Hospital service quality evaluation with IVIF-PROMETHEE and a case study

Measuring satisfaction of patients and understanding their perceptions are important for the hospital management to respond to customers' growing demands for acceptable quality of healthcare services. The main purpose of this paper is to present a methodology that can be used in the healthcare service quality evaluation. IVIF-PROMETHEE method is applied for service quality evaluation based on patients' views in a real-life case study of a public hospital in Istanbul and the results are compared with the results from IVIF-TOPSIS method. Interval Valued Intuitionistic Fuzzy (IVIF) set is considered an appropriate tool because of the complexity and vagueness of the evaluation of healthcare services. The evaluation of the quality level of the healthcare service provides detailed information about the effects of considered criteria as well as creates opportunities in implementing effective procedures to overcome service quality problems via analysing the patients' views. The proposed methodology can be a useful tool for hospital management.     

Analysis of different public policies through simulation to increase total social utility in a healthcare system

Public and private hospitals are seen to co-exist in several countries and they have different levels of service, waiting times and prices. Public hospitals, in general, are cheaper, but more crowded and offer lower quality service than private ones while private ones are underutilized because of the higher payments required for their services. These differences among hospitals affect patients’ choices in hospital selection and result in different levels of satisfaction in the community. Appropriate subsidy mechanisms can be developed to balance the capacity utilization of both sectors and to improve overall access to healthcare. The objective of this study is to develop an estimate of the magnitude of this improvement and differential effectiveness of various policies in achieving this improvement. For this purpose, we develop a simulation model that includes all the emergency departments of main public and private hospitals in a certain region of Turkey. We analyze the effects of different public policies on patients’ preferences regarding hospital choices and the results of these choices on social utility and public healthcare spending. Different capacity decisions, contracting and subsidy mechanisms are proposed and the optimal system parameters are determined under these mechanisms over this simulation model. After the validation and verification of the simulation model, several scenarios are designed and executed to increase social utility, decrease government expenses, improve patient satisfaction level and decrease waiting times. We compare the proposed scenarios based on multiple objective functions and present numerical results for different scenarios in this system.     

Public and private healthcare services: What drives the choice?

This paper has explored patients' propensity to consume private healthcare services. We based our analysis on the typical tangible and intangible (for instance, responsiveness, reliability, assurance and staff empathy) domains of the SERVQUAL and SERVPERF methods. These variables may influence patients' decision-making when they choose between the public and private sectors. We combined factor analysis (to obtain a set of latent factors related to perceived quality) and a partial proportional ordered logit model to estimate the probability that a patient would access private healthcare services. To test the main hypotheses, we used data from a stratified sample in Sardinia, a peripheral region of Italy. Findings revealed that private and public healthcare are substitutes, especially for primary/specialised services. Patients who used public healthcare frequently and had a low income were unlikely to change to private healthcare or to recommend private services. ‘Responsiveness’ and perceptions on ‘tangibles’ were key in determining the probability that a patient would choose and recommend private services. This paper offers a multifaceted framework that can be used in future research to generalise these findings, especially in insular regions that are constrained by mobility.     

A data-driven methodology for supporting resource planning of health services

In recent years, healthcare systems have been forced to better organize their services in the final attempt to maximize both care effectiveness and efficiency. In particular, emergent trends are prompting hospitals to pay more attention to the effective and efficient planning of resources and to the creation of patient-centred services, in which current activities and resources are reorganized around patients.This paper proposes a process mining based methodology to systematically support the resource planning of health services. Specifically, combining Time-Driven Activity Based Costing and process mining approaches, it automatically identifies the patient flow and analytically evaluates activities, service times, and resource consumptions for a specific class (-es) of patients (e.g., a DRG, patients with specific medical condition, etc.). Thus, it allows to reliably estimate the expected resource consumptions for the patient group under investigation. Thanks to process mining, the method overcomes the limitations of existing quantitative approaches that are often time-consuming, based on subjective observations, and too case specific. The method was applied to a real case study of lung cancer patients in an Italian hospital.     

