Are we operating effectively? A lean analysis of operating theatre changeovers

Hospital operating theatres are a critical but costly resource in healthcare processes. Their efficiency and utilisation impact upon hospital finances, clinical effectiveness and patient outcomes. Operations management techniques have now been applied widely to optimise flow. An important challenge is to balance the needs of process flexibility, efficiency and work standardisation with clinical requirements. This paper applies operations management methods to analyse elective orthopaedic surgery at five international hospitals to describe the issues that affect operating theatre productivity. It utilises an innovative method of video analysis to observe patient changeovers over 29 days of surgery and data is analysed to understand the causes of variability and waste. The findings suggest that processes which are standardised via operations management methodologies can improve productivity in a process that exhibits wide variation in practice. There are apparent trade-offs associated with efficiency and clinical concerns such infection control, that lead to different standard process archetypes being utilised. Recommendations for standardising patient changeovers are provided.     

Discussion of: “Flattening the organization: the effect of organizational reporting structure on budgeting effectiveness”

This paper is a discussion of Hannan et al. (Rev Account Stud, 2010), wherein subordinate-participants are endowed with private information, and superior-participants can potentially affect budget requests through their ability to reject them. Their findings are of interest to research on both the design of budgeting systems and span of control. I discuss the relevance of HRT to these literatures and comment on their implementation and experimental design. Also, I offer suggestions for future research, one of which is to explicitly introduce monitoring into experiments on span of control.     

The effects of education in early-stage agriculture: some evidence from China

The stochastic production frontier approach is used to study the effects of education on agricultural efficiency for a cross-section of 'early-stage' farms from Guanghan County, Sichuan Province, China. Education for farm families in rural China is multifaceted with a combination of formal education, intragenerational transfer of knowledge within the home, and agricultural extension services. Since our survey data span two different years with markedly different policy environments, we are able to examine not only which aspects of education affect agricultural efficiency, but also whether or not the policy environment matters. We find limited evidence that in a policy environment that is conducive to agriculture, formal education provides positive returns in agriculture. Furthermore, general education may provide greater returns than the more targeted extension services.     

Nobelity and novelty: Finn Kydland and Edward Prescott’s contributions viewed from Vienna

The awarding of the Nobel Prize in Economics in 2004 to Finn Kydland and Edward Prescott represents an opportunity to evaluate their contributions in light of Austrian economics. We lay out the basics of their contributions—the general equilibrium approach to economic fluctuations and the game theoretic approach to policy—and argue that they have tenets similar to those of Austrianism. We argue that their methodology parallels Austrian methodology in several significant ways that have gone unnoticed. We conclude that Kydland and Prescott’s Nobel Prize suggests Austrian approaches can have a more prominent impact than they have had in the past.     

THE NONPROFIT SECTOR OF THE U.S. ECONOMY: A METHODOLOGICAL STATEMENT

United States input-output accounts identify and measure the interrelationships between the various industries in the United States economy. However, these accounts do not identify nonprofit activities from their for-profit counterparts in the service-producing sector. This paper, prepared by Gabriel Rudney and Paula Young, presents the methodology and summary data produced by disaggregating the service-producing industries to identify separately nonprofit activities.
The input-output accounts for 1977 produced in this study include 107 industries, but in this paper the results are summarized into 14 industries showing only nonprofit and for-profit components. The GNP and total outputs in this study are consistent with the revised input-output accounts for 1977 prepared by the U.S. Department of Commerce, Bureau of Economic Analysis.