1
|
Zubir MZ, Noor AA, Mohd Rizal AM, Harith AA, Abas MI, Zakaria Z, A. Bakar AF. Approach in inputs & outputs selection of Data Envelopment Analysis (DEA) efficiency measurement in hospitals: A systematic review. PLoS One 2024; 19:e0293694. [PMID: 39141630 PMCID: PMC11324144 DOI: 10.1371/journal.pone.0293694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 06/26/2024] [Indexed: 08/16/2024] Open
Abstract
The efficiency and productivity evaluation process commonly employs Data Envelopment Analysis (DEA) as a performance tool in numerous fields, such as the healthcare industry (hospitals). Therefore, this review examined various hospital-based DEA articles involving input and output variable selection approaches and the recent DEA developments. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was utilised to extract 89 English articles containing empirical data between 2014 and 2022 from various databases (Web of Science, Scopus, PubMed, ScienceDirect, Springer Link, and Google Scholar). Furthermore, the DEA model parameters were determined using information from previous studies, while the approaches were identified narratively. This review grouped the approaches into four sections: literature review, data availability, systematic method, and expert judgement. An independent single strategy or a combination with other methods was then applied to these approaches. Consequently, the focus of this review on various methodologies employed in hospitals could limit its findings. Alternative approaches or techniques could be utilised to determine the input and output variables for a DEA analysis in a distinct area or based on different perspectives. The DEA application trend was also significantly similar to that of previous studies. Meanwhile, insufficient data was observed to support the usability of any DEA model in terms of fitting all model parameters. Therefore, several recommendations and methodological principles for DEA were proposed after analysing the existing literature.
Collapse
Affiliation(s)
- M. Zulfakhar Zubir
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - A. Azimatun Noor
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - A. M. Mohd Rizal
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - A. Aziz Harith
- Occupational and Aviation Medicine Department, University of Otago Wellington, Wellington, New Zealand
| | - M. Ihsanuddin Abas
- Department of Public Health, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Zuriyati Zakaria
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Anwar Fazal A. Bakar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Medical Practice Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| |
Collapse
|
2
|
Pai DR, Pakdil F, Azadeh-Fard N. Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984-2022. Health Care Manag Sci 2024; 27:284-312. [PMID: 38438649 DOI: 10.1007/s10729-024-09669-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/20/2024] [Indexed: 03/06/2024]
Abstract
This study reviews scholarly publications on data envelopment analysis (DEA) studies on acute care hospital (ACH) efficiency published between 1984 and 2022 in scholarly peer-reviewed journals. We employ systematic literature review (SLR) method to identify and analyze pertinent past research using predetermined steps. The SLR offers a comprehensive resource that meticulously analyzes DEA methodology for practitioners and researchers focusing on ACH efficiency measurement. The articles reviewed in the SLR are analyzed and synthesized based on the nature of the DEA modelling process and the key findings from the DEA models. The key findings from the DEA models are presented under the following sections: effects of different ownership structures; impacts of specific healthcare reforms or other policy interventions; international and multi-state comparisons; effects of changes in competitive environment; impacts of new technology implementations; effects of hospital location; impacts of quality management interventions; impact of COVID-19 on hospital performance; impact of teaching status, and impact of merger. Furthermore, the nature of DEA modelling process focuses on use of sensitivity analysis; choice of inputs and outputs; comparison with Stochastic Frontier Analysis; use of congestion analysis; use of bootstrapping; imposition of weight restrictions; use of DEA window analysis; and exogenous factors. The findings demonstrate that, despite several innovative DEA extensions and hospital applications, over half of the research used the conventional DEA models. The findings also show that the most often used inputs in the DEA models were labor-oriented inputs and hospital beds, whereas the most frequently used outputs were outpatient visits, followed by surgeries, admissions, and inpatient days. Further research on the impact of healthcare reforms and health information technology (HIT) on hospital performance is required, given the number of reforms being implemented in many countries and the role HIT plays in enhancing care quality and lowering costs. We conclude by offering several new research directions for future studies.
