conflicting directions

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conflicting directions

Postby richard steyn » Tue Feb 01, 2011 9:06 am

Considering operating theatres:

Most hospitals push for a 90% utilisation rate (as this matches with the belief that efficiency = good utilisation).
Equally over-runs are inconveneient for staff and planning and must also be inefficeint (as they cost more than finishing on time)
Patient experience means that there should not be cancellations on the day of surgery.

However let us note that the length of individual operations (start of anaesthetic time to out of the operating theatre) varies.

In the presence of variation all 3 measures above can not be met.

If we never overrun we must either accept that our utilisation will be under 90% (how far under depends on the extent of variation) or we must be prepared to cancel patients.
If we never cancel we must either accept overruns or be prepared to lower our utilisation rate.
If we must have >90% utilisation we must accept either overrunning or cancelling patients (or alternatively just stretch the cases (ie slow down) to fill the day).

Alternatively let us lose our fixation that efficiency = high utilisation.
The true purpose of operating is to treat patients not keep a facility busy. Our measure of efficiency should be related to outcome ie the number of patients treated with desired outcome (improvement in health, resection of disease etc). We should of course work to reduce excess slack in operating room utilisation provided that does not impact on any other outcome (number of case, quality of outcome result, patient expereince).

Richard
richard steyn
 
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