Contract Labor Reliance and Subsequent Patient Experience Performance: Evidence from U.S. Short-Term Acute Care...

Area of Science:

• Healthcare Management
• Hospital Operations
• Patient Experience Research

Background:

• U.S. hospitals face persistent workforce shortages, leading to increased reliance on contract labor.
• The impact of contract labor on patient experience performance is not well understood.

Purpose of the Study:

• To examine the association between contract labor reliance and subsequent patient experience outcomes in U.S. hospitals.

Main Methods:

• An observational study using a national sample of 2099 U.S. short-term acute care hospitals.
• Contract labor reliance measured as contract labor expense divided by total salary expense.
• Patient experience outcomes assessed using HCAHPS Summary Star Rating and Hospital Compare Overall Rating via regression and logit models.

Main Results:

• Higher contract labor reliance was significantly associated with lower patient experience ratings (HCAHPS: β = -5.288, p < 0.001; Hospital Compare: β = -6.463, p < 0.001).
• A convex relationship was observed, indicating diminishing negative associations at higher reliance levels.
• Patient experience performance showed a monotonic decline across increasing quartiles of contract labor reliance.

Conclusions:

• Contract labor reliance is significantly associated with subsequent patient experience performance.
• Findings suggest workforce composition is a key structural factor influencing hospital quality.
• Results highlight associations, not causal effects, emphasizing the need for further investigation.