Nexus Between Operational Efficiency and New Quality Productivity in Hospitals: Does Dean Overconfidence Matter?

IntroductionImproving hospital care quality while controlling costs has become a major challenge in emerging healthcare systems. This study examines the relationship between hospital operational efficiency (HOE) and operational new quality productivity in hospitals (HONQP) and further investigates whether hospital dean overconfidence (HDO) moderates this relationship.MethodsThis study used panel data from 55 tertiary public hospitals in City A in China, from 2022 to 2025. HONQP was conceptualized as a multidimensional construct reflecsting innovation-driven, technology-enabled, and quality-oriented operational upgrading, and was measured using an entropy-weighted composite index. HOE was measured based on revenue-expenditure structure and cost-control indicators, while HDO was proxied by managerial demographic and positional characteristics. Fixed-effects regression models were employed to test the hypotheses, with additional robustness checks using dependent-variable replacement, random subsample regression, and propensity score matching.ResultsThe results show that HOE is significantly and positively associated with HONQP. In addition, HDO significantly strengthens this positive relationship, indicating that managerial characteristics are relevant to the extent to which operational efficiency is associated with hospital operational upgrading. These findings remain robust across multiple alternative specifications and robustness tests. Heterogeneity analyses further show that the strength of the relationship varies across hospital type, affiliation, and regional economic development.ConclusionThis study provides context-specific evidence that operational efficiency is an important driver of hospital operational upgrading and that HDO functions as a meaningful moderating factor. The findings contribute to hospital governance research and offer practical implications for leadership selection and operational reform in public hospitals.