1
|
Gartner JB, Lemaire C. Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review. Int J Health Plann Manage 2022; 37:1941-1952. [PMID: 35288968 DOI: 10.1002/hpm.3452] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/23/2021] [Accepted: 02/12/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address. METHODS A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses. RESULTS We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted. CONCLUSION Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.
Collapse
Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, Québec, Canada.,Centre de recherche en gestion des services de santé, Université Laval, Québec, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
| | - Célia Lemaire
- Université de Strasbourg, EM Strasbourg-Business School, HuManiS, Strasbourg, Alsace, France
| |
Collapse
|
2
|
Barra C, Lagravinese R, Zotti R. Exploring hospital efficiency within and between Italian regions: new empirical evidence. JOURNAL OF PRODUCTIVITY ANALYSIS 2022; 57:269-284. [PMID: 35311015 PMCID: PMC8916485 DOI: 10.1007/s11123-022-00633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 06/14/2023]
Abstract
This paper investigates the efficiency of Italian hospitals and how their performances have changed over the years 2007-2016, characterized by the great economic recession and budget constraints. We apply the Benefit of Doubt (BoD) approach to determine a composite index that considers the multi-dimensionality of the hospital outcome to be used as main output in a metafrontier production function based on a stochastic frontier framework. The efficiency score distribution is then used to construct a Theil index in order to compare, over time, the inequality of the estimated efficiency between hospitals, both within and between regions. The main findings show that the primary source of inefficiency comes from managerial inefficiency especially for hospitals located in southern regions. A clear and persistent North-South gap in efficiency performances of hospitals has been found along with an increase in the inequality in terms of efficiency between the areas of the country mostly determined by between region inequality.
Collapse
Affiliation(s)
- Cristian Barra
- Department of Economics and Statistics, University of Salerno, Fisciano, SA Italy
| | - Raffaele Lagravinese
- Department of Economics and Finance, University of Bari “A.Moro”, Bari, BA Italy
| | - Roberto Zotti
- Department of Economics and Statistics “Cognetti de Martiis”, University of Torino, Torino, TO Italy
| |
Collapse
|
3
|
Efficiency of Human Resources in Public Hospitals: An Example from the Czech Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094711. [PMID: 33925160 PMCID: PMC8124684 DOI: 10.3390/ijerph18094711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
Healthcare is a highly sophisticated segment of the public sector, which requires not only highly professional and competent staff, but also a properly set ratio of healthcare professionals. In the Czech Republic, the state, as the main guarantor of health care, applied strong control through price and volume control. The aim of the paper is to define the differences in the technical efficiency of public hospitals, with regard to the size of hospitals and partial types of human resources. An input-oriented Data Envelopment Analysis model (DEA model) was chosen for modeling the technical efficiency of 47 public hospitals. The personnel performance concept of the evaluation of technical efficiency was further implemented in eight specific models, from the perspective of individual input variables relative to output variables and according to different assumptions regarding the character of economies of scale. The results of technical efficiency were analyzed using correlation, regression analysis, and the Bootstrap method. The least efficient hospitals in terms of hospital size are large hospitals, and the most balanced results have been achieved by medium-sized hospitals. The average efficiency rate in models that include all selected input and output variables is highest in medium-sized hospitals, with a value of 0.866 for CRS and an efficiency rate of 0.926 for VRS. The rationalization of human resources should be implemented in order not to reduce the quality of care provided.
Collapse
|
4
|
Franco Miguel JL, Fullana Belda C, Cordero Ferrera JM, Polo C, Nuño-Solinís R. Efficiency in chronic illness care coordination: public-private collaboration models vs. traditional management. BMC Health Serv Res 2020; 20:1044. [PMID: 33198716 PMCID: PMC7667775 DOI: 10.1186/s12913-020-05894-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this paper is to analyze the differences in the coordination of chronic illness care between the different public hospital management models coexisting in the Spanish region of Madrid (25 hospitals) during the period 2013–2017. Methods The performance of hospitals might be affected by the characteristics of the population they serve and, therefore, this information should be taken into account when estimating efficiency measures. For this purpose, we apply the nonparametric Data Envelopment Analysis (DEA) conditioned to some contextual variables and adapted to a dynamic framework, so that we can assess hospitals during a five-year period. The outputs considered are preventable hospitalizations, readmissions for heart failure and readmissions for chronic obstructive pulmonary disease, whereas the inputs considered are the number of beds, personnel (physicians and other healthcare professionals) and total expenditure on goods and services. Results The results suggest that the level of efficiency demonstrated by the public-private collaboration models of hospital management is higher than traditionally managed hospitals throughout the analyzed period. Nevertheless, we notice that efficiency differences among hospitals are significantly reduced when contextual factors were taken into account. Conclusions Hospitals managed under public-private collaboration models are more efficient than those under traditional management in terms of chronic illness care coordination, being this difference attributable to more agile and flexible management under the collaborative models. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12913-020-05894-z.
