Monitoring operating room performance with control charts: findings from a Greek public hospital

OBJECTIVE

To describe the development and demonstrate the use of a statistical framework based on statistical quality control (SQC) in order to monitor the performance of operating rooms (ORs).

DESIGN

Data related to scheduled surgical operations have been collected from the information system of an existing Greek hospital. The data that contain the anesthesia and operation start and completion times of the operations carried out in the 14 ORs of the hospital are analyzed using control p-charts and hypotheses testing. The results obtained provide crucial information to health-care managers.

SETTING

A large Greek public hospital.

PARTICIPANTS

Real-world data captured on daily basis from January 2015 to November 2017.

INTERVENTION

The proportion of the idle time of an OR over its total available time is proposed as an OR key performance index. We present two directions of data monitoring and analysis: one that uses control p-charts and a second based on hypotheses testing. The improved Laney's p΄-chart and the Laney's approach for cross-sectional data are employed in order to overcome overdispersion that affects OR idle time data.

RESULTS

The proposed methodology allows hospital management (i) to monitor the percentage of the idle time of an operating room through time and (ii) to identify the ORs that demonstrate exceptionally high or low percentage of idle time at a given period of time.

CONCLUSION

SQC charts are simple, yet powerful tools that may support the hospital management in monitoring OR performance and decision-making. The development of a dedicated management information system that automatically captures the required data and constructs the corresponding control charts would support effectively managerial decision-making.

ED healthcare professionals and their notions of productivity

OBJECTIVE

The combination of constrained resources, patient complexity and rapidly increasing demand has meant that healthcare productivity constitutes a significant problem for emergency medicine. However, healthcare productivity remains a contentious issue, with some criticising the level of professional engagement. This paper will propose that productivity improvements in healthcare could occur (and be sustained) if professionals' perceptions and views of productivity were better understood.

METHODS

An 8-month ethnographic study was conducted in a large UK ED, using semistructured interviews with healthcare professionals (HCPs) (n=26), a focus group and observation. Thematic analysis of the data was undertaken based on an interpretivist philosophy.

RESULTS

The data demonstrate that HCPs accept productivity improvement as part of their contemporary professional role. In particular, their understanding of productivity is focused around five key domains: the patient; the professional; the culture; the process of work and the economic.

CONCLUSIONS

By exploring how these HCPs experienced and made sense of productivity improvement and productive healthcare, the data reveals how HCPs may reconcile a culture of caring with one of efficiency. Understanding healthcare productivity from this perspective has potential implications for service improvement design and performance measurement.