Determining and Ranking of Indicators for Efficiency Evaluation of Hospitals

Document Type : Original Article

Authors

1 Student Research Committee, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Health Policy and Management Research Center, Department Of Healthcare Management, School Of Public Health, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran

3 Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background/Objectives: Selecting the best set of input and output indicators and allocation of correct weights to them is a sensitive step in any efficiency evaluation study. Therefore, the present study aims to determine and rank the efficiency indicators of hospitals.
Method: This mixed-method study was carried out in three steps:  comprehensive literature review, application of the Delphi method to determine the best indicators for efficiency evaluation of the hospitals, and utilization of a fuzzy analytic hierarchical process (FAHP) for weighting of final indicators and ranking them.
Results: 8 input and 9 output indicators were selected for efficiency evaluation of the hospitals which were  weighted by FAHP. Among the input indicators, the number of physicians and  active beds and among the output indicators, length of stay and number of surgeries were identified to be the most important indicators.
Conclusion: According to the proposed indicators and their accurate weights, efficiency evaluation of hospitals can be done more accurately, reliably, and comprehensively.
 

Keywords


1. Sepehrdust H, Rajabi E. Technical efficiency measurement of social security hospitals. Journal of School of Public Health and Institute of Public Health Research. 2013;10(3):91-9.
2. Hatam N. Technical Efficiency Measurement of Hospitals of country’s Social Security Organization through Data Envelopment Analysis method. Management Quarterly. 2016;7:6-18. [In Persian]
3. Than TM, Saw YM, Khaing M, Win EM, Cho SM, Kariya T, et al. Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting? BMC Health Serv Res. 2017;17(1):669. doi: 10.1186/s12913-017-2619-z.
4. Liu JS, Lu LY, Lu W-M, Lin BJ. A survey of DEA applications. Omega. 2013;41(5):893-902.
5. Hashemi N, Hosein-Zadeh Lotfi F, Najafi E. Performance evaluation of educational groups using Data Envelopment Analysis. Development and Evolution Management. 2010;2:85-91. [In Persian]
6. O’Neill L, Rauner M, Heidenberger K, Kraus M. A cross-national comparison and taxonomy of DEA-based hospital efficiency studies. Socio-Economic Planning Sciences. 2008;42(3):158-89. doi: 10.1016/j.seps.2007.03.001.
7. AliMohammadiArdakani M, SaeidaArdekani S, SayadiToranloo H. Staff Relative Efficiency Appraisal of Health Centers Using Data Envelopment Analysis Models. Journal of Rafsanjan University of Medical Sciences. 2011;10(4):255-66.
8. Farah Abadi SME, Yousefi M, Bahman ziyari N, et al. Efficiency Analysis of Selected Urban Health Centers affiliated to Isfahan University of Medical Sciences. Hospital Quarterly. 2011;1(36):43-35 [In Persian]
9. Alam Tabriz A, Faraji R, Saiedy H. Efficiency Evaluation Faculties of Shahid Beheshti University using Composed Approach of DEA and Goal Programming Model. Industrial Management Studies. 2010;8(19):1-22.
10. Saber-Mahani A, Goodarzi Gh, Barouni M, Khakian M. Estimation of Technical Efficiency of General Hospitals of Kerman University of Medical Sciences by Data Envelopment Analysis (DEA) Method in 2007. Journal of Kerman University of Medical Sciences. 2010;17(1):59-67. [In Persian]
11. Hatam N, Moslehi S, Askarian M, Shokrpour N, Keshtkaran A, Abbasi M. The efficiency of general public hospitals in Fars Province, Southern Iran 2010;12(2);138-44.
12. ALAMTABRIZ A, IMANIPOUR M. Measuring the relative efficiency of health care offered in hospitals of Shahid Beheshti University of medical sciences using Data Envelopment Analysis (DEA) technique. 2011;8(3):325-15. [In Persian]
13. Alamtabriz A, Imanipour M. Measuring the relative efficiency of health care offered in hospitals of Shahid Beheshti University of
medical sciences using Data Envelopment Analysis (DEA) technique. Health Information Management. 2009;3(19):315-25. [In Persian]
14. Pourmiri M, Ketabi S. Evaluation of Performance in Non-Clinical Educational Departments in Isfahan University of Medical Sciences, Iran with Data Envelopment Analysis Method. Health Inf Manage. 2013;10(3):471-80.