Collapse
|
5
|
Investigating the link between medical urgency and hospital efficiency - Insights from the German hospital market. Health Care Manag Sci 2020; 23:649-660. [PMID: 32936387 PMCID: PMC7674330 DOI: 10.1007/s10729-020-09520-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/06/2020] [Indexed: 10/27/2022]
Abstract
With hospital budgets remaining tight and healthcare expenditure rising due to demographic change and advances in technology, hospitals continue to face calls to contain costs and allocate their resources more efficiently. In this context, efficiency has emerged as an increasingly important way for hospitals to withstand competitive pressures in the hospital market. Doing so, however, can be challenging given unpredictable fluctuations in demand, a prime example of which are emergencies, i.e. urgent medical cases. The link between medical urgency and hospitals' efficiency, however, has been neglected in the literature to date. This study therefore aims to investigate the relationship between hospitals' urgency characteristics and their efficiency. Our analyses are based on 4094 observations from 1428 hospitals throughout Germany for the years 2015, 2016, and 2017. We calculate an average urgency score for each hospital based on all cases treated in that hospital per year and also investigate the within-hospital dispersion of medical urgency. To analyze the association of these urgency measures with hospitals' efficiency we use a two-stage double bootstrap data envelopment analysis approach with truncated regression. We find a negative relationship between the urgency score and hospital efficiency. When testing for non-linear effects, the results reveal a u-shaped association, indicating that having either a high or low overall urgency score is beneficial in terms of efficiency. Finally, our results reveal that higher within-hospital urgency dispersion is negatively related to efficiency.
Collapse
|
6
|
Fuentes R, Ferrándiz-Gomis R, Fuster-Garcia B. Efficiency of acute public hospitals in the region of Murcia, Spain. J Comp Eff Res 2019; 8:929-946. [PMID: 31464149 DOI: 10.2217/cer-2018-0150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the level of efficiency of public acute hospitals situated in the region of Murcia (Spain). Materials & methods: Data from nine acute general hospitals of Murcia's Health Service (SMS by its Spanish acronym) were analyzed over the 2012-2014 period. The data were extracted from the In-patient Health Establishment Statistics of the Ministry of Health, Social Services and Equality, from the National Health Service (SNS) portal and the SMS portal. To this end, the data envelopment analysis (DEA)-window method was used, since this extension of the basic DEA model allows to compare the efficiency of a small number of units over different years and analyze changes in efficiency over time. In addition, the model was complemented by smooth bootstrapping and a superefficiency analysis to improve the quality of the data interpretation. Four inputs were used (number of beds, number of operating rooms, personnel costs and operating costs), two undesirable outputs (average stay and rate of return) and three desirable outputs (weighted discharges, emergencies and surgical interventions). Results: The average level of inefficiency was 1.58% over the study period, with a good evolution between 2012 (3.53%) and 2014 (0.20%). This improvement was also reflected in the number of efficient hospitals that rose from two in 2012 to eight in 2014. Moreover, the slack levels detected were small. Conclusion: The management of the public hospitals analyzed was favorable, both regarding average level of efficiency and the number of hospitals qualified as efficient. However, the analysis revealed several ways to increase efficiency by reducing specific inputs and nondesirable outputs (mainly operating and personnel costs as well as average length of stay) while increasing desirable outputs (mostly the number of surgical interventions). To finish, specific policy measures are suggested to improve the performance of these hospitals.
