Improving efficiency in surgical services a production planning and control approach

The pressure to improve health while spending less money has forced healthcare organizations to find new ways of arranging their services. Healthcare organizations have widely discussed the needs of both evidence-based medicine and evidence-based management. Surgical operating units are cost-intensive, multi-professional parts of health-service production. Managing operating units efficiently is essential when hospitals and healthcare systems aim to maximize health outcomes with limited resources. The research questions this study addresses explore the phenomenon of efficiency and its improvement in operating units. The main objective is to define the features of production planning and control that maximize efficiency. Based on a literature, several strategic and operative variables could promote high efficiency. However, performance measures recently applied to operating units fail to include all relevant phenomena that affect their total efficiency. The study developed economic and technical efficiency measures that include relevant aspects when measuring operating units' output and input. We tested the measure in single-case settings. After that, we tested, in a multi-hospital study that included 26 units, 12 hypotheses that propose connections between the use of strategic and operative practices and efficiency. The study's results indicate that personnel incentive systems, especially for surgeons, and personnel flexibility improve efficiency most significantly. Units' size does not affect their performance. In general, the study reveals that operative practices, such as personnel management, case scheduling and performance measurement, affect efficiency more remarkably than do strategic decisions that relate to, e.g., units' size, scope or academic status. We also found that units with different strategic positions should apply different operative practices. Focused hospital units benefit most from hard-based practices such as sophisticated case scheduling, parallel processing and performance measurement; whereas central and ambulatory units with a wide range of services and specialties should apply soft-based initiatives, such as flexible working hours, incentives and multi-skilled personnel. This study highlights staffing issues' role in improving operating units' efficiency.