The impact of service design and process management on clinical quality: An exploration of synergetic effects⋆

• DOI: http://doi.org/10.1016/j.jom.2015.03.006
• Published date: 01 May 2015
• Author: Xin (David) Ding
• Date: 01 May 2015

Journal of Operations Management 36 (2015) 103–114

Contents lists available at ScienceDirect

Journal of Operations Management

journal homepage: www.elsevier.com/locate/jom

The impact of service design and process management on clinical

quality: An exploration of synergetic effects夽

Xin (David) Ding∗

Information and Logistics Technology Department, University of Houston, Houston, TX 77004, United States

article info

Article history:

Received 10 May 2014

Received in revised form 3 February 2015

Accepted 19 March 2015

Available online 6 April 2015

Accepted by Thomas Younghoon Choi

Keywords:

Clinical quality

Quality improvement initiatives

Focus

Service design

Process management

abstract

While service design and process management have received research attention in the past, there is

limited empirical work examining both factors in the hospital setting. Through operationalizing focus as

a service design approach and quality improvement (QI) initiatives as process management efforts, we

hypothesize that focus and QI initiatives affect clinical quality both individually and collectively. Utilizing

heart attack procedures as the study context, we examine a set of hypotheses based on a panel dataset

consisted of 201 hospitals from 2005 to 2011 in the state of Florida. After accounting for potential lag

effects and endogeneity biases, we find empirical support to the proposed hypotheses.

© 2015 Elsevier B.V. All rights reserved.

1. Introduction

The synergies between service design and process management

have been repeatedly argued for in the literature. Service design

includes the design of a mix of key physical and non-physical com-

ponents in a service system (Goldstein et al., 2002). Effective service

design adopts simplified and standardized components and pro-

cesses, through which it reduces variations, improves quality and

efficiency (Flynn et al., 1995). By designing what service offerings

to which customers at what levels, a firm naturally chooses a com-

bination of service offerings that not only aligns with its operations

strategies but also maximizes its potential profit (Heskett, 1987).

While such design approaches and results may vary significantly

from industry to industry (e.g., the type of memorable experi-

ence staged by Disneyland Theme Park may not be transferrable to

patient experience at Mayo Clinics), service systems and accompa-

nying offerings are largely interlinked through various processes,

which can be “‘engineered’ for strategic service positioning pur-

poses” (Shostack, 1987; p. 34).

夽The authors would like to thank Agency for Healthcare Research and Quality

(AHRQ), Centers of Medicare and Medicaid Services (CMS), and Florida Hospital

Association (FHA) for assistance in assembling the data. Conclusions and opinions

expressed herein do not reflect official positions of AHRQ, CMS, or FHA.

∗Tel.: +1 713 743 4095.

E-mail address: xding@uh.edu

Process management, on the other hand, “involves concerted

efforts to map, improve, and adhere to organizational processes”

(Benner and Tushman, 2003; p. 238). By orchestrating the inter-

linked processes within an organization, process management

practices can reduce process variations and increase process con-

trol, resulting in reduced operating costs, improved service quality,

and better financial outcomes (Ahire and Dreyfus, 2000). Through

adopting simplified and standardized processes and components,

service design helps reduce the variation in organizational pro-

cesses and subsequently the complexity in process management

(Flynn et al., 1995; Zu et al., 2008). The interaction between service

design and process management further improves both internal

and external quality (Shostack, 1987; Soteriou and Zenios, 1999;

Ahire and Dreyfus, 2000).

Although the synergies between service design and process

management have received research attention, they are rarely sup-

ported with empirical evidence. A few studies attempt to address

the gap in the literature by utilizing cross-sectional data collected

from bank branches (Soteriou and Zenios, 1999) and firms across

different industries (Ahire and Dreyfus, 2000). As service design

and process management involve standardizing and routing key

components in a service system (e.g., technology, facilities, peo-

ple, processes), their results may not be noticeable in short periods

(Hyer et al., 2009). In addition, prior studies utilizing cross-sectional

approaches cannot effectively address endogeneity issues (e.g.,

hospitals with larger sizes and longer history are more likely to

involve in quality improvement initiatives) (Greene, 2008). Hence,

http://dx.doi.org/10.1016/j.jom.2015.03.006

0272-6963/© 2015 Elsevier B.V. All rights reserved.