Collapse
Affiliation(s)
- Ramón Fuentes
- Department of Applied Economic Analysis, University of Alicante, Ctra. San Vicente del Raspeig s/n, San Vicente del Raspeig, Alicante 03080, Spain
| | - Roberto Ferrándiz-Gomis
- Management & Planning of Health Services, Catholic University of Murcia, Campus de los Jerónimos, 135, Guadalupe, Murcia 30107, Spain
| | - Begoña Fuster-Garcia
- Department of Applied Economic Analysis, University of Alicante, Ctra. San Vicente del Raspeig s/n, San Vicente del Raspeig, Alicante 03080, Spain
| |
Collapse
|
7
|
Kryś J, Łyszczarz B, Wyszkowska Z, Kędziora-Kornatowska K. Prevalence, Reasons, and Predisposing Factors Associated with 30-day Hospital Readmissions in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132339. [PMID: 31269713 PMCID: PMC6651338 DOI: 10.3390/ijerph16132339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022]
Abstract
There is a growing interest in quality issues associated with hospital care, with readmissions (rehospitalizations) being one of the main areas of interest. Retrospective data from a 914-bed university hospital in Bydgoszcz, Poland, was used to identify 30-day readmissions in 2015. We developed a catalogue of reasons for rehospitalization and differentiated between planned and unplanned readmissions, as well as those related and unrelated to index (initial) hospitalization. Multilevel logistic regression was used to determine factors associated with readmission risk. A total of 12.5% of patients were readmitted within 30 days of being discharged. The highest readmission rates were identified in pediatric, transplantation, and urology patients. The highest share of readmissions was due to the specific nature of a disease and its routine treatment practice. Almost two-thirds of readmission cases were classified as unplanned and related to the index hospitalization. The following characteristics were associated with a higher risk of rehospitalization: female gender, residing >35 km from the hospital, longer than average and very short stays at index admission, higher comorbidity score, and admission to a high-volume hospital sector. Due to the importance of quality issues in health policy, the topic should be further pursued to identify evidence-based practices that would improve hospitals’ performance.
Collapse
Affiliation(s)
- Jacek Kryś
- Antoni Jurasz University Hospital No. 1, 85-094 Bydgoszcz, Poland
- Department of Public Health, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, 85-830 Bydgoszcz, Poland
| | - Błażej Łyszczarz
- Department of Public Health, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, 85-830 Bydgoszcz, Poland.
| | - Zofia Wyszkowska
- Department of Organization and Management, Faculty of Management, University of Science and Technology, 85-790 Bydgoszcz, Poland
| | - Kornelia Kędziora-Kornatowska
- Department and Clinic of Geriatrics, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| |
Collapse
|
8
|
Kohl S, Schoenfelder J, Fügener A, Brunner JO. The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals. Health Care Manag Sci 2018; 22:245-286. [DOI: 10.1007/s10729-018-9436-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/29/2018] [Indexed: 12/21/2022]
|
9
|
Demartini C, Trucco S. Are performance measurement systems useful? Perceptions from health care. BMC Health Serv Res 2017; 17:96. [PMID: 28143468 PMCID: PMC5282789 DOI: 10.1186/s12913-017-2022-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/16/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Prior literature identified the use of Performance Measurement Systems (PMS) as crucial in addressing improved processes of care. Moreover, a strategic use of PMS has been found to enhance quality, compared to non-strategic use, although a clear understanding of this linkage is still to be achieved. This paper deals with the test of direct and indirect models related to the link between the strategic use of PMS and the level of improved processes in health care organizations. Indirect models were mediated by the degree of perceived managerial discretion. METHODS A PLS analysis on a survey of 97 Italian managers working for health care organizations in the Lombardy region was conducted. The response rate was 77.6%. RESULTS The strategic use of PMS in health care organizations directly and significantly (p < 0.001) enhances performance in terms of improved processes. Perceived managerial discretion is positively and significantly (p < 0.001) affected by the strategic use of PMS, whereas the mediation effect is non-significant. CONCLUSIONS This study contributes to the literature investigating the design and implementation of a non-financial measurement tool, such as the non-financial information included into a balanced scorecard (BSC), in health care organizations. Managers in health care organizations can benefit from the strategic use of PMS to effectively allocate their time to strategic opportunities and threats, which might arise and affect organizational, output-related performance, such as improving processes.
Collapse
Affiliation(s)
- Chiara Demartini
- Department of Economics and Management, University of Pavia, Via S. Felice, 5/7, 27100, Pavia, Italy
| | - Sara Trucco
- Faculty of Economics, Rome University of International Studies, Via Cristoforo Colombo, 200, 00147 Rome, Italy
| |
Collapse
|