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An Exploratory Study of Dynamic Capabilities and Performance Improvement in Hospitals.

Mona Al-Amin, Erin Sullivan1, Nicole E Szalay2

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Hospitals need dynamic capabilities for sustained performance improvement. Developing these dynamic capabilities, which involve identifying, seizing, and learning from opportunities, is crucial for optimizing hospital performance beyond ad hoc projects.

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Area of Science:

  • Healthcare Management
  • Organizational Capabilities
  • Performance Improvement

Background:

  • Hospitals face pressure to provide high-value care, often relying on payment incentives.
  • A significant percentage (70-90%) of performance improvement projects fail to meet goals.
  • Operational capabilities alone are insufficient for sustained superior performance; dynamic capabilities are needed.

Purpose of the Study:

  • To propose the dynamic-capabilities framework as a model for developing and managing hospital performance improvement (PI) capabilities.
  • To explore the implications of a strategy driven by dynamic-capabilities PI in healthcare settings.
  • To assess if hospitals engage in activities aligned with the dynamic-capabilities framework.

Main Methods:

  • A semi-structured interview guide was developed based on a literature review of the dynamic-capabilities framework.
  • Nine participants from hospital PI departments in Massachusetts and New Hampshire were recruited.
  • Qualitative data analysis involved thematic indexing and coding of de-identified interview transcripts using NVivo12.

Main Results:

  • Hospitals showed no significant variation in PI structures, methodologies, or weaknesses.
  • Most hospitals had PI departments and favored top-management-initiated projects, but lacked programs for general staff PI training.
  • Common weaknesses included PI project selection, communication, coordination, learning from past projects, and sustaining improvements.

Conclusions:

  • Dynamic PI capabilities enable systematic identification, exploitation, and learning from improvement opportunities, alongside resource reconfiguration for optimal performance.
  • Ad hoc PI projects are inadequate for achieving sustained superior performance in hospitals.
  • Developing dynamic PI capabilities is essential for hospitals to systematically and effectively address pressures for high-value care and achieve superior performance.