Thomas R. Sexton

Two-Stage DEA: An Application to Major League Baseball

We show how to use DEA to model DMUs that produce in two stages, with output from the first stage becoming input to the second stage. Our model allows for any orientation or scale assumption. We apply the model to Major League Baseball, demonstrating its advantages over a standard DEA model. Our model detects inefficiencies that standard DEA models miss, and it can allow for resource consumption that the standard DEA model counts towards inefficiency. Additionally, our model distinguishes inefficiency in the first stage from that in the second stage, allowing managers to target inefficient stages of the production process.

Evaluating managerial efficiency of Veterans Administration medical centers using Data Envelopment Analysis.

This study applied the methodology of Data Envelopment Analysis (DEA) to the set of VA medical centers to evaluate their relative managerial efficiencies. Each VAMC was viewed as a producer of multiple outputs and a consumer of multiple inputs. DEA uses linear programming to identify resources that were underutilized and services that were inefficiently produced. Managerial strategies based on the dual variables were constructed to indicate the manner in which inefficient VAMCs may be made efficient. The analysis showed that relative inefficiency existed in about one third of the VAMCs nationwide. Elimination of this inefficiency would save the VA over

The impact of prospective reimbursement on nursing home efficiency.

300 million annually on personnel, equipment, drugs, and supplies, without reducing the level of services provided. A subsequent analysis of co-variance revealed that VAMCs affiliated with a university were generally less efficient than those without such an affiliation. A similar finding was obtained for larger VAMCs relative to smaller medical centers. In neither case, however, should these results be construed to imply that VAMCs should terminate their university affiliations or that VAMCs should be made smaller since factors other than relative efficiency are clearly as or more important in such decisions.

The effect of head posture on muscle contact position using the T-Scan system of occlusal analysis.

Data Envelopment Analysis (DEA) was used to estimate the relative efficiencies of nursing homes in Maine for 2 years before the introduction of a prospective payment system and for 2 years afterward. A multiple regression was performed in which the DEA-estimated efficiency was the dependent variable and a number of facility characteristics and study year were the independent variables. Study findings indicate that nursing home efficiency scores fell after the introduction of prospective reimbursement; that is, generally speaking, more inputs were being used per unit of output in the period after the introduction of prospective reimbursement than in the period preceding it. This may be the result of poor management, degraded quality of inputs, improved quality of outputs, or some other unobserved trend during this same period. The study also concludes that higher occupancy rates are associated with lower efficiencies and that patients in restraints produce severe negative effects on efficiency. In addition, it appears that a sudden increase in administrative hours in the final study year played a role in that years lower average efficiency scores, but also that all input levels generally rose while output levels remained virtually constant.

Alleviating blood shortages in a resource-constrained environment.

The purpose of this study is to investigate the effect of sagittal plane head-neck posture on initial tooth contacts (muscle contact position) using the T-Scan system of occlusal analysis. Thirty-five subjects from 14 to 72 years old were selected. Computerized T-Scan occlusal printouts were obtained on each subject with the head-neck in 45 degrees dorsiflexion and 30 degrees ventroflexion. To quantify the location of the contacts on the upper arch, the dotted lines appearing on the printout were assigned numerical values. Low numbers represent distal contacts and the higher the number, the more mesial the contact. Wilcoxons Rank Sum Test was used to analyze the data. Results indicated that below the age of 30 years no significant relationship was demonstrated between head posture and muscle contact position. However, over the age of 30 there was an increasingly significant relationship between sagittal plane head-neck posture and initial occlusal contacts. Based on these findings, the authors recommend that management of occlusally related problems, i.e., temporomandibular disorders include an assessment of the craniovertebral region especially in patients over the age of 30 years.

Organizational capability, efficiency, and effectiveness in Major League Baseball: 1901–2002

BACKGROUND:  The nation devotes considerable resources to the collection, processing, and distribution of blood products. Nonetheless, shortages of virtually every blood component persist. Economic theory suggests that the national blood supply can be increased either by increasing the level of resources used in the collection and production of blood components or by utilizing existing resources more efficiently.

