All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Douglas J Ayers

Emily Bess Levitan

Stephen J O'Connor

Grant T Savage

Ferhat Zengul

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Quantitative scores enumerating patient experience with care have been introduced to healthcare via the Patient Protection and Affordable Care Act of 2010. Consumers can now compare with relative ease, different healthcare providers on the basis of standardized metrics. As government mandated transparency initiatives become commonplace as a result of the law, hospitals are more cognizant of how patient experience with care (operationalized using Hospital Consumer Assessment of Healthcare Providers and Systems: HCAHPS) has an impact on where patients decide to seek treatment. The proliferation of technological tools now enables patients to make meaningful quality and cost comparisons across providers. HCAHPS scores and other publicly available comparative data, is theorized to have an effect on hospital financial performance. In lieu of this era of transparency and its resulting fiscal consequences, hospitals might be more inclined to strategically allocate resources, exercise certain strategies, or make strategic investments in quality improvement programs to achieve maximum financial performance. Taken together and examined independently, market and organizational factors are hypothesized to influence HCAHPS scores. It is also posited that a larger market share may mediate the relationship between HCAHPS and financial performance. When hospitals achieve higher HCAHPS scores than their competitors, they are hypothesized to capture a higher share of the market. With a larger market share, they would be able to achieve better experience-based economies of scale, which results in higher revenue. Assuming that they are able to sustain their differentiation strategy of consistently high HCAHPS scores, hospitals are theorized to achieve better financial performance than its competitors. The relationship between HCAHPS and financial performance is hypothesized to be moderated by competition, because it increases the pressure on hospitals to deliver quality patient experience at a competitive cost. This dissertation addresses the following research questions: 1. Among organizational, market, and patient factors, which are significant predictors of HCAHPS scores at the hospital level? 2. Do higher HCAHPS scores result in better financial performance? 3. Is patient market share a mediator of the relationship between HCAHPS scores and financial performance? 4. Is market competition a moderator of the relationship between HCAHPS scores and financial performance?



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