Collapse
Affiliation(s)
- Dinesh R Pai
- School of Business Administration, Penn State Harrisburg, 777 West Harrisburg Pike, Middletown, PA, 17057, USA
| | - Fatma Pakdil
- College of Business, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA.
| | - Nasibeh Azadeh-Fard
- Rochester Institute of Technology, Kate Gleason College of Engineering, Rochester, NY, 14623, USA
| |
Collapse
|
3
|
Ibrahim MD. Efficiency and productivity analysis of maternal and infant healthcare services in Sub-Saharan Africa. Int J Health Plann Manage 2023; 38:1816-1832. [PMID: 37674352 DOI: 10.1002/hpm.3705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/26/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
The paper examines the efficiency and productivity of Sub-Saharan African (SSA) countries towards maternal and infant healthcare services between 2015 and 2019. Data envelopment analysis is utilised to evaluate efficiency, and Malmquist-Luenberger's (ML) productivity estimation is employed for productivity analysis. The results indicate inefficiency in SSA maternal and infant healthcare services. Average efficiency is pegged at 85%, and 60% of the countries evaluated had below-average efficiency. Effects of socioeconomic dynamics of countries were analysed. Preliminary estimations on the impact of Gross domestic product (GDP), education, urban population, and total population on efficiency are not significant. Although GDP and education sometimes show that they influence efficiency positively. Sensitivity analysis indicates efficiency to be more responsive to health expenditure, as well as to nurses and midwives. ML Productivity decomposition into technical efficiency change and technological change indicates improvement in technical efficiency as the principal driver of efficiency and productivity. Policy recommendations are made in line with the findings, requirements, and constraints of SSA countries.
Collapse
Affiliation(s)
- Mustapha D Ibrahim
- Industrial Engineering Technology, Higher Colleges of Technology, Sharjah, United Arab Emirates
| |
Collapse
|
4
|
Afonso GP, Ferreira DC, Figueira JR. A Network-DEA model to evaluate the impact of quality and access on hospital performance. ANNALS OF OPERATIONS RESEARCH 2023:1-31. [PMID: 37361087 PMCID: PMC10170039 DOI: 10.1007/s10479-023-05362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
The relationship between efficiency, quality, and access in healthcare is far from being well defined. In particular, there is no consensus on whether there is a trade-off between hospital performance and its social dimensions, such as the care appropriateness, safety, and access to proper health care. This study proposes a new approach based on the Network Data Envelopment Analysis (NDEA) to evaluate the existence of potential trade-offs between efficiency, quality, and access. The aim is to contribute for the heated debate around this topic with a novel approach. The suggested methodology combines a NDEA model with the weak disposability of outputs to handle with undesirable outputs related to the poor quality of care or the lack of access to appropriate and safe care. This combination results in a more realistic approach that has not yet been used to investigate this topic. We utilised data of the Portuguese National Health Service from 2016 to 2019, with four models and nineteen variables selected to quantify the efficiency, quality, and access to public hospital care in Portugal. A baseline efficiency score was calculated and compared with the performance scores obtained under two hypothetical scenarios to quantify the impact of each quality/access-related dimension on efficiency. The first scenario considers that each variable, individually, is at its best situation (for example, absence of septicaemia cases), and the second one, at its worst (e.g., all seen inpatients had a septicaemia case). The findings suggest that there might exist meaningful trade-offs between efficiency, quality, and access. Most variables exhibited a considerable and negative impact on the overall hospital efficiency. That is, we may expect a trade-off between efficiency and quality/access.
Collapse
Affiliation(s)
- G. P. Afonso
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1, 1049-001 Lisbon, Portugal
| | - D. C. Ferreira
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1, 1049-001 Lisbon, Portugal
| | - J. R. Figueira
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1, 1049-001 Lisbon, Portugal
| |
Collapse
|
5
|
Ravaghi H, Afshari M, Isfahani P, Mahboub-Ahari A, Bélorgeot VD. Hospital efficiency in the eastern mediterranean region: A systematic review and meta-analysis. Front Public Health 2023; 11:1085459. [PMID: 36817899 PMCID: PMC9936516 DOI: 10.3389/fpubh.2023.1085459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Background Recent rising costs and shortages of healthcare resources make it necessary to address the issue of hospital efficiency. Increasing the efficiency of hospitals can result in the better and more sustainable achievement of their organizational goals. Objective The purpose of this research is to examine hospital efficiency in the Eastern Mediterranean Region (EMR) using data envelopment analysis (DEA). Methods This study is a systematic review and meta-analysis of all articles published on hospital efficiency in Eastern Mediterranean countries between January 1999 and September 2020, identified by searching PubMed through MEDLINE, Web of Science, Scopus, Science Direct, and Google Scholar. The reference lists of these articles were checked for additional relevant studies. Finally, 37 articles were selected, and data were analyzed through Comprehensive Meta-Analysis Software (v.2.2.064). Results Using the random-effects model, the mean hospital efficiency in Eastern Mediterranean hospitals was 0.882 ± 0.01 at 95% CI. Technical efficiency (TE) was higher in some countries such as Iraq (0.976 ± 0.035), Oman (0.926 ± 0.032), and Iran (0.921 ±0.012). A significant statistical correlation was observed between the hospital efficiency and the year of publication and sample size (p < 0.05). Conclusion Efficiency plays a significant role in hospital growth and development. Therefore, it is important for healthcare managers and policymakers in the EMR to identify the causes of inefficiency, improve TE, and develop cost-effective strategies.