Alternative Approaches to Correcting Public Sector Inefficiency

A bstract . Numerous proposals have been made for improving the provision of collective services. The major ones are explored including reduction of public sector size, introduction of greater competition into the provision of collective services, greater use of incentives to foster sector private sector production, direct substitution of private for public production , and redefinition of the outputs expected from collectively provided services. The advantages and disadvantages of each are considered in light of the multiple sources of public sector inefficiency. No one proposal to eliminate inefficiency in the provision of collective services is likely to succeed. What is needed is careful consideration of the alternatives for each type of public sector service.     

A multi-component enhanced Russell measure of efficiency: With application to water supply plans

Public water providers aim at developing a water supply plan (WSP) that not only provides a reliable and satisfactory level of service but also is efficient in terms of performance. This paper deals with evaluating the performance of WSPs within the framework of multi-component data envelopment analysis. Specifically, we consider the overall performance of each WSP as a decision making unit (DMU) so that economic, social, hygienic, technological, managerial and environmental performances of the WSP make up independent components of the defined DMU. To assess the performance of a set of WPSs, we propose a multi-component enhanced Russell measure of efficiency that takes all sources of inefficiency into account. We show that the proposed measure can be decomposed into individual efficiency measures at component level. This decomposition much enhances the efficiency of computing the proposed measure, noting the fact that this measure is obtained by solving a single linear program. It also guarantees the proposed measure to inherit two important—unit invariance and strong monotonicity—properties of the conventional enhanced Russell measure. In our empirical study, we apply our model to evaluate the efficiency of 10 urban WSPs in Qom city of Iran. In line with experts’ practical opinions, our findings reveal that the (relatively) most efficient WSP is to construct a potable water network and separation of non-drinking water network for urban usage.     

Exploring the performances and determinants of public service provision in 35 major cities in China from the perspectives of efficiency and effectiveness

The measurement of public service provision (PSP) performance and identification of its influencing variables are of great importance for the government to efficiently utilize public resources and provide more effective public services. However, existing studies have mainly focused on the efficiency to provide public services and ignored the effectiveness to improve public subjective well-being. To fill this gap, this study constructs a two-stage PSP conceptual model from the perspective of service production and consumption and develops a corresponding PSP performance evaluation indicator system to evaluate PSP efficiency, effectiveness, and comprehensive performance. The PSP performances of 35 major cities in China during 2011–2018 are calculated using the super efficiency network slack-based measure model. Moreover, the influencing factors of these performances are identified through the truncated regression model. Results indicate that the comprehensive performance of these cities is relatively low and shows a trend of decrease that is predominantly caused by provision efficiency. Owing to the absolute advantage in effectiveness and the catch-up effect in efficiency, cities in the western region perform the best in comprehensive performance, followed by the eastern region and then the central region. In addition, only seven cities achieve a balance between efficiency and effectiveness. Factors from economy, society, government, and public aspects have different impacts on PSP performances. On the basis of these findings, several policy suggestions are proposed. This study proposes a relatively comprehensive and accurate measurement framework of PSP performance that considers both efficiency and effectiveness and can help policymakers implement appropriate strategies promoting PSP in an efficient, effective, and sustainable manner.     

The effect of management commitment to service quality on frontline employees' affective and performance outcomes: an empirical investigation of the New Zealand public healthcare sector

• Very little attention has been given to understand the antecedents of service recovery performance in a public healthcare setting. In this study, a cross-sectional survey investigates a model of service recovery performance. Frontline hospital employees completed a self-administered questionnaire on how factors characterising management commitment to service quality (MCSQ) affect their service recovery efforts. The results suggest the influence of MCSQ is mediated by frontline employees' affective commitment to their hospital. The research advances understanding of frontline service recovery performance in a public healthcare setting and the findings indicate that public healthcare managers can take actions on a number of fronts to assist progress towards the achievement of frontline service recovery excellence.

Copyright © 2006 John Wiley & Sons, Ltd.     

The impact of the residency teaching model on the efficiency of the emergency department at an academic center

The residency teaching model is often cited as a source of inefficiency in the healthcare system. We build a simulation model of an Emergency Department (ED) at a large urban academic hospital. Using historical data and a natural experiment involving residents in the ED, we show that residents in fact increase throughput and lower service and waiting times compared to not being there at all.     

