The Effects of Focus on Performance: Evidence from California Hospitals
利用加州心脏病患者出院数据，研究医院在三个组织层面（企业、运营单元、流程）的专注度对运营绩效的影响，发现专注度与更短住院时间和更低死亡率相关，但企业层面优势在控制患者选择后消失，运营单元层面专注度仍有效。
We use hospital-level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization—at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely, faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply “cherry-picking” easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g., operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects. This paper was accepted by Yossi Aviv, operations management.