Service specialization and operational performance in hospitals

Purpose - The purpose of this paper is to examine the link between service specialization and operational performance in hospitals. Existing literature has mostly been concerned with the performance effects of operational focus, which can be seen as an extreme form of specialization. It is not clear, however, whether an effect similar to the focus effect can be observed also in cases where specialization takes on less extreme forms. The authors analyze this effect up to and above the effects of volume, learning and patient selection. Design/methodology/approach - Ordinary least squares (OLS) and two-stage regression models were used to analyze patient data from 142 Austrian hospitals over the 2002-2006 period. The sample contains 322,193 patient groups (841,687 patient group-year observations). Findings - The authors find that increased specialization in a service leads to a more efficient provision of this service in terms of shorter length of stay. The analysis shows that this effect holds even after controlling for volume, learning, and patient selection effects. The authors suggest that the pure specialization effect is due to the increased administrative and medical attention that is given to a service when the relative importance of that service increases. Practical implications - The paper's results indicate hospital managers should pay attention to the impact of specialization when making service-mix decisions. If two services have the same or a similar level of operational performance, then this does not mean that hospital managers should be indifferent as to the relative volume of these services. Originality/value - The paper provides additional insights into the impact of service-level specialization not examined in prior literature.