3) Social and Institutional Resources
Identifying the significant role of social and institutional factors, we draw a hypothesis to examine whether social or institutional factors can affect organizational performance in the healthcare sector. A community characteristic, such as racial composition, reflects the distribution of available resources and the task environment the organization serves, directly impacting its performance (Pendeya & Oyama, 2019).
In the healthcare sector, this tendency has become more apparent. The socioeconomic conditions of a community determine the demand for healthcare services and are likely to affect the performance of hospitals. Community segregation is a primary cause of racial differences in Socioeconomic Status (SES), and it remains a fundamental cause of a racial gap in health (Williams & Collins, 2001). The literature suggests that minorities exhibit lower levels of trust in their physicians compared to Whites, are more inclined to seek care from providers of lower quality, and demonstrate lower health literacy. In addition, their neighborhoods often lack resources, including diminished social capital and higher incidences of substance abuse, smoking, or violence (Chen et al., 2017). These racial compositions in a community directly affect their health status and needs, increasing a hospital’s uncertainty in managing their outcomes.
Similarly, hospitals in communities with lower income, lower educational attainment, and higher minority populations showed lower quality of care (Shi et al., 2020). Therefore, previous studies acknowledged the impact of racial composition as a critical social attribute that determines the performance of hospital and community health outcomes (Williams & Collins, 2001; Chen et al., 2017; Shi et al., 2020; Golestaneh et al., 2021). This study hypothesizes that hospitals in a county with higher non-white populations are negatively associated with their quality of care and patient satisfaction.
H3-1: Hospitals located in a county with higher non-white populations are less likely to provide better quality of care.
H3-2: Hospitals located in a county with higher non-white populations are less likely to lead to higher patient satisfaction.