Walston S L, Burns L R, Kimberly J R
Health Serv Res. 2000 Feb;34(6):1363-88.
To examine the effect of reengineering on the competitive position of hospitals. Although many promises have been made regarding outcomes of process reengineering, little or no research has examined this issue. This article provides an initial exploration of the direct effects of reengineering on the competitive cost position of hospitals and the modifying effects of implementation factors.
DATA SOURCES/STUDY SETTING: Obtained for primary data from a 1996/1997 national survey of hospital restructuring and reengineering sponsored by the American Hospital Association and the Leonard Davis Institute for Health Economics. Responses from approximately 30 percent of all U.S. acute care hospitals with 100 or more inpatient beds in metropolitan service areas were combined with American Hospital Association annual survey and InterStudy HMO data in this study.
A first-difference multivariate regression was utilized to examine the effects of reengineering and other explanatory variables on the change in the cost position of a hospital's expenses per adjusted patient day relative to its market's costs per adjusted patient day.
DATA COLLECTION/EXTRACTION METHODS: The survey of hospital restructuring and reengineering was mailed to hospital chief executive officers. The CEOs identified reengineering and restructuring hospital activities over the previous five years. The extensiveness and components of reengineering and internal restructuring were identified and used in the empirical analysis.
Results suggest that reengineering without integrative and coordinative efforts may damage an organization's cost position. The use of steering committees, project teams, codification of the change process, and executive involvement in core changes modifies the results of reengineering to improve an organization's competitive position.
In a national sample of hospitals, reengineering alone was not found to improve the relative cost-competitive position. Organizations attempting to improve their cost competitiveness must consider the way in which change is implemented. This research suggests that the process of change may be as important as the change instrument. Additional research is needed to explore differences between early and late adopters.
研究流程再造对医院竞争地位的影响。尽管关于流程再造的成果已有诸多承诺，但很少有研究对此问题进行考察。本文初步探讨了流程再造对医院竞争成本地位的直接影响以及实施因素的调节作用。
数据来源/研究背景：主要数据来自1996/1997年由美国医院协会和伦纳德·戴维斯健康经济研究所发起的全国医院重组与再造调查。本研究将美国大都市服务区内100张及以上住院床位的所有急性护理医院中约30%的回复，与美国医院协会年度调查和InterStudy健康维护组织数据相结合。
采用一阶差分多元回归来考察流程再造及其他解释变量对医院每调整后患者日费用的成本地位相对于其市场每调整后患者日成本变化的影响。
数据收集/提取方法：医院重组与再造调查通过邮寄方式发送给医院首席执行官。首席执行官们确定了过去五年中进行的流程再造和医院重组活动。确定了流程再造和内部重组的广度及组成部分，并用于实证分析。
结果表明，缺乏整合与协调努力的流程再造可能会损害组织的成本地位。使用指导委员会、项目团队、变革过程的编纂以及高管参与核心变革会改变流程再造的结果，从而提高组织的竞争地位。
在全国医院样本中，仅流程再造并未被发现能提高相对成本竞争地位。试图提高成本竞争力的组织必须考虑变革的实施方式。本研究表明，变革过程可能与变革手段同样重要。需要进一步研究以探索早期采用者和晚期采用者之间的差异。
