• Eric G Kirby, Michael J Keeffe, and Kay M Nicols.
• Department of Management, McCoy College of Business Administration, Texas State University, San Marcos, TX, USA. egkirby@txstate.edu
• Health Care Manage Rev. 2007 Oct 1;32(4):352-9.

BackgroundDue to changes in social norms, funding initiatives, and other environmental factors, the business of hospice care has significantly evolved over the past 40 years. There has been an influx of for-profit firms, increased consolidation, and significant funding changes. We have witnessed a growth in utilization rates, an increase in insurance coverage, and improved governmental funding. Hospice care organizations have responded to these pressures by pursuing more efficient and innovative business practices.PurposeDrawing upon institutional theory, this study seeks to address whether quality of care provided to hospice patients is affected as organizations respond to environmental pressures for innovative and efficient business practices.Methodology/ApproachThis study uses hierarchical regression to analyze data from 111 hospices in California.FindingsInnovative practices are positively related to quality of care. However, efficient practices have no significant relationship with quality of care.Practical ImplicationsIt appears that incorporating innovative practices is positively related to quality of care. Although cost containment may be necessary for continued survival, efficiency improvement efforts do not seem to lead to improved quality of care.

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