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Linking Antecedents and Consequences of Value Density in the Healthcare Delivery Supply Chain
Dobrzykowski, David D.

2010, Doctor of Philosophy, University of Toledo, Manufacturing and Technology Management.

Unprecedented scientific and technological advancements now enable people to live longer, and with this increase in the aging population comes increased demand for healthcare services (IOM, 2001). These shifts have contributed to disturbing trends related to cost, quality, and even competition among healthcare providers. The Centers for Medicare and Medicaid Services is estimated to spend more than $2.5 trillion for healthcare services in 2009, or about $8,160 per U.S. resident compared to $75 billion, or $356 per resident in 1970 (Kaiser, 2009). Healthcare spending is estimated to represent 17.6% of gross domestic product (GDP) in 2009, compared with only 7.2% in 1970 (Kaiser, 2009). Concomitant to these cost increases has been a decrease in consumer confidence regarding access to quality care (Cogan et al., 2004). Such quality concerns have been substantiated by reports that each year nearly 2 million people acquire infections during hospital stays resulting in death for almost 99,000 patients (Klevens et al., 2007). Consequently, interest in improving cost, quality, and other outcomes has increased in recent years, highlighting the need for better operational coordination during healthcare delivery (Gittell et al., 2000; Fredendall et al., 2009). As such, practitioners and scholars are directing their attention toward the benefits that can be realized by efficient and effective supply chain management in healthcare (Schneller and Smeltzer, 2006). However, while a fair amount of supply chain management research exists in the manufacturing context, generalizing these findings in healthcare has proven thorny (Smeltzer and Ramanathan, 2002). As such, researchers have identified the need for new studies exploring supply chain management in the uniquely decentralized context of healthcare delivery (Shah et al., 2008).

This research study conceptualizes the healthcare delivery supply chain focusing on the information and resource flows between admitting/attending physicians (e.g., surgeons) who make referrals to hospitals and deliver care to inpatients, and the internal clinical staff members (e.g., nurses and other allied health professionals) who coordinate and provide care to inpatients (Lambert and Cooper, 2000; Ford and Scanlon, 2007; Schneller and Smeltzer, 2006). Sinha and Kohnke (2009) refer to such a conceptualization from a macro level as the downstream, decentralized (Shah et al., 2008) portion of the healthcare supply chain.

Service-dominant logic (SDL), and its central theme of value co-creation, are employed to hypothesize that a partner relationship with admitting/attending physicians will serve as a coordination mechanism affecting a hospital’s strategy for integrating information and resources during patient care, and also a hospital’s culture or entrepreneurial orientation. An integrative information and resource strategy (Sabherwal and Chan, 2001; and Vonderembse et al., 2006) and entrepreneurial culture (Jambulingam et al., 2005) will affect the work practices/interactions among admitting/attending physicians and a hospital’s clinical staff. These work practices are conceptualized herein as integrative supply chain practices. Value is co-created in this supply chain by the personalized interactions among patients, physicians, hospital employees, and other supply chain actors (Prahalad and Ramaswamy, 2004a; Prahalad and Krishnan, 2008). Thus, the focus of the hospital may be well served to shift from the product/service itself to the supply chain or value creation system which comprises these actors. Outcomes are enhanced when these actors work in a value dense environment comprised of the information, knowledge, and other resources needed during patient care (Normann and Ramirez, 1993). Value density, and consequently the performance of the healthcare delivery supply chain, are enhanced by integrative supply chain practices such as physician partnerships, patient relationships, information sharing, information quality, lean principles, and Information Systems (IS) enabled processes (Li et al., 2005; Shah et al., 2008; Rai et al., 2006). Finally, a value dense environment and the supply chain performance of the care delivery team are hypothesized to affect a hospital’s healthcare delivery capability with regard to safety, effectiveness, patient-centeredness, timeliness, and efficiency (IOM, 2001).

In order to test these hypothesized relationships, instruments were developed or revalidated for seven major constructs and thirty-five subconstructs using pre-test, structured interviews, and Q-sort pilot testing procedures. Next, the proposed model was tested using Structural Equation Modeling (SEM) to analyze data collected from a large-scale survey of 190 acute care hospitals in the United States. The empirical results support eight out of nine hypothesized relationships with the exception of the link between a value dense environment and a hospital’s healthcare delivery capability. A value dense environment is shown to influence healthcare delivery capability; however, this relationship is mediated by the supply chain performance of the care delivery team. Specifically, this study provides evidence of critical linkages between partner relationship and integrative information and resource strategy, partner relationship and entrepreneurial culture, integrative information and resource strategy and integrative supply chain practices, entrepreneurial culture and integrative supply chain practices, integrative supply chain practices and value dense environment, integrative supply chain practices and supply chain performance, value dense environment and supply chain performance, and finally supply chain performance and healthcare delivery capability.

Mark Vonderembse, PhD (Committee Co-Chair)
T.S. Ragu-Nathan, PhD (Committee Co-Chair)
Michael Bisesi, PhD (Committee Member)
Stephen Callaway, PhD (Committee Member)
Joseph Shapiro, MD (Committee Member)
Monideepa Tarafdar, PhD (Committee Member)
323 p.

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Dobrzykowski, D. (2010). Linking Antecedents and Consequences of Value Density in the Healthcare Delivery Supply Chain. (Electronic Thesis or Dissertation). Retrieved from

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Dobrzykowski, David. "Linking Antecedents and Consequences of Value Density in the Healthcare Delivery Supply Chain." Electronic Thesis or Dissertation. University of Toledo, 2010. OhioLINK Electronic Theses and Dissertations Center. 27 Mar 2015.

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Dobrzykowski, David "Linking Antecedents and Consequences of Value Density in the Healthcare Delivery Supply Chain." Electronic Thesis or Dissertation. University of Toledo, 2010.


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