JIANGXI University of Finance and Economics

International Business Research Methodology

Assignment A

COURSE INSTRUCTOR PROFESSOR: LIU YI

ID 32340048 - David Massawe

ID32340039 - Eduardo Jose

ID 32340050 - Masumbuko Mwatujobe

ID32340037- Neusia Cossa

April 2024
Authors: Timothy Powell-Jackson, Jessica J. C. King, Christina Makungu, Matthew Quaife and
Catherine Goodman.

Date published: 18 September 2023

Date of issued: January 2024

Volume: 134

Page numbers: 436–456

Link: https://doi.org/10.1093/ej/uead075

Journal name: Economic Journal

Name of publishing: Oxford University Press on behalf of Royal Economic Society.

The key words in the title:

1.Cause – Management practices of private health care

2.Effect – Quality Care

3.Title fit in structure type: AB

Abstract:
This study investigates the impact of management practices on the quality of care
in the private health care sector in Tanzania. By analyzing data from over 220 private health
facilities, the research explores the relationship between management practices and key
quality-of-care metrics, including correct treatment rates and adherence to clinical
guidelines. The findings reveal that facilities with better management tend to provide
higher-quality care, as evidenced by improved treatment outcomes and compliance with
essential care practices. Additionally, a field experiment assessing a management support
intervention suggests that enhancing management practices in this setting may present
challenges. The study underscores the significance of effective management in driving
healthcare quality and calls for further research to explore innovative management
interventions for improving patient care in similar contexts.
 1. Research Question:
 Does quality facility and management practices are associated with quality of clinical care?
 What is the relationship between management practices and the quality of clinical care in
small and medium-sized private health facilities in Tanzania?
 How adoption of management practices influence the checklist adherence to treatment
guidelines and infection control protocols?
 What are the effects of the Safe Care intervention on management practices and the quality
of clinical care in private health facilities in Tanzania?

2. Key Argument:

The key argument presented in the content is that:

Effective management practices in health facilities play a crucial role in ensuring the delivery of
high-quality care to patients. The argument suggests that management practices are not only
important for operational efficiency but also significantly impact the quality and safety of care
provide

Key Hypothesis:

The key hypothesis of the study is that:

 There is a positive association between management practices in private health facilities

and the correct treatment of patients.
 It hypothesized that facilities with better management practices are more likely to provide
higher quality care to patients.
 It hypothesized there is positive relationship between management practices and checklist
adherence.
4. Findings:

 Indicate a positive and statistically significant association between management practices

and
 Correct treatment.
 Adherence to treatment guidelines
 Infection control measures.

Demonstrates that effective management is linked to improved quality of care in private health
facilities.

5. Result:

 Management practices in health facilities can lead to better adherence to treatment

protocols
 Improved infection control, and
 Quality care for patients.

This highlights the importance of focusing on management practices as a key factor in healthcare
quality improvement.

Table 2 presents our main results from the SPs. Panel A shows results from regressions in which
the independent variable of interest is the primary measure of management from our health facility
survey. Including no controls, we find a statistically significant and positive relationship between
management practices and correct treatment (column (1)). The coefficient falls slightly to 0.29
when we control for facility characteristics (column (2)) and remains the same with the inclusion
of SP and case fixed effects, with results significant at the 1% level (column)
6. Research Method:

 The research method employed in the study includes assessing management practices
through surveys and evaluations, analyzing the relationship between management scores
and quality of care indicators, and conducting robustness checks to validate the findings.
 The study utilizes quantitative analysis to explore the impact of management practices on
healthcare quality by using model and is shown on other page below.

7. Contribution:

 The study contributes to the existing literature by providing empirical evidence of the
significant role management practices play in influencing the quality of care in private
health facilities.
 It emphasizes the importance of effective management in healthcare settings and highlights
the potential for improving patient outcomes through better management practices.
8. Relation to Your Research:

 This question remains answered simply because every member on a group has its own tittle
of the Research therefore the question will be answered clear on individual final
presentation.