Technical efficiency,specialization and ownership form: evidences from a pooling of Italian hospitals

We evaluate how the productive structure and level of specialization of a hospital affect technical efficiency by analyzing a six-year panel database (2000/2005) drawn from hospital discharge records and Ministry of Health data. We adopt a distance function approach, while measuring the technical efficiency level with stochastic frontier techniques. After controlling for environmental variables and hospital case-mix, inefficiency is negatively associated with specialization and positively associated with capitalization. Capitalization is typical of private structures which, on average, use resources less efficiently with respect to public and not-for-profit hospitals. Finally, by looking at scale elasticities, we find some evidence of unexploited economies of scale, leaving room for centralization.     

中小型公共图书馆网络信息服务的发展策略解析

中小型公共图书馆发展网络信息服务有利于提高图书馆公共文化服务在中小城市的辐射能力,有利于发展地区特色文化,从而让公众享受普遍均等的服务,丰富公众的休闲文化生活。目前服务理念认知尚浅、服务质量欠佳、专业人才匮乏和公众享用信息服务的意识不够等因素制约着中小型公共图书馆网络信息服务的发展。可以从创新网络信息服务理念、拓展立体服务空间、提供特色信息服务、培养新型服务人才以及开展公众信息素养教育等几个方面加以深化和改善,以期提升中小型公共图书馆的网络信息服务能力。     

Assessing the impact of tourist flows on emergency department treatment speed for residents and tourists. The case of Sorrento

Tourism is a fundamental lever of the economic and cultural development of a location. Large tourist flows can negatively impact the provision of public services, such as healthcare. This study aims to investigate emergency department (ED) treatment speed under increased demand caused by tourism. The analysis was conducted on data (covering March–October 2018) collected from the ED of a hospital in Sorrento, a renowned coastal tourist destination in Campania, Italy, by using a two-step strategy. First, we resort to the Kaplan-Meier method to compare treatment in the ED between residents and tourists. Second, through the Cox proportional hazards model, we study the impact of group-specific characteristics on the speed of treatment. The main empirical findings highlight that treatment speed is highly influenced by age and by the languages spoken by tourists. Foreign tourists are best served in off-peak periods, while in the peak arrival period, the healthcare system experiences difficulties, especially for those facing higher language barriers. What emerges is the necessity for a tourism destination to adopt measures to cope with the language heterogeneity of tourists. In a multi-cultural touristic context, healthcare providers and institutions should address the challenge of language barriers by using specialist interpreter services.     

Measuring technical and scale inefficiencies in the beer industry: Nonparametric and parametric evidence

Two alternative approaches of efficiency measurement, nonparametric and statistical, are employed to calculate three types of efficiency indexes for the U.S. beer industry over the period 1950–1986. The results indicate that the beer industry was operating at a high level of pure technical efficiency over that period. The mean value of this efficiency measure is 93.7 percent based on the nonparametric approach and 87.5 percent based on the statistical approach. The two approaches yield dissimilar values and sources for overall technical inefficiency. The overall technical efficiency index computed under the nonparametric approach stands at 91.10 percent and the observed inefficiency is found to be more due to pure technical inefficiency than to scale inefficiency. Using the statistical approach, the beer industry is found to be less overall technically efficient (68.42 percent) than indicated by the nonparametric methodology and the observed inefficiency is found to be primarily contributed to by scale inefficiency.     

The impact of public service values on services of general interest reform debates

Abstract

Competing values complicate debates on the reform of public services. Attention for competition and efficiency is balanced by concerns for equity and universality in service delivery. These potential value conflicts are best visible in the reform of services of general interest. Despite debates at the European and the national level, current research on services of general interest has been limited to scholars in law and economics. Citizens' opinion on the guiding principles of service delivery is generally disregarded. In this article, we analyse a number of Eurobarometer surveys dealing with services of general interest, as well as a general survey of citizens' perceptions of the public sector in Belgium. We delineate clusters of citizens' public service delivery value orientations, and show that one-sided or ideology-based reform strategies probably negate many of the continuing dilemmas in public service delivery.     

