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Purpose – This paper focuses on efficiency as a central theme of the Italian health care reforms, combining macrolevel policies with microlevel (i.e., operating room) perceptions of the concept.

Design/Methodology/Approach – According to the phenomenographic approach, this analysis investigates how the components of a surgical team (22 semistructured interviews) experience efficiency in their daily workflows.

Findings – The main findings show that the concept of efficiency is multidimensional. According to participants’ perspective, several categories of efficiency collected in an outcome space emphasize an holistic view of efficiency driving health policies and strategies.

Social implications – The suggestion of further relationships between perspectives and other constructs (i.e., quality, safety, patient focus, process) at micro and macro level could enhance the impact of health reforms.

Originality/Value – A qualitative approach conducted at microlevel help to recognize the phenomenon (of efficiency), engaging the individual conception that practitioners have of the health efficiency.

The high variability in cardiac surgery length – is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open‐heart surgery operating theatre productivity.

A discrete operating theatre event simulation model with empirical operation time input data from 2,603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time.

A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work.

A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open‐heart surgery.

The challenge in scheduling two open‐heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired.

A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

Overall equipment effectiveness (OEE) is a performance indicator that is been used to measure manufacturing productivity. The purpose of this paper is to propose the operating room effectiveness for hospital operating rooms (ORs), adapted from the OEE, to measure performance and identify losses based on lean health-care principles.

The present study is an exploratory, descriptive and applied research work. Literature review, documents of the hospital, observation and interviews with employees of a large university hospital in southern Brazil were analyzed to organize the proposed effectiveness indicator. After that, historical data of the ORs was collected and the usefulness of the indicator was analyzed. The indicator was applied for 10 months and validated with an expert committee from the hospital.

The present study describes an adaptation of a performance indicator to ORs of hospitals, allowing to classify its types of operational losses in a lean health-care context. The application of this indicator and the development of improvement actions to a university hospital, resulted in operational efficiency gains of 12 per cent and estimated annual savings of US$400,000.

ORs are a critical service for hospitals. This paper presents a new way to measure the performance of ORs and identify their main types of wastes. It also shows how to implement it and the potential gains of its application. The main research limitations are related to technical analysis of care data from doctors and nurses involved.

This paper fulfills the need to study how ORs performance can be measured and its operational wastes can be identified. In addition, this paper classifies the planning, performance and quality related losses, which can be used by researchers and practitioners to improve the performance of operation rooms.

The purpose of this paper is to generate a daily operating theater schedule aiming to minimize completion time and maximum overtime while integrating real-life surgeon constraints, such as their role, specialty, qualification and availability.

The paper deals with complete surgery process using multi-objective surgery scheduling approach. Furthermore, the combinatorial nature of the studied problem does not allow to solve it to optimality. Therefore, the authors developed two approaches embedded in a tabu search metaheuristic, namely, weighted sum and e-constraint, to minimize completion time and maximum overtime.

The integration of the upstream and downstream services of an intervention and the consideration of the specific constraints related to surgeons are very essential to obtaining more closed schedules to the realty.

The paper includes implications for the development of efficient schedules for a significant number of operations coming from different specialties throughout its complete surgery process under multi-resource constraints.

The paper can help hospital managers and decision makers to well manage the budget by minimizing the overtime cost and by offering efficient daily operating theater schedule.

The results of the paper will help hospital managers and decision makers to well manage the budget by minimizing the overtime cost and offering efficient daily operating theater schedule.

Benchmarking is increasingly considered a useful management instrument to improve performance in healthcare. The purpose of this paper is to assess if a nationwide long-term benchmarking collaborative between operating room (OR) departments of university medical centres in the Netherlands leads to benefits in OR management and to evaluate if the initiative meets the requirements of the 4P-model.

The evaluation was based on the 4P-model (purposes, performance indicators, participating organisations, performance management system), developed in former studies. A mixed-methods design was applied, consisting of document study, observations, interviews as well as analysing OR performance data using SPSS statistics.

Collaborative benchmarking has benefits different from mainly performance improvement and identification of performance gaps. It is interesting that, since 2004, the OR benchmarking initiative still endures after already existing for ten years. A key benefit was pointed out by all respondents as “the purpose of networking”, on top of the purposes recognised in the 4P-model. The networking events were found to make it easier for participants to contact and also visit one another. Apparently, such informal contacts were helpful in spreading knowledge, sharing policy documents and initiating improvement. This benchmark largely met all key conditions of the 4P-model.

The current study has the limitations accompanied with any qualitative research and particularly related to interviewing. Qualitative research findings must be viewed within the context of the conducted case study. The experiences in this university hospital context in the Netherlands might not be transferable to other (general) hospital settings or other countries. The number of conducted interviews is restricted; nevertheless, all other data sources are extensive.