9. Worth Reading the Rest of the Article:

 It is worth reading the rest of the article to gain a comprehensive understanding of how
management practices influence the quality of care in private health facilities.
 The study provides detailed insights, empirical evidence, and implications for policy and
practice, which can inform future research and initiative.

10. Analysis of Research Question, Hypothesis, Argument, and Research Result:

Research Question:
 The research question focuses on investigating the relationship between management
practices in private health facilities in Tanzania and the quality of care provided to patients.
It seeks to understand how management practices impact treatment adherence and infection
control.
Hypothesis:

 The hypothesis posits that there is a positive association between effective management
practices and the quality of care in health facilities.
 It suggests that facilities with better management are more likely to provide correct
treatment, adhere to guidelines, and comply with infection control practices.

Argument:

 The argument presented is that management practices play a crucial role in determining the
quality and safety of care in healthcare settings.
 Effective management is not only essential for operational efficiency but also significantly
influences the delivery of high-quality care to patients.
 Research Result:
 The research findings demonstrate a significant and positive relationship between
management practices and the quality of care provided in private health facilities.
 Facilities with better management scores were more likely to deliver correct treatment,
complete checklist items, and comply with infection prevention and control practices.

11. Definition of Cause, Focus, and Effects:

 Cause: The cause in this research context is the level of management practices in private
health facilities.
 Focus: The focus is on how management practices influence the quality of care, treatment
adherence, and infection control in these facilities.
 Effects: Quality care. That is the outcomes of effective management practices, such as
improved adherence to treatment guidelines, better infection control, and overall higher
quality care for patients.

12. Quantification of Cause and Effects:

 The cause, which is the level of management practices, is quantified through a management
score based on a set of questions prepared.
 The effects, such as treatment adherence and infection control, are quantified through
metrics like correct treatment rates, completion of checklist items, and compliance with
infection prevention practices.

13. what are the proxies of A or B

 In this article on management practices and quality of care in Tanzania, the cause and
effects are quantified using various proxies and measures.
 Here are some proxies for A or B as mentioned in the article.

Proxies for Management Practices (A)

 Management Score from the Safe Care assessment: This measure of management
practices is complementary to the study's own measure and draws on distinct elements from
hospital accreditation [T2].
  Facility Survey Management Score: This score is scaled from 0 to 1 and represents the
proportion of management practices adopted in health facilities [T3].

Proxies for Quality of Care (B):

 Correct Treatment: A primary measure of quality of care, benchmarked against national

treatment guidelines, derived from data on standardized patients presenting with specific
symptoms [T4].
 Compliance with Infection Prevention and Control (IPC) Practices: Measured through
clinical observations of provider-patient interactions to ensure adherence to IPC practices
for health worker and patient safety [T4].
 These proxies help quantify the relationship between management practices and quality of
care in private health facilities in Tanzania.
 Other proxies: we used patient volume (number of patient visits per month) to weight the
data. By fitting a weighted version of (1), the results reveal the association between
management and quality for the average patient.

14. Observations and Time-Range:

 The research story involves observations of over 220 private health facilities in Tanzania
across 64 districts.
 The time-range of the research is not mentioned in the journal, but it likely spans the period
during which data collection and analysis took place, according our views it is collect
within one year that is data collected at once -cross sectional data.

15. Definition and Quantification of Research Target:

 The research target is defined as the relationship between management practices and the
quality of care in private health facilities.
 It is quantified through the assessment of management scores and their correlation with
treatment adherence, checklist completion, and infection control practices.
16. What are the Evidence to Support the Research Hypothesis?

 The evidence provided to support the research hypothesis includes the significant
association found between management practices and quality of care metrics in the study.
 The positive relationship between management scores and correct treatment rates, checklist
completion, and compliance with infection control practices serves as empirical evidence
validating the hypothesis aimed at enhancing healthcare quality through effective
management strategies.

