Essays on Healthcare Coordination
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In recent years, there has been a dramatic increase in the push for various organizational interventions aimed at improving the coordination of healthcare delivery services. Two examples of such interventions are care coordination teams (CCTs), which are used in hospitals to coordinate patient flow across care units; and Accountable Care Organizations (ACOs), which are used to coordinate care delivery across healthcare organizations. Despite the widespread adoption of, and continued push for these interventions, there is very little systematic and rigorous research investigating their impacts on operational performance, such that to date, how beneficial they are remains an open question. Research findings in this area have been inconclusive, and there is a lack of theory to explain or reconcile these inconclusive results. This dissertation, which consists of two essays, addresses these shortcomings. The first essay focuses on the value of CCTs to hospitals. Using theories of organizational coordination, we develop hypotheses describing the influence of CCT structure on the efficiency and effectiveness of patient flow processes, and how team-patient coordination causally mediates this direct effect. We test this hypothesis in a field study of CCTs using quasi-experimental methods. The second essay focuses on the recent emergence of ACOs as an organizational form that can promote care coordination across healthcare organizations. Drawing on the contingency theory of organization, we propose and test the hypothesis that input uncertainty, knowledge insufficiency, and prevalence influence hospitals’ decision to participate in ACOs, as well as its effect on cost and quality performance. The theoretical contribution of this dissertation focuses on clarifying how these organizational interventions work to affect performance. The practical contribution focuses on identifying specific elements of the intervention that are most beneficial to hospitals, and conditions under which these interventions work best.