Scaling performance frontiers across multiple perioperative services

Background

One of the primary principles governing operating room management includes maximizing clinical efficiency and optimizing the time used in the high-cost, high-revenue environments represented by operating rooms. Under-utilized and over-utilized times are elementary metrics that describe the operating room performance. Performance frontiers, the graphical representation of a hypothetical maximum performance of a manufacturing unit given a set of operating choices, visualize the maximal efficiency of systems and their existing constraints.

Methods

Monthly aggregated operating room metrics from services at the University of Vermont Medical Center (UVM), Stanford Hospital, and the University of Alabama (UAB) at Birmingham Hospital were extracted. Paired under- and over-utilized times were plotted against each other. Performance frontiers representing the optimal performance of each service were overlaid.

Results

The Kolmogorov-Smirnov test for goodness-of-fit at 95 % level of significance confirms that the performance frontiers representing UVM and Stanford (K-S = 0.9507, p < 0.0001), UVM and UAB (K-S = 0.9989, p < 0.0001), and Stanford and UAB (K-S = 0.9773, p < 0.0001), indicating each service is represented by a different performance frontier.

Conclusions

Our analysis shows that the performance frontier defining the optimal efficiency of UVM is more efficient than that of Stanford and UAB. Differences in efficiency may be the result of a collection of factors that must be the subject of future research, including but not limited to organizational differences limited in scale of institutions. Choices in operating room management must be made in relation to the existing organizational structures of each institution and their specific capacity to make changes in tactical decisions. Systemic interventions should be implemented via qualitative analysis of more efficient services, defined by the relative positioning of relevant performance frontiers.