16.1. Estimation Framework

 We estimate the relationship between management practices and quality, where the latter
is measured by correct case management of SPs and compliance with IPC practices.
 For SPs, we estimate q(i(scf )r) = β0 + β1MNGMT f + β 2X f + δs + δc + δr + μ(i(scf )r),
(1) which regresses quality q (correct treatment and other SP measures of quality) in
consultation i with standardised patient s presenting case c in health facility f and region r
on the management practice score.
 The coefficient of interest is β1. Our analysis considers both measures of management: the
facility survey management score and the management score from the SafeCare
assessment. We control for X f , a vector of facility characteristics: the type of health
facility, whether it is for-profit or non-profit, urban location and the SafeCare trial arm.
 our main model includes fixed effects for SPs (δs), case (δc) and region (δr) to account for
systematic differences across them. Given that the analysis is at the level of the SP visit
and we have multiple visits per facility, we cluster SEs at the facility level.

16.2.q(n(ipf )r) = β0 + β1MNGMT f + β 2X f + β 3Zi + δn + δr + μ(n(ipf )r),

 regressing compliance with IPC practices q for indication n in patient observation i with
health provider p in health facility f and region r on the management practice score;
 β1 is again the coefficient of interest.
 With clinical observations, we lose the advantage of SPs to be able to compare across
providers without confounding due to patient case mix.
 At the same time, IPC compliance, as a measure of patient safety, is less likely to be
conditional on the patient.
  Nonetheless, we adjust for patient characteristics, Zi , by including controls for patient age
and gender. Given that compliance varies substantially by IPC domain, we include indication
fixed effects, δn.
 As before, we cluster SEs at the facility level. It bears noting that we observed patients for
a fixed number of hours, which means that facilities with higher patient volume will
implicitly be given a greater weight in the analysis.

Table 2. Management and Quality of Care for Standardised Patients.

(1) (2) (3) (4) (5) (6) (7)

Control
Sample Full Full Full group Full Full Full
Proportion
of checklist IRT Any N
Correct Correct Correct Correct items checklist unnecessary a
Dependent variable treatment treatment treatment treatment completed score care p
Panel A: facility management survey
Management score 0.337∗∗∗ 0.291∗∗∗ 0.290∗∗∗ 0.489∗∗∗ 0.104∗∗∗ 0.740∗∗∗ −0.036 −
(0.069) (0.073) (0.073) (0.108) (0.038) (0.221) (0.078)
General controls No Yes Yes Yes Yes Yes Yes
SP and case fixed effects No No Yes Yes Yes Yes Yes
Facilities 227 227 227 116 227 227 227
Observations 909 909 909 465 908 908 909
R2 0.018 0.046 0.398 0.441 0.225 0.221 0.157
Bias-adjusted coefficient — — 0.267 0.499 0.084 0.614 −0.013 −
Panel B: SafeCare standards
Management score 0.308∗∗∗ 0.228∗∗ 0.213∗ 0.446∗∗ 0.196∗∗∗ 1.264∗∗∗ −0.140 −
(0.088) (0.107) (0.110) (0.180) (0.049) (0.257) (0.102)
General controls No Yes Yes Yes Yes Yes Yes
SP and case fixed effects No No Yes Yes Yes Yes Yes
Facilities 219 219 219 110 219 219 219
Observations 877 877 877 441 876 876 877
R2 0.011 0.039 0.395 0.444 0.238 0.231 0.160
Bias-adjusted coefficient — — 0.156 0.402 0.209 1.330 −0.166 −
Notes: The table reports OLS coefficients with SEs in parentheses, clustered at the facility level. In panel A, the management score from the
facility survey is the unweighted average of the score on each of the 13 management questions. In panel B, the management score from the
SafeCare assessment is the unweighted average of the score on each of the 55 management-related items that were pre-specified prior to
data collection. Observations are at the SP visit level. The full sample is used in all regressions, with the exception of column (4) in which the
sample is limited to facilities assigned to the control arm of the SafeCare field experiment. General controls capture characteristics: facility type,
region,

