In this study we examine the association of clinical quality and clinical flexibility capabilities on cardiology unit length of stay and cost performance. These relate to the operational performance of cardiology units and capture the timeliness and cost efficiency of cardiac care. We also investigate the complementary role played by the experiential quality in enhancing the impact of clinical quality and clinical flexibility on operational performance measure. Experiential quality relates to patient‐centered delivery of care by a hospital. We collect and combine data for 876 U.S. hospitals from four distinct sources and undertake multi‐level analyses that consider a hierarchical structure in which the hospital is nested within county and state. To disentangle the effects at the levels of states, counties, and hospitals, we use the mixed‐effects modeling approach. The results obtained from econometric analyses indicate that clinical quality and clinical flexibility reduce cardiology unit average length of stay. Clinical flexibility also helps in reducing the average cost of cardiology units. Experiential quality moderates the impact of clinical quality on length of stay and plays a complementary role in the relationship between clinical flexibility and cost. The paper discusses the implications of the findings and presents directions for future research.

In today's highly competitive environment, a goal-oriented supply chain needs coordination to manage the interdependent activities of supply chain partners. The role of coordination mechanisms is critical in achieving supply chain performance. We thus suggest that supplier coordination and customer coordination influence performance, operationalised in this paper under two dimensions, e.g., quality and flexibility. Moreover, drawing on contingency theory, we suggest that the relationships are contingent upon factors such as firm size and clockspeed. Using empirical data collected from 197 production/operations managers of Chinese manufacturing firms, a regression analysis approach is employed to test the theoretical framework. The results provide support for the four direct and positive relationships between each coordination mechanism studied and quality and flexibility performance. The interaction between supplier coordination and size was directly and positively related to quality performance (large size effect). However, the interaction between customer coordination and size was directly and negatively related to flexibility performance (small size effect). The interaction between supplier coordination and clockspeed was directly and positively related to only flexibility performance. Implications for managers and academics and suggestions for future research are offered.

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Purpose -The purpose of this paper is to verify whether product orientation (make-to-order versus make-to-stock) affects how coordination mechanisms combine to influence quality performance in total quality management (TQM). Design/methodology/approach -The authors used survey response data from a large sample of single industry respondents (auto supplier industry) to test the research model. Findings -The study found support for the idea that organizational and inter-organizational coordination mechanisms influence product and process quality performance. Moreover, significance of many of these linkages varied according to whether the product orientation was make-to-order or make-to-stock. The study is one of the first to suggest that the influence of select coordination factors on performance can vary according to product orientation.Research limitations/implications -The study suggests that plant managers may pursue different approaches to implement select coordination factors (not all) according to whether their product focus is make-to-stock or make-to-order. Practical implications -The research isolates those select coordination mechanisms which have significantly different performance effects in one product orientation environment (make-to-order) versus another (make-to-stock). Managers interested in TQM implementation can gain insights into those select coordination mechanisms identified in this study that could positively enhance product quality and process quality performance. Originality/value -To the knowledge of the authors, this is the first study that has examined the contextual influence of product orientation on the relationships between select coordination mechanisms in TQM implementation and their impact on process and product quality.

This study examines lean implementation's effects on hospital financial performance using survey and secondary data for a large sample of US hospitals. Using sociotechnical systems theory, a social context is identified that should motivate the use of lean process improvement tools (LPT) in a hospital setting and accentuate its performance benefits. Shah and Ward's employee involvement (EI) construct is adapted to a hospital setting to define a supportive social context for LPT, which is further shaped by organizational psychological safety (PS). The research model depicts PS as amplifying the effect of EI on LPT, which, in turn, influences a hospital's return on assets (ROA) via three potential pathways: (a) through enhanced revenues; and/or (b) through reduced hospital discharge costs; and/or (c) directly. The results show that EI engenders LPT and that this effect is heightened as PS improves. LPT is shown to positively impact ROA indirectly through higher revenues, but not through lower discharge costs. The findings reveal positive, indirect effects of EI on revenue and profitability at moderate/high levels of PS. Robustness is investigated using an alternate performance metric-hospital excess margin-with consistent results. Post hoc analyses explore potential mechanisms through which lean implementation may increase hospital revenues, including hospital throughput (discharges), readmission rate, experiential quality, length of stay, and overall patient recommendation. The analyses reveal that the impact of LPT on hospital revenue is potentially realized through higher hospital discharges. Overall, the study demonstrates that lean implementation as a sociotechnical system contributes to superior performance. K E Y W O R D Semployee involvement, healthcare management and hospital performances, hospital process improvement, lean tools, psychological safety climate 1