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Virginia Commonwealth University

1. Lucas, D. Pulane. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.

Degree: PhD, Public Policy & Administration, 2013, Virginia Commonwealth University

Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into… Advisors/Committee Members: Carl F. Ameringer, Roice D. Luke, Wally R. Smith, I-Shian Suen.

Subjects/Keywords: Disruptive; Disruptive Innovation Theory; Disruptive Transformations; Disruptive Innovation; Innovation; Technology; Technological Innovation; Medical Innovation; Medical Technology; Medical Advancement; Laparoscopy; Laparoscopic Surgery; open surgery; appendectomy; cholecystectomy; bariatric surgery; weight loss surgery; appendectomies; cholecystectomies; inpatient; outpatient; ambulatory; ambulatory surgery; ambulatory surgery center; acute care general hospital; hospital; acute care hospital; general hospital; health care; healthcare; hospital industry; health care industry; Clayton Christensen; Clayton M Christensen; Michael Porter; Harvard Business School; Virginia Commonwealth University; Center for Medicare & Medicaid Services; CMS; Health policy; public policy; public administration; organizational theory; organization theory; Population Ecology Theory; Competitive Strategy; policy analysis; John Kimberly; Organization Size; Structural Inertia; liability of smallness; health spending; health care cost; specialty medical facility; open system; niche width dynamic; outpatient department; technology shift; surgical setting; surgical setting shift; medical facility shift; substitution threat; health system; system level analysis; Ecological Approach; hospital trends; ambulatory surgery trends; reimbursement rate; Medicare; CMS coverage decision; P J DiMaggio; DiMaggio and Powell; w w Powell; Hannan and Freeman; M T Hannan; Organizational change; minimally invasive surgery; less invasive surgery; Prospective Payment System; Outpatient Prospective Payment System; entreprenuerial physician; health care organization; health care management; Roice Luke; Carl Ameringer; new technology; surgical utilization; elective surgery; Medicare Payment Advisory Commission; MedPAC; coverage decision; trends in surgery; abdominal surgery; surgical variation; physician-owned; physician ownership; physician autonomy; outpatient clinic; utilization trends; unnecessary surgery; Pfeffer Salancik; technology diffusion; redefining health care; interdisciplinary research; health care delivery; panel design; diffusion of hospital technology; state variation; regional variation; local health care market; government intervention; medical facility; health care capacity; focused factory; advances in health care; physician organization relationship; hospital competition; medical specialization; hospital expansion; medical arms race; integrated care; integrated health system; J E Wennberg; health care transformation; reimbursement scheme; surgical volume; Florida; Wisconsin; policy making; health policy analysis; competitive dynamics; center of excellence; intervening factor; service line competition; service-line competition; surgical reimbursement; innovative business model; innovative technology; environmental influence; established firm; new market entrant; patient safety; sophisticated technology; Harvard Divinity School; Wilder School of Government and Public Affairs; Public Affairs, Public Policy and Public Administration; Social and Behavioral Sciences

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Lucas, D. P. (2013). Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. (Doctoral Dissertation). Virginia Commonwealth University. Retrieved from ;

Chicago Manual of Style (16th Edition):

Lucas, D Pulane. “Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.” 2013. Doctoral Dissertation, Virginia Commonwealth University. Accessed February 24, 2020. ;

MLA Handbook (7th Edition):

Lucas, D Pulane. “Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.” 2013. Web. 24 Feb 2020.


Lucas DP. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. [Internet] [Doctoral dissertation]. Virginia Commonwealth University; 2013. [cited 2020 Feb 24]. Available from: ;

Council of Science Editors:

Lucas DP. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. [Doctoral Dissertation]. Virginia Commonwealth University; 2013. Available from: ;