Collapse
Affiliation(s)
- Hamid Ravaghi
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Mahnaz Afshari
- School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran,Student Research Committee, Saveh University of Medical Sciences, Saveh, Iran,*Correspondence: Mahnaz Afshari ✉
| | - Parvaneh Isfahani
- School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Alireza Mahboub-Ahari
- Department of Health Economics, Iranian Evidence Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | |
Collapse
|
6
|
Pereira MA, Dinis DC, Ferreira DC, Figueira JR, Marques RC. A network Data Envelopment Analysis to estimate nations' efficiency in the fight against SARS-CoV-2. EXPERT SYSTEMS WITH APPLICATIONS 2022. [PMID: 35958804 DOI: 10.1016/j.eswa.2021.115169] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The ongoing outbreak of SARS-CoV-2 has been deeply impacting health systems worldwide. In this context, it is pivotal to measure the efficiency of different nations' response to the pandemic, whose insights can be used by governments and health authorities worldwide to improve their national COVID-19 strategies. Hence, we propose a network Data Envelopment Analysis (DEA) to estimate the efficiencies of fifty-five countries in the current crisis, including the thirty-seven Organisation for Economic Co-operation and Development (OECD) member countries, six OECD prospective members, four OECD key partners, and eight other countries. The network DEA model is designed as a general series structure with five single-division stages - population, contagion, triage, hospitalisation, and intensive care unit admission -, and considers an output maximisation orientation, denoting a social perspective, and an input minimisation orientation, denoting a financial perspective. It includes inputs related to health costs, desirable and undesirable intermediate products related to the use of personal protective equipment and infected population, respectively, and desirable and undesirable outputs regarding COVID-19 recoveries and deaths, respectively. To the best of the authors' knowledge, this is the first study proposing a cross-country efficiency measurement using a network DEA within the context of the COVID-19 crisis. The study concludes that Estonia, Iceland, Latvia, Luxembourg, the Netherlands, and New Zealand are the countries exhibiting higher mean system efficiencies. Their national COVID-19 strategies should be studied, adapted, and used by countries exhibiting worse performances. In addition, the observation of countries with large populations presenting worse mean efficiency scores is statistically significant.
Collapse
Affiliation(s)
- Miguel Alves Pereira
- INESC TEC, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Duarte Caldeira Dinis
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Diogo Cunha Ferreira
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - José Rui Figueira
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Rui Cunha Marques
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| |
Collapse
|
7
|
Pereira MA, Dinis DC, Ferreira DC, Figueira JR, Marques RC. A network Data Envelopment Analysis to estimate nations' efficiency in the fight against SARS-CoV-2. EXPERT SYSTEMS WITH APPLICATIONS 2022; 210:118362. [PMID: 35958804 PMCID: PMC9355747 DOI: 10.1016/j.eswa.2022.118362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/27/2022] [Accepted: 08/01/2022] [Indexed: 05/28/2023]
Abstract
The ongoing outbreak of SARS-CoV-2 has been deeply impacting health systems worldwide. In this context, it is pivotal to measure the efficiency of different nations' response to the pandemic, whose insights can be used by governments and health authorities worldwide to improve their national COVID-19 strategies. Hence, we propose a network Data Envelopment Analysis (DEA) to estimate the efficiencies of fifty-five countries in the current crisis, including the thirty-seven Organisation for Economic Co-operation and Development (OECD) member countries, six OECD prospective members, four OECD key partners, and eight other countries. The network DEA model is designed as a general series structure with five single-division stages - population, contagion, triage, hospitalisation, and intensive care unit admission -, and considers an output maximisation orientation, denoting a social perspective, and an input minimisation orientation, denoting a financial perspective. It includes inputs related to health costs, desirable and undesirable intermediate products related to the use of personal protective equipment and infected population, respectively, and desirable and undesirable outputs regarding COVID-19 recoveries and deaths, respectively. To the best of the authors' knowledge, this is the first study proposing a cross-country efficiency measurement using a network DEA within the context of the COVID-19 crisis. The study concludes that Estonia, Iceland, Latvia, Luxembourg, the Netherlands, and New Zealand are the countries exhibiting higher mean system efficiencies. Their national COVID-19 strategies should be studied, adapted, and used by countries exhibiting worse performances. In addition, the observation of countries with large populations presenting worse mean efficiency scores is statistically significant.
