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Hospital operations and length of stay performance

Christopher McDermott (Lally School of Management, Rensselaer Polytechnic Institute, Troy, New York, USA)
Gregory N. Stock (Department of Operations Management and Information Systems, College of Business, Northern Illinois University, DeKalb, Illinois, USA)

International Journal of Operations & Production Management

ISSN: 0144-3577

Article publication date: 14 August 2007




As hospital costs continue to rise, increasing attention is being paid to the way these organizations are and should be managed. This attention typically comes in the form of focus on costs of services, quality (often measured through mortality rates) and length of stay. Hospital management has a broad array of choices at their disposal to address these challenges. As service operations, hospitals present a significant opportunity to apply the many tools and techniques from the field of operations strategy to this important industry. The objective of this paper is to use the operations strategy framework to assess the relationship between a set of operational elements and hospital performance in terms of average length of stay (ALOS), so that hospital managers improve the effectiveness and efficiency of patient care of their hospitals.


Using the structural and infrastructural operations strategy framework, this study examines the relationship between several strategic variables and hospital performance. To analyze these relationships the paper employs data from the population of hospitals in New York State. The performance measure is the ALOS for patients, adjusted for the mix and severity of cases in each hospital.


The paper finds that a direct relationship exists between the dependent variable and location, capacity, and teaching status, and failed to find a direct relationship for capital expenditures, salary, and staffing levels. However, the paper did find significant interaction effects between capital expenses and both salary and staffing levels.

Practical implications

There appear to be trade‐offs between capital expenditures and workforce decisions that have significant implications in light of current and expected hospital staffing shortages. The findings indicate that reductions in staff may not be perfectly replaced by corresponding increases in capital expenditures.


This paper further expands the body of research that addresses the important challenges hospitals face from an operations management perspective.



McDermott, C. and Stock, G.N. (2007), "Hospital operations and length of stay performance", International Journal of Operations & Production Management, Vol. 27 No. 9, pp. 1020-1042.



Emerald Group Publishing Limited

Copyright © 2007, Emerald Group Publishing Limited

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