Policy analysts have argued that public disclosure of health care quality stimulates quality improvements in health care delivery organizations. One proposed mechanism for such an effect is the organization's reputation: Provider organizations improve their quality after public reporting because the reported information affects their reputation. However, research evidence to date is mixed on whether and how reputation affects an organization's response to public disclosure of health care quality data. Drawing from organizational theory and social psychology literature, this dissertation examines the role of reputation in organizational response to public reporting of health care quality. In particular, it examines whether quality improvement is more likely in organizations whose performance ranking are inconsistent with their prior reputations.
The study employs observational data sets and a non-equivalent control group quasi-experimental research design. The unit of analysis is the primary care clinic. The sample includes 156 clinics in the state of Minnesota that publicly disclosed quality performance information on the Minnesota Community Measurement (MNCM) Health Care Quality Reports from 2007 to 2010. The dissertation improves on previous studies by using longitudinal data and by adopting more comprehensive measures of reputation. Optimal Diabetes Care (ODC) is used as a proxy measure of clinical quality performance, and the data are drawn from MNCM Health Care Quality Reports of 2007-2010. The reputation measures are constructed from several other sources of data that represent the reputation of clinics during the period of 2000-2006, including endorsement from Minneapolis-St. Paul Magazine's Top Doctors 2000-2005 and recipients of Buyer Health Care Action Group's PatientChoice Excellence in Quality Awards 2000-2006. Analysis examines the effects of reputation and public performance ranking on subsequent quality improvement, as well as the interaction effects between reputation and public performance ranking. The fixed effects (FE) estimator and the two-stage least squares (2SLS) estimator are used to address the endogeneity issues in the data set. The findings are also compared with those obtained from the traditional ordinary least square (OLS) estimator.
The results show that an organization's low ranking on public performance reports leads to a greater degree of quality improvement, and public performance ranking has heterogeneous effects on quality improvement based on the prior reputations of organizations. Health care organizations do not only learn about their quality performance relative to peers and competitors, but also relative to their organization's prior reputation. The dissonance between prior reputations and public performance rankings of organizations is a predictor of quality improvement. The findings expand the empirical evidence on the influence of organizational reputation on subsequent change in health care quality. The findings also advance knowledge of the role of an organization's reputation in quality management theories and practices and have implications for how policymakers and health care administrators can more effectively make use of public reporting to promote quality improvement in health services organizations.
University of Minnesota Ph.D. dissertation. December 2011. Major: Health Services Research, Policy and Administration. Advisor:James W. Begun, Ph.D. 1 computer file (PDF); viii, 158 pages.
The roles of reputation in organizational response to public disclosure of health care quality.
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