Tyler Towers and Jonathan Clark earn Academy of Management ‘best paper’ honors

A study by Tyler Towers, a recent doctoral graduate, and Jonathan Clark, assistant professor, has been judged by reviewers to be among the best papers accepted for inclusion in the 2013 Academy of Management annual meeting.

Titled "The Cyclical Impact of Joint Commission Site Visits on Risk-Adjusted Mortality Rates in Hospitals,” the paper will be featured at the August 2013 meeting in Lake Buena Vista (Orlando), Florida.

For the study, the researchers obtained 10 years of New Jersey hospital discharge data (1999-2008) from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID), administered by the Agency for Healthcare Research and Quality (AHRQ). They found that accreditation site visits lead to temporarily improved mortality rates. The researchers argue that these temporary improvements are consistent with the idea that site visits trigger changes in patient care processes, which presumably bring these processes into closer alignment with Joint Commission standards, but that those process changes tend to evaporate in the weeks immediately following the site visit.

The authors provide two possible reasons why hospitals might allow such improvements to evaporate. First, “hospital personnel simply do not notice the improvements as they are occurring. This oversight may be particularly likely to occur when hospital personnel consider accreditation—rather than improved patient outcomes—as the primary objective of the accreditation process.”

Second, some hospitals might be more capable of sustaining the process changes that drive these improvements. Towers explains, “Hospitals are such complicated organizations, and they constantly face a multitude of competing demands from the external environment. Accordingly, the ability to sustain accreditation-induced improvements might depend on the organization’s ability to avoid becoming distracted away from the improved processes. As such, the ability to sustain these improvements might be rooted in having the resource slack and strategic flexibility to simultaneously direct the organization’s attention across multiple competing demands.” The authors support this conclusion by showing that hospitals with more resource slack have both better mortality rates overall and little or no fluctuation around accreditation site visits.

“It is important to note that the cyclical improvements we observe are primarily an issue among resource challenged hospitals,” Towers explains. “Therefore, from our perspective, leaders of such hospitals should understand both that the practices embedded in the Joint Commission standards work and that sustaining those practices depends on their ability to maintain the organization’s attention in that direction.”

The study will be published later this year as part of the 2013 volume of the Academy of Management Annual Meeting Proceedings.