Labor productivity in hospitals

Increased competition as a means of health care cost control has brought hospital productivity under scrutiny. Hospital personnel per adjusted census has been increasing. Productivity increases require active participation of workers at all levels, including doctors and trustees. Participation is its own powerful reward; external standards inevitably imply sanctions. Real gains in productivity require integration of clinical and nonclinical activities. These will also require reduced hospital employment. A four-step outline for increased productivity is included.