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Surgeons’ efficiency change is a major determinant of their productivity change

Yoshinori Nakata (Teikyo University, Tokyo, Japan)
Yuichi Watanabe (Graduate School of Public Health, Teikyo University, Tokyo, Japan)
Hiroto Narimatsu (Cancer Prevention & Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan)
Tatsuya Yoshimura (Department of Anesthesia, Shin-Yurigaoka General Hospital, Kawasaki, Japan)
Hiroshi Otake (Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan)
Tomohiro Sawa (Medical Information and System Research Center, Teikyo University, Tokyo, Japan)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 9 May 2016



The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year.


The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI.


The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups.


EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.



Nakata, Y., Watanabe, Y., Narimatsu, H., Yoshimura, T., Otake, H. and Sawa, T. (2016), "Surgeons’ efficiency change is a major determinant of their productivity change", International Journal of Health Care Quality Assurance, Vol. 29 No. 4, pp. 417-424.



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