Timothy W. Butler

The effect of location, strategy, and operations technology on hospital performance

Abstract Hospitals in the US are faced with challenges in how to compete and remain viable in an increasingly competitive environment. Using data from a primary survey of hospitals and from various secondary sources, we investigate the incremental effects on hospital performance of location, strategy, and technology. We find that hospital location is significantly related to performance, but that a hospital’s choice of strategy can moderate the effect of location. Additionally, we find hospitals that invest more extensively in clinical technologies tend to be better performers regardless of location. Hospital size, measured as number of beds, captures the effects of location and technology investment in accounting for a major portion of hospital performance. While we cannot argue that larger is always better for hospitals, mergers, partnerships, and other forms of consolidation currently observed in the marketplace indicate that managers in the hospital industry understand the advantage of size.

The operations management role in hospital strategic planning

Abstract Although there is a wealth of research on operations management and strategic planning in hospitals, there has been little if any research on the integration of these two issues. Hospital administrators are being pressured to improve the quality of services and to curb costs - two primary themes within the field of operations management. This leads us to wonder to what extent operations are considered within the strategic planning process and what impact it may have. By surveying the literature, we identify a pattern in hospital management research, and identify articles which address the operations capabilities of quality, flexibility, delivery and cost control. These articles can serve as a springboard for research in hospital operations strategy, an area that is largely neglected in the literature. We also provide examples of how hospitals are addressing operations capabilities, and conclude with implications for hospital administrators and a research agenda for researchers.

The utility of returns to scale in DEA programming: An analysis of Michigan rural hospitals

Abstract In 1984, Banker, Charnes, and Cooper introduced the capability of using data envelopment analysis to assess increasing, decreasing, or constant returns to scale. This analysis would appear to make an important contribution to the health care field because of the regulatory environment within which the industry exists and the competition among hospitals for additional services and capacity. In many states, hospitals must submit a “certificate of need” to prove eligibility to add capacity or services. Agency administrators at the state level should analyze each hospitals production performance to determine the effectiveness of resource utilization. Residents of a state where hospitals are regulated need to know the effectiveness of agencies in allowing resources to be properly allocated to hospitals. Returns to scale analysis can help provide answers to these concerns. We examine Michigan rural hospitals and propose a simple, yet logical procedure for evaluating returns to scale for technically inefficient hospitals.

Predicting patient nonappearance for surgery as a scheduling strategy to optimize operating room utilization in a Veterans' administration hospital

Background: Previous attempts at improving operating room utilization have generally emphasized more accurate scheduling, starting the first case on time, and reducing turnover time. Surgical case cancellations have largely been ignored except for recommendations for preoperative screening and good physician–patient communication to improve patient compliance. Methods: A retrospective review of operating room records was initially used to identify reasons for surgical cancellations. This was followed by a retrospective stratified case–control study of patient records to identify preexisting factors that predict the failure of patients to appear for surgical procedures as scheduled. Factors assessed included demographics, type of surgical procedure, compliance with previous healthcare visits, substance abuse, mental illness, travel distance, and neurologic problems. Results: The authors reviewed their operating room utilization and found patient nonappearance rates to be a substantial source of surgical cancellations. Furthermore, multivariate analysis demonstrated that patient nonappearance could be strongly predicted from patient noncompliance with clinic visits and other clinical procedures without reference to the other variables assessed. Further analysis of data from an independent sample of patients confirmed this observation. Conclusions: Noncompliance with hospital visits for surgical procedures can be predicted from noncompliance with other healthcare encounters. Surgical procedures for previously noncompliant patients should be booked at the end of the operating room day, when the cancellation is least likely to interfere with operating room flow.

COMPARATIVE STUDIES IN INTERACTIVE MULTIPLE OBJECTIVE MATHEMATICAL PROGRAMMING

Abstract In the past two decades, there has been a significant increase in the number of interactive algorithms proposed for solving multiple objective mathematical programming (MOMP) problems. Most of these procedures have neither been tested in real decision making situations, nor compared to each other. In this study, we emphasize the importance of comparative studies of interactive MOMP procedures and present a state of the art review. Our scope is limited to the comparisons of interactive procedures for solving deterministic, linear, integer or nonlinear constrained multiple objective optimization problems involving a single decision maker.

The impact of operations competitive priorities on hospital performance

A notable lack of empirical analysis exists on hospital operations strategy in spite of widespread debate on quality, cost, and service delivery – issues which are widely included within the realm of operations competitive priorities. We empirically examine the degree of emphasis placed by administrators on competitive priorities and what impact this might have on performance of not-for-profit, general hospitals. Performance is defined as a composite of financial and operational performance. Our research shows that managements emphasis of cost containment and service delivery consistently results in superior business performance. Quality programs are found to be the most preferred competitive priority initiative, yet show relatively low relation with performance. This suggests that quality programs are a necessary, though not sufficient, component of hospital operations strategy. The competitive dimension of flexibility is being employed, but on a less universal scale. We conclude that administrators are not yet sufficiently skilled in the flexibility priority to make this dimension consistently result in superior business performance.

An Integrative Model-Based Approach to Hospital Layout

Abstract The issues of facility layout and bed allocation in health care settings are typically evaluated separately using very different model-based approaches. This paper describes a two-phase approach to the hospital layout problem that incorporates a number of considerations from typical layout models and methods used in determining bed allocations. The first phase involves a quadratic integer goal programming model that determines a configuration and recommended allocation of beds to hospital services. The detailed ramifications of the proposed layout are then evaluated in the second phase via a simulation model. The application of the optimization-simulation approach in a general purpose hospital is described. Handled by the Department of Health Systems.