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The Impact of War on Military Hospital Performance: a Study of Organizations’ Response to an Environmental Jolt

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The Impact of War on Military Hospital Performance: a Study of Organizations’ Response to an Environmental Jolt Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2013 THE IMPACT OF WAR ON MILITARY HOSPITAL PERFORMANCE: A STUDY OF ORGANIZATIONS’ RESPONSE TO AN ENVIRONMENTAL JOLT Cynthia Childress Virginia Commonwealth University Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Medicine and Health Sciences Commons © The Author Downloaded from https://scholarscompass.vcu.edu/etd/3171 This Dissertation is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. © Cynthia Childress 2013 All Rights Reserved THE IMPACT OF WAR ON MILITARY HOSPITAL PERFORMANCE: A STUDY OF ORGANIZATIONS’ RESPONSE TO AN ENVIRONMENTAL JOLT A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. by CYNTHIA CHILDRESS Master of Health Administration, Baylor University, 2002 Director: Dolores G. Clement, Dr.P.H. Professor, Department of Health Administration Virginia Commonwealth University Richmond, Virginia August, 2013 ii Acknowledgement I would like to thank my loving and supportive family: husband, Byron, and children, Nick and Marlene. I would also like to thank my parents for encouraging me to pursue doctoral studies and my parents-in-law for keeping the kids occupied and providing moral support in Richmond. I would like to deeply thank my chair, Dr. Dolores Clement, for being patient, being thorough, and prodding me for progress in the dissertation. I truly valued your substantive and quick feedback. Thank you for reminding me to reflect as I got mired in the details. I thank the rest of my committee members Dr. Kelly Devers, Dr. David Harless and Dr. Jan Clement for their invaluable assistance and patience during this long process. Without your support and understanding, I would not have been able to complete this mission. Finally, I thank my fellow classmates, Anna and Nailya, who provided encouragement and support throughout the whole process. iii Table of Contents Page List of Tables .................................................................................................................................. v List of Figures ............................................................................................................................... vii Abstract ........................................................................................................................................... 1 Chapter 1: Introduction ................................................................................................................... 1 Study Purpose ............................................................................................................................. 2 Data and Analysis ....................................................................................................................... 4 Significance of the Study ............................................................................................................ 5 Organization of the Dissertation ................................................................................................. 6 Chapter 2: Literature Review .......................................................................................................... 7 Military Health System ............................................................................................................... 7 Wars in Iraq and Afghanistan ................................................................................................... 11 War -- An Environmental Jolt ................................................................................................... 17 Productivity ............................................................................................................................... 18 Quality....................................................................................................................................... 23 Summary ................................................................................................................................... 29 Chapter 3: Theoretical Framework ............................................................................................... 30 Contingency Theory.................................................................................................................. 30 Theoretical/Conceptual Model.................................................................................................. 35 Hypotheses Development ......................................................................................................... 38 Summary ................................................................................................................................... 43 Chapter 4: Methods ....................................................................................................................... 44 Design ....................................................................................................................................... 44 Data ........................................................................................................................................... 45 Sample................................................................................................................................... 46 Dependent variables. ............................................................................................................. 46 Productivity. ...................................................................................................................... 47 Quality (quality indicators). .............................................................................................. 49 Independent variables. .......................................................................................................... 51 Wounded discharges. ........................................................................................................ 51 Staff FTEs. ........................................................................................................................ 51 Deployed FTE. .................................................................................................................. 53 Teaching status.................................................................................................................. 53 Branch of service. ............................................................................................................. 54 Case mix index. ................................................................................................................. 54 Statistical Modeling .................................................................................................................. 54 Multilevel modeling. ............................................................................................................. 55 Level 1 model structure. ....................................................................................................... 56 iv Page Productivity multilevel model............................................................................................... 60 Quality multilevel models. .................................................................................................... 61 Summary ................................................................................................................................... 62 Chapter 5: Results ......................................................................................................................... 64 Descriptive Analysis ................................................................................................................. 64 Mixed Effects Models ............................................................................................................... 73 Productivity. .......................................................................................................................... 73 Quality................................................................................................................................... 75 Inpatient quality indicators. .............................................................................................. 75 Patient safety indicators. ................................................................................................... 77 Sensitivity Analyses .................................................................................................................. 82 Productivity sensitivity analyses. .......................................................................................... 83 Classification of overseas hospitals as non-teaching hospital. ......................................... 83 Fixed effects models. ........................................................................................................ 85 Quality sensitivity analyses................................................................................................... 85 Classification of overseas hospitals as non-teaching hospital. ......................................... 85 Fixed effects models. ........................................................................................................ 90 Summary of Results
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