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Article
Publication date: 8 July 2019

Yoshinori Nakata, Yuichi Watanabe, Hiroto Narimatsu, Tatsuya Yoshimura, Hiroshi Otake and Tomohiro Sawa

The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

Abstract

Purpose

The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

Design/methodology/approach

The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method.

Findings

The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05).

Originality/value

The authors demonstrated that the surgeonsefficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 13 July 2015

Yoshinori Nakata, Tatsuya Yoshimura, Yuichi Watanabe, Hiroshi Otake, Giichiro Oiso and Tomohiro Sawa

– The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014.

Abstract

Purpose

The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014.

Design/methodology/approach

The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeonsefficiency scores using data envelopment analysis.

Findings

The efficiency scores of each surgical specialty were significantly different (p=0.000).

Originality/value

This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 9 May 2016

Yoshinori Nakata, Yuichi Watanabe, Hiroto Narimatsu, Tatsuya Yoshimura, Hiroshi Otake and Tomohiro Sawa

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

International Journal of Health Care Quality Assurance, vol. 29 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 3 August 2015

Saeedeh Ketabi, Hamid Ganji, Samireh Shahin, Mehdi Mahnam, Marzieh Soltanolkottabi and Shirin Alsadat Hadian Zarkesh Moghadam

Different surgical services demand operating rooms (OR) to treat elective patients, each competing for a limited supply of OR time. The purpose of this paper is to obtain…

Abstract

Purpose

Different surgical services demand operating rooms (OR) to treat elective patients, each competing for a limited supply of OR time. The purpose of this paper is to obtain empirical measures of performance in the management of OR. The current research compares technical efficiency of 11 specialties in elective operating theatre of Alzahra Hospital in Isfahan, Iran in autumn of 2009.

Design/methodology/approach

Data envelopment analysis (DEA) can be used as tools in management control and planning. First, the input oriented and variable returns to scale model of DEA technique has been applied and separate benchmarks for possible reductions in resources used has been derive, and significant savings are possible on this account.

Findings

The efficiency scores of inefficient specialties are between 0.62 and 0.96. Neurosurgery and general surgery are the best and the worst units. DEA results determine by how much hospitals can increase elective inpatient surgeries for each specialty.

Originality/value

The originality of this study is to obtain empirical measures of performance in the management of OR. DEA has not been applied to measure the efficiency of different department in an organization. The measures are common in different units and have been collected in a similar way.

Details

Benchmarking: An International Journal, vol. 22 no. 6
Type: Research Article
ISSN: 1463-5771

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Article
Publication date: 30 September 2013

Mehmet Tolga Taner

The article's aim is to focus on the application of Six Sigma to minimise intraoperative and post-operative complications rates in a Turkish public hospital cataract…

Abstract

Purpose

The article's aim is to focus on the application of Six Sigma to minimise intraoperative and post-operative complications rates in a Turkish public hospital cataract surgery unit.

Design/methodology/approach

Implementing define-measure-analyse-improve and control (DMAIC) involves process mapping, fishbone diagrams and rigorous data-collection. Failure mode and effect analysis (FMEA), pareto diagrams, control charts and process capability analysis are applied to redress cataract surgery failure root causes.

Findings

Inefficient skills of assistant surgeons and technicians, low quality of IOLs used, wrong IOL placement, unsystematic sterilisation of surgery rooms and devices, and the unprioritising network system are found to be the critical drivers of intraoperative-operative and post-operative complications. Sigma level was increased from 2.60 to 3.75 subsequent to extensive training of assistant surgeons, ophthalmologists and technicians, better quality IOLs, systematic sterilisation and air-filtering, and the implementation of a more sophisticated network system.

Practical implications

This article shows that Six Sigma measurement and process improvement can become the impetus for cataract unit staff to rethink their process and reduce malpractices. Measuring, recording and reporting data regularly helps them to continuously monitor their overall process and deliver safer treatments.

Originality/value

This is the first Six Sigma ophthalmology study in Turkey.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 8
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 20 October 2020

Ali Mohammad Mosadeghrad and Mahnaz Afshari

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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%.

Originality/value

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.

