchical linear modeling) provides a technically robust framework to resolve the challenge when data have a hierarchical structure. Multilevel analysis sophisticatedly integrates analyses at both the individual and the collective level by taking the nested structure of data (e.g., hospitals being grouped together in healthcare markets) into account. By using multilevel modeling, variances within healthcare markets and variances between markets are systematically disentangled; as a result, individual and aggregate predictors can be simultaneously accounted for. Moreover, standard errors are also more correctly calculated than traditional ordinary least-squares regression analysis with multilevel data and varying market sizes are taken into account.14, 15, 16, 17 and 18 Because of the importance of competitive advantage for hospital management, this research endeavored to uncover the factors that affect hospital executives' perception of competitive advantage of their hospitals. Specifically, the research question of the study is: “To what extent is perceived competitive advantage of hospital managers determined by hospital characteristics and to what extent by market competition?” The current study extends previous literature using multilevel modeling to account for the nested data structure that may mask a relationship between predicting factors and competitive advantage, as noted above. Addressing these issues has the potential to enrich understanding of the vital theme of competitive advantage of hospitals.
نتیجه گیری انگلیسی
Taiwan's hospitals have been under steadily environmental pressure, mainly because of an evolutionary payment scheme undertaken by the Bureau of National Health Insurance. Therefore, it may reasonable to assume that hospital executives should have a keen interest in what factors would have impact on a hospital's competitive advantage. This article reports the results of an exploratory analysis designed to identify correlates of perceived competitive advantage among hospital executives. Taken together, the results of our empirical study shed light on some interesting issues regarding perceived competitive advantage. We observed that, on the whole, the respondents held a modest assessment of their hospitals' competitive advantage (mean = 3.5 on a five-point Likert scale). We conducted multilevel analysis reflecting the hierarchical structure of our data, where hospitals (level 1) were nested within healthcare markets of different intensities of competition (level 2). Hence, utilizing multilevel analysis allowed us to simultaneously estimate the effects of group-level and individual-level factors, accounting for nonindependence of observations within groups. One of the main findings is the significant role played by hospital level, a proxy of hospital size and capacities in the present investigation. Our results join a body of healthcare literature suggesting that hospital size is a significant predictor of hospital performance.1, 25, 26, 27 and 28 Specifically, our data show that hospital executives of regional hospitals perceived better competitive advantage of their hospitals than their counterparts at district hospitals. A possible explanation for this finding is that regional hospitals have more available resources and superior competency to provide a variety of health services to attract patients than do district hospitals, and therefore hospital executives of regional hospitals would reasonably perceive a better competitive advantage of their hospitals. Although the coefficient of medical center (0.40) was larger than that of regional hospital (0.31) in regard to the relationship of hospital level and perceived competitive advantage, the result was not significant. In fact, such a statistically insignificant result echoes some studies' findings that although larger hospitals perform better than smaller ones, so supporting the existence of economies of scale, such economies of scale arise for hospitals with around 100 beds and would become exhausted for larger hospitals.29, 30 and 31 With respect to the contribution of hospital ownership on perceived competitive advantage of hospital executives, the analytical result is not significant. A significant amount of literature has supported a link between organizational attributes (such as ownership status) and conduct and performance of hospitals.28, 29, 30, 31, 32, 33 and 34 For example, for-profit hospitals tend to pursue more aggressive strategies, such as market development, than their counterparts. However, some scholars point out that economic forces have made the environment for the healthcare industry more competitive and turbulent; as a result, the distinctions of strategic behaviors and competencies between for-profit hospitals and not-for-profit hospitals have blurred.35, 36, 37 and 38 Accordingly, our finding is not very startling. Moreover, we detected the absence of a relationship between teaching status and perceived competitive advantage of hospital executives. Although Blumenthal and colleagues39 declared teaching status to play a significant role with regard to competitive advantage of hospitals, our finding concurs with the conclusion of Douglas and Ryman.1 Lastly, an intriguing finding of the study is that we found no evidence of a strong relationship between the degree of local market competition and perceived competitive advantage of respondents. Contradictory evidence exists regarding the impact of market competition in the hospital industry.1, 40, 41, 42, 43 and 44 For instance, the findings by Rivers and Asubonteng43 as well as Douglas and Ryman1 revealed that market competition was negatively associated with hospitals' cash flow margins. However, our result is in line with the finding by Dooley and colleagues45 who detected no relationship between market competition and financial performance of hospitals. Further efforts are necessary to shed additional light on the mixed findings reported in the literature on market competition and competitive advantage of hospitals.