Abstract
In recent years, it has become increasingly important to improve efficiency and economic balance in hospitals. The department chairperson (or Chair) contends with a production function consisting of inputs and outcomes, rife with managerial constraints. These constraints can be reduced with proper management by diverting resources and activity. Lack of a proper management algorithm at the department level is a significant impediment to improving operational efficiency in hospitals without significant additional costs. In this work we aimed to develop and implement a management algorithm in a teaching hospital department, in order to improve performances and quality of care. From September 2012 to December 2017 we developed a novel management algorithm for a surgical department and implemented it in the Head and Neck Surgery Department at Rambam Medical Center, Haifa, Israel. Changes were made to the organization structure and the concept of service provision. We defined core measures reflecting operative actions and outcomes and identified actions that could affect these measures. Based on our analysis of outcomes we constructed a management intervention process that defines operative actions leading to improved performance. The result was over 400% improvement in the department’s outcome measures including quality, activity, and service. Analysis of data from the Israeli Ministry of Health revealed that the department’s ranking in performance measures and volume improved from no. 14 of 23 departments in Israel in 2011, to no. 1 in 2013, which was sustained through 2014–2016. Improvement in efficiency also translated to economic balance and transformation from deficit to profitability. If this algorithm is implemented in the rest of the system, it is expected to improve the function of the hospital as a whole. Our results have the potential to foster the development of a new organizational culture of measurement and improvement in the hospital, and subsequently in the entire health system.
Highlights
Most adults have been a hospital or outpatient clinic patient at some time in their life
To improve department performance under constrained resources a new management protocol was initiated in the Department of Otolaryngology Head and Neck Surgery at Rambam
We show that implementing the management algorithm, to monitor improvements in department outcomes, led to improvement in the function of the unit and eventually had the potential to improve productivity and profitability of the hospital as a whole
Summary
Most adults have been a hospital or outpatient clinic patient at some time in their life. There has been increased awareness of the benefits that successful management of health-care organizations as a whole and hospitals can provide Hospitals can use their operations and managerial properties to thrive in hostile conditions and to improve organizational performance.[1]. New programs and policies focus on performance measures, quality, and accreditation and have been proven to be an engine of improvement.[2] Since transparency is a key element for improvement, publishing measures of parallel departments at the same hospital or of different hospitals is of high importance Such a culture of transparency is executed by the Israeli Ministry of Health and in other OECD countries.
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