Collapse
Affiliation(s)
- Miguel Alves Pereira
- INESC TEC, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Duarte Caldeira Dinis
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Diogo Cunha Ferreira
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - José Rui Figueira
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Rui Cunha Marques
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| |
Collapse
|
8
|
Lobo MSDC, Estellita Lins MP, Rodrigues HDC, Soares GM. Planning feasible and efficient operational scenarios for a university hospital through multimethodology. SOCIO-ECONOMIC PLANNING SCIENCES 2022; 84:101450. [PMID: 36247975 PMCID: PMC9554220 DOI: 10.1016/j.seps.2022.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic required managerial and structural changes inside hospitals to address new admission demands, frequently reducing their care capacity for other diseases. In this regard, this study aims to support the recovery of hospital productivity in the post-pandemic context. The major challenge will be to make use of all the resources the institution has obtained (equipment, beds, temporarily hired human resources) and to increase production to meet the existing repressed demand. To support evidence-based decision-making at a major university hospital in Rio de Janeiro, hospital managers and operations research analysts designed an approach based on multiple methodologies. Besides multimethodology, one important novelty of this study is the application of a productivity frontier function to future scenario planning through the quantitative DEA methodology. Concept maps were used to structure the problem and emphasize stakeholders' perspectives. In sequence, data envelopment analysis (DEA) was applied, as it combines benchmarking best practices and assigns weights to inputs and outputs. To guarantee that the efficiency measurement considers all inputs and outputs before any inclusion of expert judgment, the scope was redirected to full dimensional efficient facet, if any, or to maximum efficient faces. The results indicate that production scenarios proposed by stakeholders based on the Ministry of Health parameters overestimate the viable production framework and that the scenario that maintains temporary human resource contracts is more compatible with quality in health provision, teaching, and research. These findings will serve as a basis for decision-making by the governmental agency that provided temporary contracts. The present methodology can be applied in different settings and scales.
Collapse
Affiliation(s)
- Maria Stella de Castro Lobo
- Institute for Studies in Public Health (IESC), Federal University of Rio de Janeiro (UFRJ), 21941-598, Avenida Horácio Macedo s/n, Cidade Universitária, lha do Fundão, Rio de Janeiro, Brazil
| | - Marcos Pereira Estellita Lins
- Production Engineering Department, CCET, Federal University of the State of Rio de Janeiro (UNIRIO), 22290-240, Av. Pasteur 458, Urca, Rio de Janeiro, Brazil
- Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering (COPPE), Federal University of Rio de Janeiro (UFRJ), 21941-914, Centro de Tecnologia, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Brazil
| | - Henrique de Castro Rodrigues
- Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering (COPPE), Federal University of Rio de Janeiro (UFRJ), 21941-914, Centro de Tecnologia, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Brazil
- Clementino Fraga Filho University Hospital (HUCFF), Federal University of Rio de Janeiro (UFRJ), 21941-913, Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Brazil
| | - Gabriel Martins Soares
- Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering (COPPE), Federal University of Rio de Janeiro (UFRJ), 21941-914, Centro de Tecnologia, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Zhang M, Gajewski J, Pittalis C, Shrime M, Broekhuizen H, Ifeanyichi M, Clarke M, Borgstein E, Lavy C, Drury G, Juma A, Mkandawire N, Mwapasa G, Kachimba J, Mbambiko M, Chilonga K, Bijlmakers L, Brugha R. Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study. PLoS One 2022; 17:e0278212. [PMID: 36449505 PMCID: PMC9710758 DOI: 10.1371/journal.pone.0278212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Efficient utilisation of surgical resources is essential when providing surgical care in low-resources settings. Countries are developing plans to scale up surgery, though insufficiently based on empirical evidence. This paper investigates the determinants of hospital efficiency in district hospitals in three African countries. METHODS Three-month data, comprising surgical capacity indicators and volumes of major surgical procedures collected from 61 district-level hospitals in Malawi, Tanzania, and Zambia, were analysed. Data envelopment analysis was used to calculate average hospital efficiency scores (max. = 1) for each country. Quantile regression analysis was selected to estimate the relationship between surgical volume and production factors. Two-stage bootstrap regression analysis was used to estimate the determinants of