Predictors of surgeons’ efficiency in the operating rooms

2016 ◽  
Vol 30 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Personal Characteristics ◽  
Positive Association ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Data Envelopment ◽  
Surgical Specialty ◽  
Independent Variables ◽  
Fee Schedule

The sustainability of the Japanese healthcare system is questionable because of a huge fiscal debt. One of the solutions is to improve the efficiency of healthcare. The purpose of this study is to determine what factors are predictive of surgeons’ efficiency scores. The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2013–2015. Output-oriented Charnes-Cooper-Rhodes model of data envelopment analysis was employed to calculate each surgeon’s efficiency score. Seven independent variables that may predict their efficiency scores were selected: experience, medical school, surgical volume, gender, academic rank, surgical specialty, and the surgical fee schedule. Multiple regression analysis using random-effects Tobit model was used for our panel data. The data from total 8722 surgical cases were obtained in 18-month study period. The authors analyzed 134 surgeons. The only statistically significant coefficients were surgical specialty and surgical fee schedule (p = 0.000 and p = 0.016, respectively). Experience had some positive association with efficiency scores but did not reach statistical significance (p = 0.062). The other coefficients were not statistically significant. These results demonstrated that the surgical reimbursement system, not surgeons’ personal characteristics, is a significant predictor of surgeons’ efficiency.

scholarly journals Equality of surgical fee schedule in Japan: a retrospective observational study

2021 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Data Envelopment Analysis ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Data Envelopment ◽  
Surgical Specialty ◽  
Gini Coefficients ◽  
Decision Making Unit ◽  
Significant Difference ◽  
Fee Schedule

Abstract Background The purpose of this study is to examine how the degree of inequality of Japanese surgical fee schedule changed during the study period by applying Gini coefficients for efficiency scores computed from data envelopment analysis. Methods All the surgeries that were performed in the main operating rooms of Teikyo University Hospital in 2013-18 were candidates used for the analysis of efficiency and equality of fee schedule. The decision making unit was defined as a surgeon with the highest academic rank in the surgery. Inputs were defined as (1) the number of assistants, and (2) the duration of operation. An output was defined as the surgical fee that was charged for reimbursement. Each surgeon’s efficiency score was calculated using data envelopment analysis. Using the medians of efficiency scores in each surgical specialty, the authors inferred Gini coefficients and their standard errors in each year and in each surgical fee schedule by the Bootstrap methods. Results The authors analyzed 16,307 surgical procedures during the study period of 2013-18. There was no statistically significant difference in the Gini coefficients between the years and between the surgical fee schedules (p > 0.05). Conclusions The authors demonstrated that the degree of inequality of Japanese surgical fee schedule remained constant from 2013 through 2018.

scholarly journals Equality of Surgical Fee Schedule in Japan: A Retrospective Observational Study

2021 ◽  
Vol 14 ◽  
pp. 117863292110481
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Data Envelopment Analysis ◽  
Efficiency Score ◽  
University Hospital ◽  
Data Envelopment ◽  
Surgical Specialty ◽  
Gini Coefficients ◽  
Significant Difference ◽  
Using Data ◽  
Fee Schedule ◽  
Duration Of Operation

The authors had previously demonstrated that the Japanese surgical fee schedule had been unequal among surgical specialties in spite of its biannual revisions. This study examined how the degree of inequality of the fee schedule changed by estimating Gini coefficients for efficiency scores computed from data envelopment analysis. All the surgeries at Teikyo University Hospital in 2013 to 2018 were candidates used for the analysis of efficiency and equality of fee schedule. Inputs were defined as (1) the number of assistants, and (2) the duration of operation. An output was defined as the surgical fee. Each surgeon’s efficiency score was calculated using data envelopment analysis. Using the medians of efficiency scores in each surgical specialty, the authors inferred Gini coefficients and their standard errors in each year and in each surgical fee schedule. The authors analyzed 16 307 surgical procedures during the study period of 2013 to 2018. There was no statistically significant difference in the Gini coefficients between the years and between the surgical fee schedules ( P > .05). It was demonstrated that the degree of inequality of the Japanese surgical fee schedule remained constant from 2013 through 2018.

scholarly journals Association Between Surgeons’ Technical Efficiency and Hospital Revenue

2019 ◽  
Vol 56 ◽  
pp. 004695801988944
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Technical Efficiency ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Surgical Volume ◽  
Surgical Specialty ◽  
Surgical Data

