Hospice Practices, Perceived Satisfaction, and Entrepreneurial Opportunities: Strategic Insights across Geographic Settings

Abstract

Introduction(Dame) Cicely Saunders, founder of the first real hospice, was clearly an entrepreneur (Thompson, 1999: 209).As the U.S. population continues to age, an increasing number of patients and families will be facing end-of-life care. Hospice and palliative care programs are uniquely designed to offer a continuum of care to serve the physical, emotional and spiritual needs of patients and families in the last months of life. According to the National Hospice and Palliative Care Organization (NHPCO), hospice care is a model for quality compassionate care for individuals who are medically defined as terminally ill or facing life-limiting illnesses. Hospice services are directed towards caring versus curing in a variety of settings to include the patient's home, freestanding hospice centers, hospitals, nursing homes, as well as other long-term care facilities (NHPCO, 2010). As a larger proportion of the U.S. population continues to age, clearly the need and demand for hospice services in all settings will continue to accelerate over the next decade. Indeed the magnitude of this challenge is significant and growing, and has important implications for healthcare recipients, providers, and policymakers alike. A fundamental question of interest across various stakeholders is how prospective entrepreneurs and strategists in established organizations can leverage various sources of entrepreneurial opportunities these dynamic changes represent and, innovate to meet the challenge of the changing hospice care landscape (Carr, Topping, Woodard, & Burcham, 2004).This study seeks to inform both members of the hospice community and broader healthcare reform discussions by examining family perceptions of the overall satisfaction with service quality in hospice care in contrasting geographical settings. Prior research suggests there are specific factors that contribute to the patient and family members' perceptions of service quality provided during the hospice episode of care. This study extends that prior work by theoretically developing and empirically testing the central thesis that geographic disparity of services and resources (i.e., urban versus rural) influences family members' perceptions within the delivery areas for hospice services differently in urban versus rural settings. Further, it extends prior work by suggesting that the type of setting in which hospice patients are treated (and ultimately die) may also influence the perceptions of the quality of care provided. It also suggests other factors such as the lapse of time between identifying the need for hospice services and the actual delivery of the hospice services can affect the perceptions of quality care. Finally, it suggests the length of time the patient receives hospice services may also influence the perceptions of care delivered during the hospice episode.Literature ReviewEntrepreneurial OpportunityThe notion ?? entrepreneurial opportunity is at the heart of entrepreneurship theory (Stevenson & Gumpert, 1985). Entrepreneurial opportunity is defined as external environmental conditions suggesting the introduction and sale of new products, services, raw materials, and/or organizing methods at prices in excess of their production costs will be feasible (Casson, 1982; Shane & Venkataraman, 2000). Such conditions change over time, impacted in part by large shifts in attitudes, government policy, economic conditions, and technology (Hills & LaForge, 1992). Environmental conditions also change as a function of the competition. Hitt, Ireland, Camp, and Sexton (2002) observe that a new competitive landscape began to develop in the 1990s, emerged in earnest in the 21st century, and is characterized by substantial and frequently frame-breaking change, a series of temporary, rather than sustainable competitive advantages for individual firms, short product life cycles, and new forms of competition. As a result, they argue an entrepreneurial mindset is required that emphasizes carefully selected and implemented entrepreneurial strategies to compete successfully. …