hospital efficiency. RESULTS Average hospital efficiency scores were 0.77 in Tanzania, 0.70 in Malawi and 0.41 in Zambia. Hospitals with high efficiency scores had significantly more surgical staff compared with low efficiency hospitals (DEA score<1). Hospitals that scored high on the most commonly utilised surgical capacity index were not the ones with high surgical volumes or high efficiency. The number of surgical team members, which was lowest in Zambia, was strongly, positively correlated with surgical productivity and efficiency. CONCLUSION Hospital efficiency, combining capacity measures and surgical outputs, is a better indicator of surgical performance than capacity measures, which could be misleading if used alone for surgical planning. Investment in the surgical workforce, in particular, is critical to improving district hospital surgical productivity and efficiency.
Collapse
Affiliation(s)
- Mengyang Zhang
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Shrime
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Henk Broekhuizen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martilord Ifeanyichi
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Morgane Clarke
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Grace Drury
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Adinan Juma
- East Central and Southern Africa Health Community, Arusha, United Republic of Tanzania
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - Gerald Mwapasa
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - John Kachimba
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | | | - Kondo Chilonga
- Department of Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
10
|
Assessing Regional Entrepreneurship: A Bootstrapping Approach in Data Envelopment Analysis. STATS 2022. [DOI: 10.3390/stats5040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of the present paper is to demonstrate the viability of using data envelopment analysis (DEA) in a regional context to evaluate entrepreneurial activities. DEA was used to assess regional entrepreneurship in Greece using individual measures of entrepreneurship as inputs and employment rates as outputs. In addition to point estimates, a bootstrap algorithm was used to produce bias-corrected metrics. In the light of the results of the study, the Greek regions perform differently in terms of converting entrepreneurial activity into job creation. Moreover, there is some evidence that unemployment may be a driver of entrepreneurship and thus negatively affects DEA-based inefficiency. The derived indicators can serve as diagnostic tools and can also be used for the design of various interventions at the regional level.
Collapse
|
11
|
Ma Z, Yin J, Yang L, Li Y, Zhang L, Lv H. Using Shannon Entropy to Improve the Identification of MP-SBM Models with Undesirable Output. ENTROPY (BASEL, SWITZERLAND) 2022; 24:1608. [PMID: 36359698 PMCID: PMC9689818 DOI: 10.3390/e24111608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
In the context of the COVID-19 global epidemic, it is particularly important to use limited medical resources to improve the systemic control of infectious diseases. There is a situation where a shortage of medical resources and an uneven distribution of resources in China exist. Therefore, it is important to have an accurate understanding of the current status of the healthcare system in China and to improve the efficiency of their infectious disease control methods. In this study, the MP-SBM-Shannon entropy model (modified panel slacks-based measure Shannon entropy model) was proposed and applied to measure the disposal efficiency of the medical institutions responding to public health emergencies (disposal efficiency) in China from 2012 to 2018. First, a P-SBM (panel slacks-based measure) model, with undesirable outputs based on panel data, is given in this paper. This model measures the efficiency of all DMUs based on the same technical frontier and can be used for the dynamic efficiency analysis of panel data. Then, the MP-SBM model is applied to solve the specific efficiency paradox of the P-SBM model caused by the objective data structure. Finally, based on the MP-SBM model, undesirable outputs are considered in the original efficiency matrix alignment combination for the deficiencies of the existing Shannon entropy-DEA model. The comparative analysis shows that the MP-SBM-Shannon model not only solves the problem of the efficiency paradox of the P-SBM model but also improves the MP-SBM model identification ability and provides a complete ranking with certain advantages. The results of the study show that the disposal efficiency of the medical institutions responding to public health emergencies in China shows an upward trend, but the average combined efficiency is less than 0.47. Therefore, there is still much room for improvement in the efficiency of infectious disease prevention and control in China. It is found that the staffing problem within the Center for Disease Control and the health supervision office are two stumbling blocks.