Unoriented two-stage DEA: The case of the oscillating intermediate products

Effective organizations need capabilities relevant to their missions and must manage those capabilities efficiently. We anticipate capability is more important in industries in which labor is highly paid, while efficiency is more important in industries in which labor is inexpensive. We explore the contributions of capability and efficiency to effectiveness for Major League Baseball teams from 1901 through 2002. Our analysis measures team capability using offensive and defensive statistics and uses Network Data Envelopment Analysis to derive efficiency scores to capture managerial performance. We define effectiveness as the teams winning percentage. Both capability and efficiency are significant contributors to regular season effectiveness. Capability is more important. Finally, we examine the post-season performance of post-season teams between 1903 and 2002. Our analysis measures post-season performance based on the teams winning percentage and that of its opponent. Post-season performance is unrelated to capability and managerial performance, accounting for about 1% of post-season success.

The importance of basic science and clinical research as a selection criterion for general surgery residency programs.

Data envelopment analysis (DEA) allows us to evaluate the relative efficiency of each of a set of decision-making units (DMUs). However, the methodology does not permit us to identify specific sources of inefficiency because DEA views the DMU as a “black box” that consumes a mix of inputs and produces a mix of outputs. Thus, DEA does not provide a DMU manager with insight regarding the internal source of the organization’s inefficiency.

Examining the effect of a patient navigation intervention on outpatient cardiac rehabilitation awareness and enrollment.

OBJECTIVE The selection criteria for surgical residents applying for residency differ among programs nationwide. Factors influencing this selection process have not been well defined, and research in particular has not been evaluated fully. This study aimed to evaluate the relative importance of basic science and clinical research in the selection criteria used by program directors (PDs). DESIGN A web-based survey consisting of 11 questions was sent to PDs using the list server of the Association of Program Directors in Surgery. Respondents were asked to rank selection factors using a 1-to-5 scoring system, with 5 as most important. Their responses were recorded and tabulated. SETTING University-based teaching hospital. PARTICIPANTS The survey went to 251 accredited general surgery residency programs in the United States. RESULTS Overall, 134 (53.3%) of the surveys were returned, representing 61 university-based programs, 57 community-based programs with university affiliation, and 16 community-based programs without university affiliation. In total, 120 PDs (89.5%) considered basic or clinical research almost always or all the time when evaluating applicants to their general surgery program. Another 73 PDs (54.5%) gave basic science and clinical research equal importance. Another 40 PDs (29.9%) rarely or never credited research unless it had been published as an abstract or paper. In ranking research, 11 (8.2%) respondents gave it the 5 score. Most respondents (n = 93; 69.4%) gave it the 3 score. An applicants interview and interest in surgery were the factors considered most important by 93 (69.4%) and 78 (58.2%), respectively, of the PDs. CONCLUSIONS Basic science and clinical research constituted an important but secondary criterion for resident selection by PDs into general surgery residency programs. PDs perceived the primary factors for residency selection to be the interview, demonstrated interest in surgery, AOA membership, letters of recommendation, and USMLE Step I scores.

Player Salaries, Organizational Efficiency, and Competitiveness in Major League Baseball

PURPOSE: Awareness of and enrollment in outpatient cardiac rehabilitation (OCR) following a cardiac event or procedure remain suboptimal. Thus, it is important to identify new approaches to improve these outcomes. The objectives of this study were to identify (1) the contributions of a patient navigation (PN) intervention and other patient characteristics on OCR awareness; and (2) the contributions of OCR awareness and other patient characteristics on OCR enrollment among eligible cardiac patients up to 12 weeks posthospitalization. METHODS: In this randomized controlled study, 181 eligible and consenting patients were assigned to either PN (n = 90) or usual care (UC; n = 91) prior to hospital discharge. Awareness of OCR was assessed by telephone interview at 12 weeks posthospitalization, and OCR enrollment was confirmed by staff at collaborating OCR programs. Of the 181 study participants, 3 died within 1 month of hospital discharge and 147 completed the 12-week telephone interview. RESULTS: Participants in the PN intervention arm were nearly 6 times more likely to have at least some awareness of OCR than UC participants (OR = 5.99; P = .001). Moreover, participants who reported at least some OCR awareness were more than 9 times more likely to enroll in OCR (OR = 9.27, P = .034) and participants who were married were less likely to enroll (P = .031). CONCLUSIONS: Lay health advisors have potential to improve awareness of outpatient rehabilitation services among cardiac patients, which, in turn, can yield greater enrollment rates in a program.