Details

The TQM Journal, vol. 33 no. 4
Type: Research Article
ISSN: 1754-2731

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Book part
Publication date: 27 October 2015

S. Ramakrishna Velamuri, Priya Anant and Vasantha Kumar

We study three private hospital organizations in India that were set up to deliver affordable high quality, services to the poor. Their distinctive feature is that they…

Abstract

We study three private hospital organizations in India that were set up to deliver affordable high quality, services to the poor. Their distinctive feature is that they have successfully balanced two apparently contradictory logics: financial (doing well) and social (doing good) through business model innovations. By analyzing abundant primary and secondary data, we document in detail the key features of their business models – customer identification, customer engagement, value chain and linkages, and monetization – and document how they contribute to the organizations’ ability to deliver high quality healthcare at very low prices. We analyze the impact of these organizations, both direct and indirect, on the healthcare delivery landscape in India. We show that while their direct impact is significant, their indirect impact could potentially transform healthcare delivery in India and in other developing countries.

Details

Business Models and Modelling
Type: Book
ISBN: 978-1-78560-462-1

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Article
Publication date: 13 August 2018

Windi Winasti, Sylvia Elkhuizen, Leo Berrevoets, Godefridus van Merode and Hubert Berden

In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To…

Abstract

Purpose

In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments – a prerequisite for solving flow problems in the entire hospital. Since most current studies focus solely on overcrowding in emergency units, additional insights are needed on system-wide patient flow management. The purpose of this paper is to look at the information available in system-wide patient flow management studies, which were also systematically evaluated to demonstrate which interventions improve inpatient flow.

Design/methodology/approach

The authors searched PubMed and Web of Science (Core Collection) literature databases and collected full-text articles using two selection and classification stages. Stage 1 was used to screen articles relating to patient flow management for inpatient settings with typical characteristics. Stage 2 was used to classify the articles selected in Stage 1 according to the interventions and their impact on patient flow within a hospital system.

Findings

In Stage 1, 107 studies were selected. Although a growing trend was observed, there were fewer studies on patient flow management in inpatient than studies in emergency settings. In Stage 2, 61 intervention studies were classified. The authors found that most interventions were about creating and adding supply resources. Since many hospital managers these days cannot easily add capacity owing to cost and resource constraints, using existing capacity efficiently is important – unfortunately not addressed in many studies. Furthermore, arrival variability was the factor most frequently mentioned as affecting flow. Of all interventions addressed in this review, the most prominent for advancing patient access to inpatient units was employing a specialized individual or team to maintain patient flow and bed placement across hospital units.

Originality/value

This study provides the first patient flow management systematic overview within an inpatient setting context.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 7 October 2014

Michael J. Brown, Arun Subramanian, Timothy B. Curry, Daryl J. Kor, Steven L. Moran and Thomas R. Rohleder

Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper…

Abstract

Purpose

Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity.

Design/methodology/approach

Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime.

Findings

Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon.

Research limitations/implications

Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability.

Practical implications

Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved.

Originality/value

Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 8
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 24 May 2019

Maude Laberge, André Côté and Angel Ruiz

The purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait…

Abstract

Purpose

The purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait time for surgery and to identify factors contributing to more efficient operations and challenges to their implementation.

Design/methodology/approach

This is a case study with a mixed methods approach. The authors conducted interviews with hospital staff. Data collected in the interviews and through on-site observation were analyzed to map the TJR process and identify the steps of the care pathway. The authors extracted and analyzed data (time stamps) from 60 hospital patient records for each step in the pathway and ran a regression on the duration of the whole trajectory.

Findings

There were wide variations in the delays observed between the seven steps identified. The delay between Step 1 and Step 2 was the only significant variable in predicting the total wait time to surgery. In one hospital, one delay explained 50 percent of the variation. There was misalignment between findings from the qualitative data in terms of strategies implemented to increase efficiency of the clinical pathway to the quantitative data on delays between the steps.

Research limitations/implications

The study identified the clinical pathway from the consultation with an orthopaedic surgeon to the surgery. However, it did not go beyond the surgery. Future research could investigate the relationship between specific processes and delays between steps of the process and patient outcomes, including length of stay, mobilization and functionality in activities of daily living, as well as potential complications from surgery, readmission and the services required after the patient was discharged.

Practical implications

Wait times can be addressed by implementing strategies at the health system level or at the organizational level. The authors found and discuss areas where there could be efficiency gains for health care organizations.

Social implications

Stakeholders in care processes are diverse and they each have their preferences in how they practice (in the case of providers) and how they perceive and wish to respond adequately to patients’ needs in contexts that have different norms and approaches. The approach in this study enables a better understanding of the processes, the organizational culture and how these may affect each other.

Originality/value

Our mixed methods enabled a process mapping and the identification of factors that significantly affected the efficiency of the TJR surgery process. It combines methods from process engineering with health services and management research. To some extent, this study demonstrates that although managers can define and enforce processes, organizational culture and practices are harder to influence.

Details

Journal of Health Organization and Management, vol. 33 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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