A comparative assessment of the productivity of Australia's public rail systems 1971/72–1991/92

There is a growing interest in the establishment of suitable measures of the overall performance of government business enterprises, particularly railways, which are a major recipient of government subsidy. They must improve their performance and become more cost efficient. Any policy designed to reduce costs must consider the implications of resultant actions on the overall productivity of a business. We propose the use of the total factor productivity index as an appropriate reference benchmark, to enable each railway to evaluate the productivity implications of any change to the operating and managerial environment. Using the Institute of Transport Studies' rail database, total factor productivity indices are derived annually from 1971/72 to 1991/92 for the 5 major public rail systems in Australia and sources of variation are identified.The paper recognizes the need to identify sources of variation in productivity which translate into operational guidelines for management in assisting them to improve performance over time. A contribution is the recognition of the importance of including both demand side (final output) and supply, side measures of output (intermediate output). Final output may be more important for monitoring the performance of an enterprise from a cost-effectiveness perspective, but a supply side measure is often more useful to operators because it is the dimension of output over which they have more control.The research reported in this paper was partially funded by an Australian Research Council grant (No. A78930595).     

Decomposing hospital productivity changes, 1985–1988: A nonparametric Malmquist approach

Annual data on U.S. hospitals from 1985–1988 are evaluated by ownership type—profit, nonprofit, state and local government, and U.S. Department of Veterans Affairs (VA)—for changes in hospital productivity over time. Distance functions are used to measure Malmquist indices of productivity change, which are then decomposed into indices of efficiency change and technology change. In contrast to previous studies using this approach, we allow for variable returns to scale and use both input and output orientations. We find that changes in technology dominate changes in inefficiency in determining changes in productivity.     

Electronic medical record use and efficiency: A DEA and windows analysis of hospitals

We use data envelopment analysis (DEA) to examine the relationship between hospital electronic medical record (EMR) use and efficiency in a national sample of acute care hospitals. Data sources include the American Hospital Association (AHA), Health Information Management Systems Society (HIMSS), and Case Mix Index. Using two research approaches including a retrospective, cross-sectional design and a first differencing repeated measures design, we find limited evidence that EMRs can improve hospital efficiency. Small hospitals may benefit in the area of efficiency through EMR use, but medium and large hospitals generally do not demonstrate such a difference. Likewise, there does not appear to be a significant increase in efficiency over time associated with EMRs when compared to the efficiency of hospitals without such documentation.     

The scale of hospital production in different settings: one size does not fit all

This paper analyses the productive efficiency of 141 public hospitals from 1998 to 2004 in two Canadian provinces; one a small province with a few small cities and a generally more rural population and the other a large province that is more urban in nature, with a population who mainly live in large cities. The relative efficiencies of the hospitals, the changes in productivity during this time period, and the relationship between efficiency and the size or scale of the hospitals are investigated using data envelopment analysis. The models for the production of health care use case mix adjusted hospital discharges as the output, and nursing hours as inputs. We find clear differences between the two provinces. Making use of ‘own’ and ‘meta’ technical efficiency frontiers, we demonstrate that efficient units in the larger and more urban province are larger than non-efficient units in that province. However, efficient hospitals in the smaller and more rural province are smaller than non-efficient hospitals in that province. Overall, efficient hospitals in the larger more urban province are larger than efficient hospitals in the smaller more rural province. This has interesting policy implications—different hospitals may have different optimal sizes, or different efficient modes of operation, depending on location, the population they serve, and the policies their respective provincial governments wish to implement. In addition, there are lessons to be learned by comparing the hospitals across the two provinces, since the inefficient hospitals in the small rural province predominantly use hospitals from the large urban province as benchmarks, such that substantially larger improvement potential can be identified by inter-provincial rather than intra-provincial benchmarking analysis.     