profit status, urban location and SafeCare trial arm. SP fixed effects are a dummy variable for each of the SP fieldworkers. Case fixed effects are a

dummy for each of the SP case presentations. The bias-adjusted coefficient is the value of β produced when δ = 1 and Rmax = 1.3 R˜ . ∗∗∗

significant at 1%, ∗∗ at 5%, ∗ at 10%

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 Table 3. Management and Compliance with Infection Prevention and Control Practices.
(1) (2) (3) (4) (5)
Control
Sample Full Full Full Full group
IPC IPC IPC IPC IPC
Dependent variable compliance compliance compliance compliance compliance
Panel A: facility management survey
Management score 0.089∗∗ 0.113∗∗∗ 0.106∗∗∗ 0.062∗∗ 0.088∗∗
(0.038) (0.037) (0.038) (0.031) (0.038)
General controls No Yes Yes Yes Yes
Patient controls No No Yes Yes Yes
Indication fixed effects No No No Yes Yes
Facilities 220 220 220 220 220
Observations 29,608 29,608 29,608 29,608 15,242
R2 0.001 0.006 0.008 0.640 0.644
Bias-adjusted coefficient — — — 0.047 0.070
Panel B: SafeCare assessment
Management score 0.060 0.144∗∗∗ 0.137∗∗∗ 0.077∗∗ 0.071
(0.042) (0.050) (0.050) (0.037) (0.054)
General controls No Yes Yes Yes Yes
Patient controls No No Yes Yes Yes
Indication fixed effects No No No Yes Yes
Facilities 212 212 212 212 108
Observations 29,054 29,054 29,054 29,054 14,773
R2 0.000 0.006 0.008 0.643 0.651
Bias-adjusted coefficient — — — 0.088 0.041

Notes: The table reports OLS coefficients with SEs in parentheses, clustered at the facility level. The dependent variable is compliance with
infection prevention and control practices in all regressions. Observations are at the level of IPC indication. In panel A, the management
score from the facility survey is the unweighted average of the score on each of the 13 management questions. In panel B, the management
score from the SafeCare assessment is the unweighted average of the score on each of the 55 management-related items that were pre-
specified prior to data collection. The full sample is used in all regressions, with the exception of column (5) in which the sample is limited
to facilities assigned to the control arm of the SafeCare field experiment. General controls capture characteristics: facility type, region, profit
status, urban location and SafeCare trial arm. Patient controls are age and gender of the patient observed. Indication fixed effects are a
dummy variable for each IPC indication. The bias-adjusted coefficient is the value of β produced when

δ = 1 and Rmax = 1.3 R˜ . ∗∗∗ significant at 1%, ∗∗ at 5%.

17. Legitimacy of the Research Question:

 Practically: The research question is practical as it addresses a significant issue in

healthcare - the impact of management practices on the quality of care. Understanding this
relationship is crucial for improving healthcare delivery.
 Quantifiably: The research question is quantifiable as it aims to measure management
practices in health facilities and link them to quality-of-care metrics, providing concrete
data for analysis. This is done through regression analysis, allowing for statistical
assessment of the relationship between management practices and quality indicators
 Significantly: The research question is significant as it addresses a gap in the literature
regarding the influence of management practices on healthcare quality in low-income
settings like Tanzania.
 Scientifically: The research question is scientifically valid as it follows a systematic
approach to investigate the relationship between management practices and quality of care,
using empirical data and analysis.
 Usefully: The research question is useful as the findings can inform policy decisions,
healthcare management strategies, and quality improvement initiatives in both Tanzania
and similar settings.

18. Relationship between Research Targets and Variables:

 The research targets, which include management practices in private health facilities and
the quality of care provided, are directly related.
 The variables involved in the study include the management score, treatment adherence,
checklist completion, and infection control practices.
 The study aims to analyze how variations in management practices impact these quality-
of-care variables.

19. Theory Used in the Research:

 The theory used in the research are organizational management theories, quality
improvement frameworks, and healthcare performance models.
  These theories may focus on how effective management practices can enhance operational
efficiency, ensure adherence to guidelines, and improve patient outcomes in healthcare
settings.