A collaborative approach in benchmarking can be effective because participants use its knowledge-sharing infrastructure which enables operational, tactical and strategic learning. Organisational learning is to the advantage of overall OR management. Benchmarking seems a useful instrument in enabling hospitals to learn from each other, to initiate performance improvements and catalyse knowledge-sharing.

This paper aims to create a model for evaluating organizational change initiatives from a stakeholder resistance viewpoint.

The paper presents a model to evaluate change projects and their expected benefits. Factors affecting the challenge to implement change were defined based on stakeholder theory literature. The authors test the model's practical validity for screening change initiatives to improve operating room productivity.

Change initiatives can be evaluated using six factors: the effect of the planned intervention on stakeholders' actions and position; stakeholders' capability to influence the project's implementation; motivation to participate; capability to change; change complexity; and management capability.

The presented model's generalizability should be explored by filtering presented factors through a larger number of historical cases operating in different healthcare contexts. The link between stakeholders, the change challenge and the outcomes of change projects needs to be empirically tested.

The proposed model can be used to prioritize change projects, manage stakeholder resistance and establish a better organizational and professional competence for managing healthcare organization change projects.

New insights into existing stakeholder‐related understanding of change project successes are provided.

To explore the perceptions of surgical team members in a tertiary hospital in Jordan toward the factors influencing patient safety culture (PSC).

This was a qualitative descriptive study intended to characterize the factors that influence PSC. Interviews were conducted with health-care providers in the operation room (OR) in a tertiary Jordanian hospital. Participants included surgeons, anesthetists, nurses and senior surgical residents who had worked for three years minimum in the OR. Thematic analysis was used to analyze the data.

A total of 33 interviews were conducted. Thematic analysis of the content yielded four major themes: (1) operational factors, (2) organizational factors, (3) health-care professionals factors and (4) patient factors. The respondents emphasized the role of the physical layout of the OR, implementing new techniques and new equipment, and management support to establish a safety culture in the operating room setting.

The present research study will have implications for hospitals and health-care providers in Jordan for developing organizational strategies to eliminate or decrease the occurrence of adverse events and improve patient safety in the OR.

The operating theater (OT) is resource-intensive, costly and assuring its productivity is a high priority. This study aimed to examine a quality management model's effects on a hospital's OT productivity.

The participatory action research approach was used for the intervention. A multidisciplinary quality improvement team was formed. The team improved OT operational processes using an eight-step quality management model. OT’s key performance indicators such as surgical cases, surgical cancellation, bill deductions, successful cardiopulmonary resuscitation, patients' complaints and employees' job satisfaction were collected before the intervention and compared with those of after intervention to determine the efficacy of the quality management model.

Applying a quality management strategy increased surgical patients' number by 14.96%, reduced surgery operations cancellation by 14.6 %, and decreased bill deduction by 44.9%. Besides, successful cardiopulmonary resuscitation increased by 21.17%, patients' complaints reduced by 61.5% and, finally, staff satisfaction increased by 15.6 %. Improved OT productivity resulted in improved financial performance. As a result, the OT revenue has risen by 68.8%.

This study highlights that implementing the right quality management model properly enhances hospitals' productivity. It also offers suggestions on how to implement a quality management model successfully in a hospital setting.

Previous studies approach surgery scheduling mainly from the mathematical modeling perspective which is often hard to apply in a practical environment. The aim of this study is to develop a practical scheduling system that considers the advantages of both surgery categorization and newsvendor model to surgery scheduling.

The research was carried out in a Finnish orthopaedic specialist centre that performs only joint replacement surgery. Four surgery categorization scenarios were defined and their productivity analyzed by simulation and newsvendor model.

Detailed analyses of surgery durations and the use of more accurate case categories and their combinations in scheduling improved OR productivity 11.3 percent when compared to the base case. Planning to have one OR team to work longer led to remarkable decrease in scheduling inefficiency.

In surgical services, productivity and cost‐efficiency can be improved by utilizing historical data in case scheduling and by increasing flexibility in personnel management.

The study increases the understanding of practical scheduling methods used to improve efficiency in surgical services.

This paper aims to identify key factors that impact operating room (OR) utilization and evaluate different scenarios on OR performance.

Five months of data were collected. stepwise regression and best subset models were used to select factors and generate regression model for OR utilization. We further used simulation to test the influence of case duration mean, case duration variation, scheduled utilization and first-case delay on OR utilization, OR cost inefficiency and patient wait time on the day of surgery.

The scheduled utilization, case cancellation and add-on cases were the most important factors identified in all models. The larger the case duration variation, the lower the OR cost efficiency and utilization, the longer the patient wait time. First-case delay and turnover times are not critical in OR utilization or cost efficiency.

OR management should focus on creating an effective way to manage case cancellation and add-on policy to tackle the change on the day of surgery. In addition, several weeks before the surgery, the management needs to consider how to schedule cases to fit the allocated OR time.

In complementary of current OR management, this research assists OR management by identifying the factors that would result in the most significant improvement on OR utilization.