Collapse
Affiliation(s)
- Zhanxin Ma
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Jie Yin
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Lin Yang
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Yiming Li
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Lei Zhang
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Haodong Lv
- School of Environment, Tsinghua University, Beijing 100084, China
| |
Collapse
|
12
|
Nepomuceno TCC, Piubello Orsini L, de Carvalho VDH, Poleto T, Leardini C. The Core of Healthcare Efficiency: A Comprehensive Bibliometric Review on Frontier Analysis of Hospitals. Healthcare (Basel) 2022; 10:healthcare10071316. [PMID: 35885842 PMCID: PMC9318001 DOI: 10.3390/healthcare10071316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Parametric and non-parametric frontier applications are typical for measuring the efficiency and productivity of many healthcare units. Due to the current COVID-19 pandemic, hospital efficiency is the center of academic discussions and the most desired target for many public authorities under limited resources. Investigating the state of the art of such applications and methodologies in the healthcare sector, besides uncovering strategical managerial prospects, can expand the scientific knowledge on the fundamental differences among efficiency models, variables and applications, drag research attention to the most attractive and recurrent concepts, and broaden a discussion on the specific theoretical and empirical gaps still to be addressed in future research agendas. This work offers a systematic bibliometric review to explore this complex panorama. Hospital efficiency applications from 1996 to 2022 were investigated from the Web of Science base. We selected 65 from the 203 most prominent works based on the Core Publication methodology. We provide core and general classifications according to the clinical outcome, bibliographic coupling of concepts and keywords highlighting the most relevant perspectives and literature gaps, and a comprehensive discussion of the most attractive literature and insights for building a research agenda in the field.
Collapse
Affiliation(s)
- Thyago Celso Cavalcante Nepomuceno
- Núcleo de Tecnologia, Federal University of Pernambuco, Caruaru 55014-900, Brazil
- Dipartimento di Economia Aziendale, University of Verona, Via Cantarane, 24, 37129 Verona, Italy; (L.P.O.); (C.L.)
- Correspondence: ; Tel.: +39-351-798-6602
| | - Luca Piubello Orsini
- Dipartimento di Economia Aziendale, University of Verona, Via Cantarane, 24, 37129 Verona, Italy; (L.P.O.); (C.L.)
| | | | - Thiago Poleto
- Departamento de Administração, Federal University of Pará, Belém 66075-110, Brazil;
| | - Chiara Leardini
- Dipartimento di Economia Aziendale, University of Verona, Via Cantarane, 24, 37129 Verona, Italy; (L.P.O.); (C.L.)
| |
Collapse
|
13
|
Liu ZJ, Le MH, Lu WM. An Innovation Perspective to Explore the Ecology and Social Welfare Efficiencies of Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095113. [PMID: 35564508 PMCID: PMC9104947 DOI: 10.3390/ijerph19095113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 01/27/2023]
Abstract
This study aims to measure the ability of 29 countries in producing competitive products and services that fulfill individual needs and improve the level of welfare with less utilization of natural resources. We build a two-stage network production process model to investigate the ecology efficiency and social welfare efficiency of the countries and then further discriminate the efficient countries in post-analysis. The two-stage network directional distance function is applied to assess the efficiencies of countries, and the network-based ranking approach is used to further discriminate the efficient countries following the panel data between the years 2013 and 2016. Results show that Poland and Spain are strongly referenced by other countries in the ecology stage, whereas Bulgaria, the United States, and Sweden are leaders in the social welfare stage. A remarkable observation is an absence of countries’ efficiency in both ecology and social welfare efficiencies. Most of the 29 countries have lower efficiency in the social welfare stage than in the ecology stage. This study suggests the strengths and highlights the weaknesses of the countries to help the governments efficiently improve and operate their countries.