To evaluate surgeons’ performance, health care managers often use the revenues that surgeons make for the hospital. The purpose of this study is to determine the relationship between surgeons’ technical efficiency and their revenues by using multiple regression analysis on surgical data. The authors collected data from all the surgical procedures performed at University Hospital from April 1 through September 30 in 2013-2018. Output-oriented Charnes-Cooper-Rhodes model of data envelopment analysis was employed to calculate each surgeon’s technical efficiency. Seven independent variables were selected; revenue, experience, medical school, surgical volume, sex, academic rank, and surgical specialty. Multiple regression analysis using Tobit model was used for our data. The data from a total of 17 227 surgical cases were obtained in the 36-month study period. The authors performed multiple regression on 222 surgeons. Revenue had significantly positive association with mean efficiency score ( P = .000). Surgical volume had significantly negative association with mean efficiency score ( P = .000). The other coefficients were statistically insignificant. An increase in revenue by 1% was associated with 0.46% to 0.52% increases in efficiency score. We demonstrated that surgeons’ revenue can serve as a proxy variable for their technical efficiency.

scholarly journals Do technically efficient surgeons continue to provide active clinical services in a university hospital?

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254515
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake ◽  
Akihiko Ozaki
Keyword(s):  
Positive Association ◽  
Efficiency Score ◽  
Negative Association ◽  
University Hospital ◽  
Data Envelopment ◽  
Surgical Volume ◽  
Clinical Services ◽  
University Hospitals ◽  
Control Variables ◽  
Technical Efficiency Score

It is difficult for university hospitals to recruit and retain technically efficient surgeons because their missions include teaching and research as well as clinical services. The authors hypothesized that technically efficient surgeons do not continue to provide active clinical services in a university hospital. The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2013–2018. The dependent variable was defined as a length of each surgeon’s active clinical services measured by month. Data envelopment analysis was employed to calculate each surgeon’s technical efficiency score. Five control variables were selected; experience, medical school, surgical volume, gender, and academic ranks. Multiple regression analysis was performed. Efficiency scores had significantly negative association with length of active clinical services. Experience and surgical volume had significantly positive association with length of active clinical services. The other coefficients of control variables were insignificant. Technically efficient surgeons provide shorter active clinical services in a university hospital.

Resource utilization in surgery after the revision of surgical fee schedule in Japan

2015 ◽  
Vol 28 (6) ◽  
pp. 635-643 ◽  
Author(s):  
Yoshinori Nakata ◽  
Tatsuya Yoshimura ◽  
Yuichi Watanabe ◽  
Hiroshi Otake ◽  
Giichiro Oiso ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Skin Incision ◽  
University Hospital ◽  
Academic Rank ◽  
Surgical Specialty ◽  
Content Type ◽  
Decision Making Unit ◽  
Using Data ◽  
Fee Schedule ◽  
Time Of Operation

Purpose – The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014. Design/methodology/approach – The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons’ efficiency scores using data envelopment analysis. Findings – The efficiency scores of each surgical specialty were significantly different (p=0.000). Originality/value – This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

Japanese surgical resource utilization in 2016

2019 ◽  
Vol 32 (6) ◽  
pp. 1013-1021
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Electronic Medical Record System ◽  
Skin Incision ◽  
Efficiency Score ◽  
Academic Rank ◽  
Surgical Specialty ◽  
Record System ◽  
Content Type ◽  
Decision Making Unit ◽  
The Difference

Purpose The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016. Design/methodology/approach The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method. Findings The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05). Originality/value The authors demonstrated that the surgeons’ efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

scholarly journals Combatting with Challenges in Medical Education During COVID-19 Pandemic: A Mixed-Methods Study Identifying the Effectiveness of Using E-Learning in Pediatric Clinical Clerkship of A University Hospital, Pakistan

2020 ◽  
Author(s):  
Mahanoor Raza ◽  
Sidra Kaleem ◽  
Sonia Qureshi ◽  
Nadeem Aslam ◽  
Akber Madhwani ◽  
...  
Keyword(s):  
Medical Education ◽  
Test Scores ◽  
Qualitative Content Analysis ◽  
Statistical Significance ◽  
Positive Association ◽  
University Hospital ◽  
Live Streaming ◽  
Post Test ◽  
E Learning ◽  
The Impact

