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In a Niche of Time: Do Specialty Hospitals Outperform General Services Hospitals?

Poole, LeJon PhD; Davis, Jullet A. PhD, MHA; Gunby, Norris W. Jr PhD, MHA

doi: 10.1097/HCM.0b013e31827ed80b

Niche hospitals represent a growing segment in the health care industry. Niche facilities are primarily engaged in the treatment of cardiac or orthopedic conditions. The effectiveness of this strategy is of interest because niche hospitals focus on only the most profitable services. The purpose of this research was to assess the financial effectiveness of the niche strategy. We theorize that firm and market-level factors concomitantly with the strategy of the hospital—niche versus traditional—are associated with financial performance. This research used 2 data sources, the 2003 Medicare Cost Report and the 2003 Area Resource File. The sample was limited to only for-profit, urban, nongovernmental hospitals (n = 995). The data were analyzed using hierarchical least squares regression. Financial performance was operationalized using the hospital’s return on assets. The principal finding of this project is that niche hospitals had significantly higher performance than traditional facilities. From the organizational perspective, the niche strategy leads to better financial performance. From a societal perspective, the niche strategy provides increased focus and efficiencies through repetition. Despite the limited focus of this strategy, patients who can access these providers may experience better outcomes than patients in more traditional hospitals.

Author Affiliations: Healthcare Management, Lundy-Fetterman School of Business, Campbell University, Buies Creek, North Carolina (Dr Poole); Management and Marketing Department, University of Alabama, Tuscaloosa (Dr Davis); and Department of Management, Innovation and Entrepreneurship, North Carolina State University, Raleigh (Dr Gunby).

The project was supported by funding from Fayetteville State University Graduate School.

The authors have no conflicts of interest.

Correspondence: LeJon Poole, PhD, Lundy-Fetterman School of Business, Campbell University, PO Box 218, 165 Dr McKoy Rd, Buies Creek, NC 27506 (

© 2013 Lippincott Williams & Wilkins, Inc.