An econometric approach to estimating support prices and measures of productivity change in public hospitals

In industry sectors where market prices for goods and services are unavailable, it is common to use estimated output and input distance functions to estimate rates of productivity change. It is also possible, but less common, to use estimated distance functions to estimate the normalised support (or efficient) prices of individual inputs and outputs. A problem that arises in the econometric estimation of these functions is that more than one variable in the estimating equation may be endogenous. In such cases, maximum likelihood estimation can lead to biased and inconsistent parameter estimates. To solve the problem, we use linear programming to construct a quantity index. The distance function is then written in the form of a conventional stochastic frontier model where the explanatory variables are unambiguously exogenous. We use this approach to estimate productivity indexes, measures of environmental change, levels of efficiency, and support prices for a sample of Australian public hospitals.     

Industry analysis and investment decision-making under conditions of uncertainty

Evaluating risk is a key element in successful investment decision-making. A major risk in forecasting company performance is associated with projecting its cash flow streams by product-line which in turn is strongly related to the expected industry outlook and likely variability about this outlook. This paper sets out a methodology for evaluating this aspect of the investment decision by developing measures of expected real cash flow growth (reward) and expected annual variability of this growth (risk). These measures are constructed for 77 industry classifications at the two and three digit SIC (Standard Industrial Classification) level of detail by solving a dynamic input–output model under various economic secenarios. Aside from producing results which are relevant for producing company valuation bands, the analysis strongly suggests that perceptions of which industries are ‘winners’ and which are ‘losers’ are significantly altered when both ‘reward’ and ‘risk’ are used as criteria as opposed to either one alone. Finally, the methodology also produces results which measures the sources of cash flow growth in terms of relative price performance, productivity, and demand for output. Since there measures can be used as indicators of the quality of industry real cash flow growth, industry performance can be further arrayed within the broad categories of winning and losing industries. Several examples of how this is done are offered.     

Effect of armed conflicts on humanitarian operations: Total factor productivity and efficiency of rural hospitals

We study an important but widely neglected topic in humanitarian operations: armed conflicts. Specifically, this paper empirically analyzes the effect of armed conflicts on the operational performance of first-layer response organizations. Using as a case study the Colombian conflict we investigate the effect of conflict on public rural hospitals' (i) total factor productivity, (ii) efficiency and (iii) efficiency variability. The panel data set (2007–2011) used in this study includes information at the hospital level for 163 hospitals and qualitative data collected from interviews with medical staff from the Colombian Ministry of Health and hospitals in different conflict zones. Our results indicate that armed conflict has a positive effect on total factor productivity, while it has a negative impact on hospital efficiency, and interestingly that efficiency and total factor productivity both increase in post conflict. Finally, the results show that efficiency variability is higher in peace and post-conflict hospitals and lower in medium and severe-conflict hospitals. These results have operations management implications and opportunities for future research related to sourcing decisions, supply chain and workforce flexibility, behavioral impacts on the workforce, and humanitarian response to conflicts.     

Relating focus to quality and cost in a healthcare setting

Focus in healthcare has been heralded as the next frontier in improving its efficiency and efficacy (Herzlinger 2004). Focus takes several different forms, ranging from standalone specialty centers to a hospital that places a strategic emphasis on a clinical area. We adopt this latter perspective and define focus as a disproportionate emphasis on a particular clinical area in a hospital. We use secondary data from hospitals providing cardiology care in New York State to examine the relationship between focus and performance. We develop two measures of focus. Proportional focus is defined to be the proportion of cases treated in a particular clinical specialty. Expertise focus is defined to be specific evidence that a hospital has taken action to build expertise in treating diseases in that specialty. We operationalize hospital performance along cost and quality dimensions, and we use hierarchical regression to examine the impact of focus on performance. Our results indicate that proportional focus, but not expertise focus, is associated with better cost performance. Quality performance, on the other hand, was associated only with the interaction between proportional focus and expertise focus, which means that only hospitals exhibiting higher levels of both proportional and expertise focus achieve better quality performance. These findings support the notion that not only is focus important in healthcare, but also that researchers and practitioners need to recognize that relationships are contingent on the performance and focus measures used and thus, findings may not be generalizable from one metric to another.     