15. Yawe B. Hospital performance evaluation in Uganda: a super-efficiency data envelope analysis model. Zambia Social Science Journal. 2010;1(1):6.
16. Mohammadi A, Mohammad Hoseini Zadeh S. Use of DEA/AHP integrated approach in rating the insurance agencies. Economic Bulletin, 2005;281-304. [In Persian]
17. Kakeman E, Forushani AR, Dargahi H. Technical efficiency of hospitals in Tehran, Iran. Iranian journal of public health. 2016;45(4):494.
18. Bahrami MA, Rafiei S, Abedi M, Askari R. Data envelopment analysis for estimating efficiency of intensive care units: a case study in Iran. Int J Health Care Qual Assur. 2018;31(4):276-82. doi: 10.1108/IJHCQA-12-2016-0181.
19. Linden A. Measuring hospital efficiency using DEA an investigation into the relationship between scale and efficiency within the South African private hospital environment: University of Cape Town; 2013.
20. Ahmadi F, Nasiriani K, Abazari P. Delphi technique: a tool for research. Iranian Journal of Medical Education. 2008;8(1):175-85.
21. Ahmadi N. Introducing and criticizing the Delphi method. Monthly Book (Social Science).2009;22:100-8 [In Persian]
22. Rahimi H, Khammar-nia M, Kavosi Z, Eslahi M. Indicators of hospital performance evaluation: a systematic review. International Journal of Hospital Research. 2014;3(4):199-208.
23. Taleghani M, Shahroudi K, Sanei F. Comparison between AHP and FAHP in buyer preferences ranking (Case study: house hold industry). Journal of Operational Research In Its Applications (Applied Mathematics)-Lahijan Azad University. 2012;9(1):0-.
24. Azar A, Khatir MV, Baerz AM, Yeganeh YH. Evaluation of hospital efficiency by data envelopment analysis: Tehran University of
Medical Sciences: 2009-2011. Journal of Health Administration (JHA). 2013;16(53).
25. Feizollah A, Mohammad A, Khosro K, Alireza D. Technical efficiency analyses in hospitals of Tabriz University of Medical Sciences. Hospital Journal. 2012;11(2):65-76 [In Persian]
26. Kashanipoor M, Ghazizadeh M. Identifying Effective influency Variables And Ratios on Measuring the Bank Branches Efficiency. Business Strategies. 2009;6(32):93-108. [In Persian]
27. Mateus C, Joaquim I, Nunes C. Measuring hospital efficiency—comparing four European countries. The European Journal of Public Health. 2015;25(suppl_1):52-8. doi: 10.1093/eurpub/cku222.
28. SALEHZADEH R, KETABI S. Measuring the efficiency of Qom hospitals with data envelopment analysis and analytic hierarchy process. 2011;8(4):479-89. [In Persian]
29. Rashidian A, Jahanmehr N, Pourreza A, Majdzadeh S, Goudarzi R. Evaluating performance of medical Universities in Iran during 2002 to 2007: a technical efficiency study. Hakim Research Journal. 2010;13(1):58-68.
30. Pourreza A, Goudarzi G, Azadi H. Determination of technical efficiency of hospitals affiliated with Tehran University of Medical Science by the data envelopment analysis method: 1996-2006. Journal of School of Public Health & Institute of Public Health Research. 2010;7(4):79-86. [In Persian]
31. Ilbeigi A, Kazemi M, Peivandi MT. Relationship between official performance measurement scores and Relative efficiency in general hospitals. Journal of Hospital. 2012;11(2):31-44.
32. Ghasemi A, Jahangard E. The Investigation of Dimensional Efficiency for Branches of Maskan Bank in Resources Collection and Facilities Allocation: Approach of Super Efficiency Model with Weight Restrictions. Industrial Management Journal. 2001;3(6):113-28. [In Persian]
33. Azadeh A, Keramati A, Songhori MJ. An integrated Delphi/VAHP/DEA framework for evaluation of information technology/ information system (IT/IS) investments. The International Journal of Advanced Manufacturing Technology. 2009;45(11-12):1233. doi: 10.1007/s00170-009-2047-2.
34. Che Z, Wang H, Chuang C-L. A fuzzy AHP and DEA approach for making bank loan decisions for small and medium enterprises in Taiwan. Expert Systems with Applications. 2010;37(10):7189-99. doi: 10.1016/j.eswa.2010.04.010.
35. Tseng Y-F, Lee T-Z. Comparing appropriate decision support of human resource practices on organizational performance with DEA/AHP model. Expert Systems with Applications. 2009;36(3):6548-58. di: 10.1016/j.eswa.2008.07.066.