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Hospital Purchasing for Implantable Medical Devices: A Triadic Perspective

Saboorideilami, Vafa
http://rave.ohiolink.edu/etdc/view?acc_num=toledo1445269068

Abstract Details

2015, Doctor of Philosophy, University of Toledo, Business Administration.
Hospitals are under fierce pressure from the Medicaid and insurance companies to cut the cost of their services. Operating rooms are among the biggest cost centers in any hospital, and a huge part of their cost is related to purchasing implantable medical devices (IMDs) and services related to IMDs. Among all different types of IMDs, orthopedic and cardiac IMDs constitute an enormous proportion of the cost. A recent Medicaid report reflects the poor performance of hospitals with regard to purchasing orthopedic and cardiac implants. One of the main factors that results in such a poor performance is the relationship between physicians and the vendors of IMDs. This relationship helps IMD vendors to impose higher prices on hospitals, and enjoy high bargaining powers as key or sole suppliers of IMDs. This is the main motivation behind conducting this research. In other words this study proposes a remedy for this poor performance of hospitals through a comprehensive research that investigates this situation and propose solutions for this problem. This study examines this problem from the lens of service triads, agency theory, social network theory, and balance theory. Based on previous conceptual works in this field, this study proposes that a service triad forms when the hospital intends to purchase IMDs. This service triad is constituted of the hospital as the buyer, the manufacturer of implant as the vendor, and the physician as the customer. This study first explores the factors that lead to the strength of ties in the mentioned triad. Secondly it proposes mechanisms that the hospital could utilize to change the balance of relationships and achieve better performance. This study examines the following research questions: How cooperation mechanisms initiated by vendor and/or hospital affect the physician’s agency role for either party? How monitoring mechanisms initiated by hospital affect the relationship between hospital and vendor? How does physician’s agency role for hospital reduce the physician’s agency role for vendor? How does each of the following three construct: physician’s agency role for vendor, physician’s agency role for hospital, and hospital-vendor relationship, affect the standardization of IMDs? How does the standardization of IMDs affect the hospital performance? To answer these research questions, this study proposes a conceptual model based on the above mentioned theories. In order to empirically test this research model, instruments were developed and validated in a pilot study for all constructs. Then, the research model has been tested using Structural Equations Modeling (SEM) based on data gathered from a large scale survey from American hospitals. Respondents of this survey are Operating Room Directors, and Chief Financial Officers of hospitals. Hospitals have been identified for future analysis. This study makes several theoretical contributions. First, it contributes to the study of triads and social network theory. Moreover, this study contributes to healthcare management literature. The issue of purchasing implantable medical devices has mostly been studied only from a dyadic perspective. Even studies that investigate these phenomena from a triadic standpoint have not supported their propositions with strong and well-established management theories. This study utilizes robust theories to investigate the causes and consequences of the relationship between hospital, vendor, and physician. In this study a relatively large sample (n=393) of usable responses from hospital administrative across the nation i.e. operating room directors and chief financial officers, has been gathered. The response rate in this study 38.57%. Responses were used for a structural equations modeling analysis to test the hypotheses. All hypotheses proposed in this study have been strongly supported. This is another contribution of this study. Empirical studies on service triads are very scarce, and extant works are mainly conceptual. Reputable research institutions in operations management and supply chain management, insistently call for empirical papers in the field of service triads. This work will be among the very first researches that answer this call and fill this gap in the literature. This study fills this gap by empirically testing the antecedents and consequences of the three relationships in a service triad.
Ananad Kunnathur, PhD (Committee Chair)
Amal Said, PhD (Committee Member)
Thomas Schwann, MD (Committee Member)
Rong Liu, PhD (Committee Member)
Yue Zhang, PhD (Committee Member)
221 p.
Business Administration
Procurement, Supply Chain Management, Operations Management, Healthcare Management, Hospital, Physisian, Service Triad, Implantable Medical Devices

Recommended Citations

Citations

  • Saboorideilami, V. (2015). Hospital Purchasing for Implantable Medical Devices: A Triadic Perspective [Doctoral dissertation, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1445269068

    APA Style (7th edition)

  • Saboorideilami, Vafa. Hospital Purchasing for Implantable Medical Devices: A Triadic Perspective. 2015. University of Toledo, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=toledo1445269068.

    MLA Style (8th edition)

  • Saboorideilami, Vafa. "Hospital Purchasing for Implantable Medical Devices: A Triadic Perspective." Doctoral dissertation, University of Toledo, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1445269068

    Chicago Manual of Style (17th edition)

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This open access ETD is published by University of Toledo and OhioLINK.