PRODUCTIVITY IN PUBLIC SERVICES

Abstract.  This paper discusses issues arising in the measurement of productivity in public services. Compared to measuring productivity in the private sector difficulties arise because the output of public services is often unpriced and because some public services are consumed collectively. A key problem is measuring the full range of outputs and quality improvements delivered by public sector organizations that are valued by society. Without comprehensive measures of output, productivity statistics may be misleading. I outline methods used in the measurement of both private and public sector productivity and discuss the measurement of public sector productivity in practice. Finally I discuss studies that examine factors underlying productivity differences and productivity growth in public and private sector organizations. Public sector reforms and the use of pilot schemes in public sector organizations present opportunities for research to identify causal effects on productivity.     

Appropriate index number formulae for productivity measurement at the plant/organizational level

Changes in productivity may be based on relating changes in physical (real) output to changes in physical input(s). Such a system of productivity measures requires the choice of an appropriate index number formula in order to convert changes in money aggregates into physical or real terms. Criteria for the choice between appropriate index number formulae are considered and developed, and an illustration provided.     

China's total factor productivity estimates by region, investment sources and ownership

This paper constructs China national and provincial physical capital and human capital for the period 1984–2006. The estimation of physical capital is extended to the use of sources of fund and ownership of fund. The growth accounting framework is used to calculate the output, input and total factor productivity growth rates. The relative variance method is used to compare the relative importance to output growth by input growth and productivity growth. The empirical findings show that although output growth in post-reform China has been contributed much by growth in total factor productivity, output volatility has relied more on input growth, and TFP growth has not been supported by complementary changes. There are regional differences when looking at the performance of individual growth rates.     

Tenure and output

A key tenet of the theory of human capital is that investment in skills results in higher productivity. The previous literature has estimated the degree of investment in human capital for individuals by looking at individual wage growth as a proxy for productivity growth. In this paper, we have both wage and personal productivity data, and thus are able to measure of the increase in workers' output with tenure as evidence of the degree of learning on the job. The data is from an autoglass company. Most of production occurs at the individual level so measures of output are clear. We find a very steep learning curve in the first eight months on the job: output is 53 percent higher after eight months than it is initially. Our data show that these output gains with tenure are not reflected in equal percentage pay gains: pay profiles are much flatter than output profiles in the first year and a half on the job. For these data, using wage profiles significantly underestimates the amount of investment compared to the gains evident in output-tenure profiles. The pattern of productivity rising more rapidly than pay reverses after two years of tenure, although our evidence on this point is less reliable. Worker selection is also important. Workers who stay longer have higher output levels and faster early learning.     

Cost Malmquist productivity index: an output-specific approach for group comparison

The cost Malmquist productivity index (CMPI) has been proposed to capture the performance change of cost minimizing Decision Making Units (DMUs). Recently, two alternative uses of the CMPI have been suggested: (1) using the CMPI to compare groups of DMUs, and (2) using the CMPI to compare DMUs for each output separately. In this paper, we propose a new CMPI that combines both procedures. The resulting methodology provides group-specific indexes for each output separately, and therefore offers the option to identify the sources of cost performance change. We also define our index when input prices are not observed and establish, in that case, a duality with a new technical productivity index, which takes the form of a Malmquist productivity index. We illustrate our new methodology with a numerical example and an application to the US electricity plant districts.     

Index Number Concepts,Measures and Decompositions of Productivity Growth

This paper explores the definitions and properties of total factor productivity growth (TFPG) indexes, focusing especially on the Paasche, Laspeyres, Fisher, Törnqvist, and implicit Törnqvist ones. These indexes can be evaluated from observable price and quantity data, and certain of these are shown to be measures of TFPG concepts and theoretical indexes that have been proposed in the literature. The mathematical relationships between these and quantity aggregates, financial measures, and price and quantity indexes are explored. Decompositions of the productivity growth indexes are also given. The paper concludes with a brief overview of some limitations on our analysis.     

Errors of measurement and the recent acceleration in manufacturing productivity growth

Using detailed (4-digit SIC) industry data for the years 1958–1989, I examine whether the recent acceleration in manufacturing productivity can be attributed to the effects of mismeasurement of the prices of inputs and output, by testing a model linking a set of proxy variables for measurement error to a series of measures of acceleration in total factor productivity (TFP). Alternative TFP estimates are presented in order to determine if the findings are sensitive to the method of TFP calculation. The results are inconsistent with the measurement error hypothesis and invariant to the specification of the TFP equation.     