20. Relation of Theory with Research Question:

 The theory used in the research is relevant to the research question as it provides a
conceptual framework for understanding how management practices influence the quality
of care in health facilities.
 By applying relevant theories, the study aims to explain the mechanisms through which
management practices impact healthcare quality.

21. Method to Validate or approve the Theory:

 The method used to validate the theory likely involves empirical analysis, statistical
modeling, and hypothesis testing.
 By collecting data on management practices and quality-of-care metrics, the study can
assess the extent to which the observed relationships align with the theoretical expectations.
 Statistical methods may be used to confirm or refute the theoretical propositions put forth
in the research.

22. To incorporate the story with the data sampling. Explain how the data serves for the
story?

 The data sampling in the research study involves collecting information over 220 private
from profit and non-profit health facilities in 64 districts across Tanzania, focusing on
management practices and quality-of-care metrics.
 The data serves the story by providing concrete evidence to support the research question
regarding the relationship between management practices and healthcare quality.
 Through data sampling, the researchers can analyze how variations in management
practices impact treatment adherence, checklist completion, and infection control practices,
thus weaving a narrative that links management effectiveness to patient outcomes.
23. Build a dataset that serves the research question:

 To build a dataset that serves the research question, the researchers would need to collect
information on management practices in private health facilities, including operational,
performance monitoring, human resource, and financial management aspects.
 Additionally, data on quality-of-care metrics such as treatment adherence rates, checklist
completion, and compliance with infection control practices would be essential.
 By aligning the dataset with the research question, the researchers can analyze the
relationship between management practices and healthcare quality effectively.

24. Story and Research Result Connection:

 The data heterogeneity in the study, stemming from the diverse sample of private health
facilities in Tanzania, helps to explain the cause and effects of management practices on
healthcare quality.
 By including facilities of varying sizes, locations, and ownership structures, the researchers
can capture a broad spectrum of management practices and their impact on patient care.
 This diversity in data allows for a comprehensive analysis of how different management
approaches influence treatment outcomes and infection control measures, providing a
nuanced understanding of the cause-and-effect relationships.

25. Connection between Academic Value and References: The author builds a connection
between academic value and references by citing relevant literature, such as studies on
management practices in healthcare settings and quality improvement interventions. By
referencing established theories and empirical evidence, the author enhances the academic rigor
and credibility of the research. Drawing on a diverse range of references helps situate the study
within the existing body of knowledge, demonstrating how the research contributes to advancing
understanding in the field. Additionally, by referencing previous studies that support the research
hypothesis, the author strengthens the theoretical foundation of the study and underscores its
academic significance
AUTHOR AND YERA MAJOR FINDINGS.

(1Bloom et al. , 2015 ; Tsai et al. , 2015 Both have shown a strong positive relationship between hospital performance and m
; McConnell et al. , 2016 ). 3

Bloom, N., & Van Reenen, J. (2007). highlights the importance of management practices in improving productivity and w

Bloom, N., Propper, C., Seiler, S., & Demonstrates a positive relationship between competition, management quality, an
Van Reenen, J. (2015) clinical quality metrics.

Tsai, T. C., Jha, A. K., Gawande, A. A., Shows a strong correlation between hospital board and management practices an
Huckman, R. S., & Bloom, N. (2015). clinical quality metrics.

Powell-Jackson, T., King, J. J. C., The study shows, better-managed health facilities are linked to improved treatmen
Makungu, C., Quaife, M., & Goodman, infection control, underscoring the importance of effective management in healthcar
C. (2023).

Bloom, N., Eifert, B., Mahajan, A., This Indian study highlights how management practices positively affect organizatio
McKenzie, D., & Roberts, J. (2013). quality of care.

Berendes, S., Heywood, P., Oliver, S., This review emphasizes ambulatory healthcare quality in low and middle-in
& Garner, P. (2011). management practices' significance in both private and public healthcare.

THANK YOU.