公立医院医疗服务体系构建的创新

当前我国公立医院医疗服务质量与患者的实际需求和服务期望值存在较大距离,本文以无锡二院对人性化医疗服务体系的探索为例,从医疗服务的人性化、医疗流程的合理性、保障服务的及时性等方面进行了介绍,并对改革的动因及成效进行了分析。     

Efficiency analysis of emergency departments in metropolitan areas

The demand in the healthcare industry is increasing exponentially due to aging population of the world and this is leading to a rapid increase in the cost of healthcare. The emergency departments of the hospitals are the frontline of health care systems and play an additional critical role in providing an efficient and high-quality response for patients. The overcrowding at the emergency departments due to growing demand results in a situation where the demand for ED services exceeds the ability to provide care in a reasonable amount of time. This has led countries to reconsider their health policies in a way to increase their efficiency in their healthcare systems in general and in emergency departments, in particular. As in many countries, there has been a steady and significant increase in the number of patients that seek health services at the emergency departments of state hospitals of Turkey, due to the significant structural reforms in health services since 2003. While meeting this increasing demand, it is ever more important to provide these critical health services efficiently. Therefore, the efficiency of the emergency departments of seven general hospitals run by Istanbul's Beyoglu State Hospitals Association have been analyzed using categorical Data Envelopment Analysis (DEA) models. The analysis of DEA results is supported by a set of statistical methods to make it easier for the hospital administrators to interpret the analysis and draw conclusions. The analysis shows that less-equipped EDs are supported by better equipped, larger EDs, resulting in a hub-and-spoke type of structure among the EDs where “satellite” EDs serve an important referral function and thus evaluating their efficiency without taking the interoperability among these units into account would not be an accurate assessment of their performance.     

Improving spatial accessibility to regional health systems through facility capacity management

In austerity times, the general interest to reduce costs and improve efficiency levels often resulted into local cuts to public expenditure and profound reorganizations of existing service networks, especially in sectors like healthcare. In Italy, a recent reform prescribed the reconfiguration of time-dependent (i.e. emergency) hospital networks with the aim of improving patients’ accessibility conditions. In order to evaluate the impacts determined by this reorganization, we perform a spatial analysis in which we consider the distance from the closest facility as an accessibility measure. Results obtained from the spatial analysis confirm that users effectively benefit from the reorganization process but also that further improvements are possible, especially for the worst served ones. To this end, we also propose solving a mathematical programming model aiming at redistributing the capacities, i.e. the supply of beds, among the hospitals of the network seeking to maximize users’ accessibility. The realized computational experiments show that averagely better and even more equitable accessibility conditions could be obtained by containing the deriving reorganization costs.     

Performance evaluation of retail banking services: Is there a trade-off between production and quality?

We propose a two-stage data envelopment analysis model to give an insight on the internal structure of the banking sector and study the important role of service quality in the production process. The first stage deals with the production performance and is related with the optimal use of resources to produce banking services, whereas the second stage deals with the service quality performance using customer-reported satisfaction and loyalty measures. This paper analyzes the efficiency and productivity of 36 branches of a single bank of Greece over the period 2016–2018. The results indicate the existence of a strong trade-off between production and service quality. Further insights of the study indicate that the branch size significantly affects the service quality and overall efficiency. Moreover, the employee assessments by the performance appraisal system of the bank are mainly associated with the service production and not with service quality. Finally, this study presents a managerial decision-making matrix and makes recommendations to help bank managers to improve the retail network performance.     

Does Super-Department Reform Improve Public Service Performance in China?

Echoing the global public management reform movement, China’s authorities advocated ‘super-department’ reform (SDR) to curb interdepartmental conflict and administrative inefficiency. However, the related performance consequences have not been empirically investigated. We test the reform’s effects on citizen satisfaction with public services through a natural experiment involving twenty-five counties in Guangdong province (2009–2012) and the difference-in-differences method. The results show that the reform has improved public service performance, but its effects are marginal and unsustainable. We discuss the theoretical contributions and policy implications of the findings and identify future research avenues.     

以服务对象为考核目标的药剂科绩效管理

目的:结合我院药剂科工作的实际情况,探讨一种以服务对象为考核目标的绩效管理模式,以提高药剂科的管理水平和医疗服务质量。方法:针对服务对象的不同,分别对药剂科各部门制定相关的考核项目并细化考核方法,建立以服务对象为考核目标的绩效管理模式。结果:提供了药剂科管理模式的新思路。结论:新的管理模式对体现药房工作人员的自身价值和社会价值、提高其工作积极性和主动性、以及树立以病人为中心的服务理念有着重要意义。