PubMed · 15218681
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Louis Malcmacher. 2004. Go wireless!. https://pubmed.ncbi.nlm.nih.gov/15218681/
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BACKGROUND: Despite a substantial increase in hospital resources, increased hospital admissions and out-patient visits, long waiting lists have been a significant problem in Norwegian health care. A detailed analysis of the development in resource allocation and productivity at St. Olavs University Hospital in central Norway was therefore undertaken. METHODS: Resource allocation and patient volume was analysed during the period 1995 to 2001. Data were analysed both for emergency and elective admissions as well as outpatient visits specified into new referrals and follow-up consultations. RESULTS: Full time employee equivalents for doctors and nurses increased by 36.6% and 25.9%, respectively, and all employees by 28.1%. However, admitted patients, outpatient consultations and surgical procedures only increased by 10%, 15% and 8.3%, respectively. Thus, the productivity for each hospital employee, defined as operations pr. surgeon, outpatient consultations pr. doctor etc. was significantly reduced. A striking finding was that although the number of outpatient consultations increased, the number of new referrals actually went down and the whole increase in activity at the outpatient clinics could be explained by a substantial increase in follow-up consultations. This trend was more evident in the surgical departments, where some departments actually showed a reduction in total outpatient consultations. CONCLUSION: In view of the slow increase in hospital activity in spite of a significant increase in resources, it can be speculated that patient volume might be a limiting factor for hospital activity. The health market (patient population) might not be big enough in relation to the investments in increased production capacity (equipment and manpower).
The pursuit of multiple objectives by public sector organisations makes it difficult to assess and compare their performance. Considering objectives in isolation ignores the possibility of correlations between objectives, and a single index of performance requires subjective judgements to be made about the relative value of each objective. An alternative approach is to estimate a multivariate system of equations in which objectives are analysed individually but correlations across objectives are considered explicitly. We analyse the performance of English health authorities against 13 objectives using hierarchical data for electoral wards that are nested within health authorities. We find evidence of correlation across objectives, suggesting that some are complementary and others subject to trade-off. The estimates generated when assessing performance with multivariate multilevel models as compared to ordinary least squares or multilevel models differ, with the magnitudes varying by objective and health authority.
Lean thinking helps speed up a patient's journey and cut waste by reworking routine procedures. Trusts are starting to use the theory in practice, with one doubling day surgery capacity and another redesigning its diagnostics procedures. Wasted time does not just frustrate patients - it can kill them.