LABOUR PRODUCTIVITY CHANGES AND WORKING TIME: THE CASE OF GREECE

In terms of the annual hours worked per employee, Greece ranks first among EU-15 countries and second among OECD countries. In this context, the austerity measures it adopted (as suggested by the EU and IMF) imply, among other things, a reduction in the over-hours. If such reductions were not to be accompanied by increases in labour productivity, output would be reduced considerably. This paper therefore addresses the question: “What change in sectoral labour productivity levels would have been required to deliver the actual change in final demands in Greece between 1995 and 2005, if working hours in each sector had been reduced to their EU averages?” In this framework, we develop a methodology for calculating labour productivity change by sector of economic activity in an input–output context. Next, we apply it to the Greek economy for the time period 1995–2005, the most recent period for which the required data are available. We find that the required productivity changes are the most substantial for the hotels and restaurants sector, followed by machinery manufacturing and the trade sectors.     

The impact of strategic operations management decisions on community hospital performance

Over the past decade, 10% of community hospitals have closed. In this challenging time, our study presents hospital administrators with some valuable information that can help improve community hospitals’ performance. The purpose of this paper is to develop a strategic operations management model that links long-term service choices, intermediate operations decisions, and hospital performance given the structural constraints of location, size, and medical teaching status. Data collected from 151 community hospitals are used to test the model. The research identifies strategic operations management decisions in the US community hospitals, shows their causal relationships, and identifies their effects on hospital performance. Specifically, we find that intermediate infrastructural operations decisions affect a community hospital’s cost, quality, and financial performance after the structural decisions of location and size have set the stage. Our study also reveals that community hospitals have adopted new staff and demand management decisions in response to the market needs.     

Evaluation of efficiency in Colombian hospitals: An analysis for the post-reform period

In this study we analyze the performance of 602 level 1 Colombian hospitals for the period 2009–2013. The analysis is carried out from both static and temporal perspectives in order to evaluate the evolution of total factor productivity (change in hospital performance) and its components throughout the period. The study also explores a question relevant not only to the Colombian health system, but to many others around the world, of whether primary care centers excessively refer patients to high-level hospitals, thereby negatively affecting the quality, efficiency, and effectiveness of all healthcare service provision. The results demonstrated that adjusted production (service provision) and levels of quality and referrals to higher-level hospitals could be improved, on average, by 44%. This increase in health service provision levels and their quality can be achieved by reducing personnel expenditure (by an average of 22%), expenditure on medicines (by 20%), and purchasing expenses (by 11%). The temporal analysis shows that total factor productivity (hospital performance change) worsened by 1% during the period, mainly due to the technological backlash experienced despite a slightly positive evolution in efficiency.     

Analysis of Hospital Production: An Output Index Approach

In this study, we develop and implement an output index approach to the estimation of hospital cost functions that reflects the differentiated nature of hospital care. The approach combines the estimation of an output index within a flexible functional form. We find, in an application to California hospitals, evidence of scope economies across specialties within primary care, and diseconomies of scope within secondary and tertiary care. Minimum efficient scale is reached at larger levels of output than would be estimated by conventional techniques. These results indicate the importance of accounting for firm output heterogeneity when estimating cost functions. Copyright © 2014 John Wiley & Sons, Ltd.     

Hospital material management in Taiwan: a survey

The new insurance policy that began in 1995 for all people in Taiwan and severe competition within the health care industry are some of the pressing issues forcing hospitals to improve their operational efficiency. A primary productivity improvement for hospitals is the reduction of the cost of material management because the materiel function on average controls 30-40 percent of the operating dollars in a Taiwan hospital. In this article, a fuzzy clustering method is used to classify the different types of materiel management systems within Taiwan hospitals. Inventory turnover rates and fill rates are compared among those different types of systems by using multivariate analysis of variance. The results show that the differences in both inventory turnover rates and fill rates are statistically significant among different material management systems.