Patient Experience and Financial Performance of United States Hospitals: A Longitudinal Analysis of 1,377 For-Profit, Non-Profit, and Governmental Hospitals.

摘要

With increasing expectations from patients and urges from advocates to improve hospital care, patient experience has emerged among top priorities of hospital leaders. Patient experience encompasses events that occurred independently and collectively across the entire continuum of care. In terms of ownership controls, U.S. hospitals are organized as for-profit, non-profit, and governmental. For-profit hospitals are owned by stockholders of corporations with a mission to maximize shareholders' wealth, whereas non-profit hospitals must satisfy their stakeholders and usually have a mission to serve their communities. As the U.S. payment system shifts from volume to value, hospitals are concerned about financial performance more than ever before. Hospital financial performance is attributed to indicators such as liquidity, leverage, and profitability.;This quantitative study analyzed hospital self-reported patient experience and financial performance panel data to examine the effects of patient experience on hospital financial performance, the moderating effects of hospital type on hospital financial performance, and the directions of these effects. The final study sample was comprised of 1,377 U.S. Medicare-certified inpatient acute care hospitals that reported the HCAHPS survey results and financial data consecutively over the four-year study period (2009-2012). The unit of analysis was U.S. hospitals. The independent variable was patient experience, a multidimensional construct with communication, clinical services, care environment, and perception dimensions that were organized from the ten measures of the HCAHPS survey. The moderating variable was hospital type, comprising for-profit, non-profit, and governmental hospitals. The dependent variable was hospital financial performance, with five indicators: operating profit margin (OPM), non-operating profit margin, cash flow margin (CFM), return on assets, and return on equity. Secondary data analyses were performed using various descriptive and inferential statistical techniques (e.g., frequency distributions, mean, median, standard deviation, quartile, Pearson's correlation; ANOVA, chi-square, Tukey's HSD analysis, Cronbach's alpha, CFA, AVE, linear regressions, ANCOVA, fitted general linear regressions, and logistics regressions).;Three empirical findings emerged. First, patient experience of care impacted hospital financial performance (when measured by OPM and CFM). Second, hospital type moderated the relationship between patient experience of care and hospital financial performance (when measured by OPM and CFM). Finally, the governmental hospital type demonstrated the greatest moderating effect on the relationship between patient experience and hospital financial performance. These results answered the two research questions. Additionally, descriptive findings indicate that patient experience improved gradually over 2009-2012, patient experience of for-profit and governmental hospitals consistently exceeded that of non-profit hospitals, patient experience of hospitals in smaller sizes (bed size and employee size) consistently exceeded that of larger hospitals, and patient experience of rural hospitals consistently exceeded that of urban hospitals.;In an effort to improve patient experience and financial performance, hospitals are recommended to engage their governing board members, executive leaders, employees, and patients and families. Study limitations pertain to validity and type of patient self-reported experience data, reliability and validity of hospital self-reported aggregated patient experience data, validity of hospital self-reported financial performance data, and validity of the financial performance construct. Future research may explore factors that influence patient experience of hospital care and hospital financial performance.