Is the quality of hospital care a function of leadership?

Multiple regression analysis was used to evaluate the relationship between hospital quality and independent variables of interest. While past studies have analyzed hospital efficiency to evaluate organizational performance, this study is unique because it evaluates the relationship between quality and efficiency. The study incorporates an independent variable, "efficiency," calculated using a variable returns-to-scale, input-oriented, data envelopment analysis methodology. This article provides an innovative approach to measuring cost and quality as the federal government attempts to realign scarce health care resources to better meet local community needs. Data for 143 hospitals in 2000 were analyzed using multiple regression and data envelopment analysis to evaluate hospital quality. These results have managerial implications related to improving hospital quality as well as enhancing organizational performance. The study has policy implications on the relationship between quality and efficiency and supports current initiatives related to pay-for-performance in the health care industry. This study clearly documents the positive relationship between quality and efficiency, which supports the premise that hospital leadership through the effective allocation of resources and development of high-performance work processes is important to improve quality of care.

Efficiency of federal hospitals in the United States.

This study evaluates the technical efficiency of federal hospitals in the United States using a variable returns to scale, input-oriented, data envelopment analysis (DEA) methodology. Hospital executives, health care policy-makers, taxpayers, and other stakeholders, benefit from studies that improve the efficiency of federal hospitals. Data for 280 federal hospitals in 1998 and 245 in 2001 were analyzed using DEA to measure hospital efficiency. Results indicate overall efficiency in federal hospitals improved from 68% in 1998 to 79% in 2001. However, based upon 2001 spending of $42.5 billion for federal hospitals potential savings of $2.0 billion annually are possible through more efficient management of resources. From a policy perspective, this study highlights the importance of establishing more specific policies to address inefficiency in the federal health care industry.

Evaluation of performance of dental providers on posterior restorations: does experience matter? A data envelopment analysis (DEA) approach.

The purpose of this study is to discern what factors affect the longevity of amalgam and of composite restorations by dentists who perform posterior restorations. Data are obtained from the Washington Dental Service and contain 1.5 million patient encounters representing visits to 23,000 providers from January 1993 through 31 December 1999. Analysis of provider performance is estimated through Data Envelopment Analysis. The principal finding is that the most efficient dentists produce posterior restorations that survive almost 5 months (4.6 months) longer than those by inefficient providers (chi2 = 18.98, p < 0.0001). The findings suggest that there is no difference in restoration longevity between amalgam and composite restorations when the restoration is performed by efficient provider.

A theoretical perspective using resource dependency to predict the potential migration of Medicare-eligible military beneficiaries into the Department of Defense's Managed Care System.

TRICARE for Life (TFL) became effective on October 1, 2001. On that date, approximately 1.5 million Medicare-eligible military beneficiaries (MEMB) regained health care reimbursement privileges resulting in significantly reduced individual out-of-pocket costs. TFL acts as a secondary payer to an eligible beneficiary's Medicare or other health insurance. Currently, TFL beneficiaries are allowed to remain in their current health care system. However, early discussions of Public Law 106-398 recommended that MEMB seek care at military treatment facilities. The return of MEMB to military treatment facilities may have presented a number of management challenges to leaders of the Military Health System. This article applies resource dependence theory to the issue of MEMB returning to military treatment facilities under the TFL program. Resource dependency theory and a conceptual model assist in identifying a number of challenges that may adversely affect MEMB in future years should this option ever become a reality.