Collapse
Affiliation(s)
- Z-John Liu
- Department of Business Administration, Ling Tung University, No. 1, Ling Tung Rd., Taichung 408213, Taiwan;
| | - Minh-Hieu Le
- Faculty of Business Administration, Ton Duc Thang University, No. 19 Nguyen Huu Tho Street, Tan Phong Ward, District 7, Ho Chi Minh City 700000, Vietnam;
| | - Wen-Min Lu
- Department of International Business Administration, Chinese Culture University, No. 55, Hwa-Kang Road, Shilin District, Taipei 114, Taiwan
- Correspondence:
| |
Collapse
|
14
|
Tavakoli M, Tavakkoli-Moghaddam R, Mesbahi R, Ghanavati-Nejad M, Tajally A. Simulation of the COVID-19 patient flow and investigation of the future patient arrival using a time-series prediction model: a real-case study. Med Biol Eng Comput 2022; 60:969-990. [PMID: 35152366 PMCID: PMC8853249 DOI: 10.1007/s11517-022-02525-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
COVID-19 looks to be the worst pandemic disease in the last decades due to its number of infected people, deaths, and the staggering demand for healthcare services, especially hospitals. The first and most important step is to identify the patient flow through a certain process. For the second step, there is a crucial need for predicting the future patient arrivals for planning especially at the administrative level of a hospital. This study aims to first simulate the patient flow process and then predict the future entry of patients in a hospital as the case study. Also, according to the system status, this study suggests some policies based on different probable scenarios and assesses the outcome of each decision to improve the policies. The simulation model is conducted by Arena.15 software. The seasonal auto-regressive integrated moving average (SARIMA) model is used for patient's arrival prediction within 30 days. Different scenarios are evaluated through a data envelopment analysis (DEA) method. The simulation model runs for predicted patient's arrival for the least efficient scenario and the outputs compare the base run scenario. Results show that the system collapses after 14 days according to the predictions and simulation and the bottleneck of the ICU and CCU departments becomes problematic. Hospitals can use simulation and also prediction tools to avoid the crisis to plan for the future in the pandemic.
Collapse
Affiliation(s)
- Mahdieh Tavakoli
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | | | - Reza Mesbahi
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohssen Ghanavati-Nejad
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Amirreza Tajally
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| |
Collapse
|
15
|
Metallo C, Agrifoglio R, Lepore L, Landriani L. Explaing users' technology acceptance through national cultural values in the hospital context. BMC Health Serv Res 2022; 22:84. [PMID: 35039014 PMCID: PMC8764785 DOI: 10.1186/s12913-022-07488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Current research demonstrates that health information technology can improve the efficiency and quality of health services. However, many implementation projects have failed due to behavioural problems associated with technology usages, such as underuse, resistance, sabotage, and even rejection by potential users. Therefore, user acceptance was one of the main factors contributing to the success of health information technology implementation. However, research suggests that behavioural models do not universally hold across cultures. The present article considers national cultural values (power distance, uncertainty avoidance, individualism/collectivism, masculinity/femininity, and time orientation) as individual difference variables that affect user behaviour and incorporates them into the Technology Acceptance Model (TAM) as moderators of technology acceptance relationships. Therefore, this research analyses which national cultural values affect technology acceptance behaviour in hospitals. Methods The authors develop and test seven hypotheses regarding this relationship using the partial least squares (PLS) technique, a structural equation modelling method. The authors collected data from 160 questionnaires completed by clinicians and non-clinicians working in one hospital. Results The findings show that uncertainty avoidance, masculinity/femininity, and time orientation are the national cultural values that affect technology acceptance in hospitals. In particular, individuals with masculine cultural values, higher uncertainty avoidance, and a long-term orientation influence behavioural intention to use technology. Conclusion The bureaucratic model still decisively characterises the Italian health sector and consequently affects the choices of firms and workers, including the choice of technology adoption. Cultural values of masculinity, risk aversion, and long-term orientation affect intention to use through social norms rather than through perceived utility. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07488-3.
Collapse
Affiliation(s)
- C Metallo
- Department of Science and Technology, University of Naples Parthenope, Centro Direzionale -Isola C4, 80143, Naples, Italy.
| | - R Agrifoglio
- Department of Business and Economics, University of Naples Parthenope, Naples, Italy
| | - L Lepore
- Department of Law, University of Naples Parthenope, Naples, Italy
| | - L Landriani
- Department of Business and Economics, University of Naples Parthenope, Naples, Italy
| |
Collapse
|