Improving on-time performance in health care organizations: a case study

Area of Science:

• Healthcare Management
• Operations Research
• Medical Informatics

Background:

• On-time performance for first surgeries is critical for healthcare efficiency.
• Surgeon delays are often perceived as the primary cause of missed surgical start times.
• Traditional performance improvement strategies may not be effective in complex healthcare systems.

Purpose of the Study:

• To propose a measurement system strategy for improving on-time performance in healthcare organizations.
• To analyze the factors influencing the on-time start of first surgeries.
• To evaluate the effectiveness of targeting specific delays versus system-wide improvements.

Main Methods:

• Analysis of a measurement system for monitoring daily first surgery start times in a U.S. hospital.
• Investigation of surgeon performance and its impact on overall surgical scheduling.
• Comparative analysis of targeted interventions versus holistic system improvements.

Main Results:

• Surgeons are not the sole cause of delays; focusing solely on them is insufficient.
• Improving the hospital's overall on-time performance positively impacts surgeon performance.
• A "snowball effect" was observed, where system-wide improvements led to better first surgery start times.

Conclusions:

• The Pareto principle (focusing on the main cause) may not be optimal for healthcare performance improvement.
• A holistic, system-wide approach to on-time performance is more effective in healthcare settings.
• Enhancing overall hospital operational efficiency can create a self-reinforcing cycle for improved surgical scheduling.