Abstract Background The emergence of COVID-19 raises the opportunity to reimagine medical education. One way of attempting this is online classes, also known as e-learning, through recordings and or live streaming. The purpose of this research is to ascertain the effectiveness of using the e-learning instructional methodology for a Pediatric module with the fourth year MBBS students at the Aga Khan University Hospital, Karachi. Methods It was a sequential (Quantitative-Qualitative) mixed-method study. The quantitative component of the study consisted of pre and post-tests, as well as feedback on each session. The qualitative component was composed of focused-group discussions to explore students' experiences. Statistical analysis was performed using SPSS 20.0. Mean ±SD was reported for quantitative variables, and frequency and percentages were calculated for nominal variables. The pre and post-test scores were compared using a paired t-test. Pre and post mean test scores were analyzed in comparison to the level of student groups (Experts, Semi-experts, and Novice) by one-way ANOVA. For qualitative content analysis, categories were clumped together to yield sub-themes that were further merged into themes.Results All students (n= 102) participated and enrolled in this study. Fifty-nine participants (68.8%) were female. Participants were stratified into three groups, Novice 41(40.2%), Semi-expert 21 (19.6%), and Expert 40 (39.2%). The majority of the students appreciated the session structure and facilitation. There was a significant effect (p<0.005) on knowledge enhancement during each session, depicted by the improvement in post-test scores. It was also supported by the positive association (r=0.242 to 0.595) between the gain in knowledge and each session held. The ANOVA yielded no statistical significance between the knowledge gained among the three group levels, denoting that our online module had been proven successful in achieving the same learning goals as an in-person rotation.Conclusion E-learning is an effective way of continuing the process of delivering medical education, especially in unprecedented times. Technological enhancements will help carry the impact forward as a blended-learning pedagogical approach in undergraduate medical education.

Influence of the revision of surgical fee schedule on surgeons’ productivity in Japan: A cohort analysis of 7602 surgical procedures in 2013–2016

2017 ◽  
Vol 31 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Procedures ◽  
Technical Change ◽  
Cohort Analysis ◽  
University Hospital ◽  
Academic Rank ◽  
Efficiency Change ◽  
Surgical Operation ◽  
Decision Making Unit ◽  
Fee Schedule

The goal of this study is to evaluate the pure impact of the revision of surgical fee schedule on surgeons’ productivity. We collected data from the surgical procedures performed by the surgeons working in Teikyo University Hospital from 1 April through 30 September in 2013–2016. We employed non-radial and non-oriented Malmquist model. We defined the decision-making unit as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of doctors who assisted surgery and (2) the time of surgical operation. The output was defined as the surgical fee for each surgery. We focused on the revisions in 2014 and 2016. We first calculated each surgeon’s natural logarithms of the changes in productivity, technique and efficiency in 2013–2014, in 2014–2015 and in 2015–2016. Then, we subtracted the changes in 2014–2015 from the changes in 2013–2014 and in 2015–2016. We analyzed 62 surgeons who performed 7602 surgical procedures. The productivity changes were not significantly different from 0. Their efficiency change was significantly greater than 0, while their technical change was smaller than 0 in revision 2014. Their efficiency change was significantly smaller than 0, while their technical change was greater than 0 in revision 2016 (p < 0.05). This finding suggests that we could increase overall productivity through revision if we could increase both efficiency and technique.

scholarly journals IT Professionals’ Personality, Personal Characteristics, and Commitment: Evidence from a National Survey

2019 ◽  
Vol 12 (3) ◽  
pp. 58 ◽  
Author(s):  
Javaid Syed ◽  
Ruth M. Tappin
Keyword(s):  
Organizational Commitment ◽  
Statistical Significance ◽  
Personal Characteristics ◽  
The United States ◽  
National Sample ◽  
Future Research ◽  
It Professionals ◽  
Cross Sectional ◽  
Continuance Commitment ◽  
Independent Variables

Drawing on personality traits theory (Costa &amp; McCrae, 1985) and organizational commitment theory (Mowday, Steers &amp; Porter, 1979), the purpose of the present study was to investigate, through four separate hierarchical regression procedures, the effect of a set of independent variables (neuroticism, gender, and generational age) on four separate dependent variables (DV): overall organizational commitment (OC), affective commitment (AC), continuance commitment (CC), and normative commitment (NC). The sample consisted of responses from 279 IT professionals in the United States, drawn from a national sample from the merged cross-sectional GSS 1972-2014 Cross-Sectional Cumulative Data, Release 5, March 24, 2016. Results of multiple regressions analyses revealed that, among IT professionals, neuroticism did not predict overall OC, AC, CC, or NC. Generational age predicted OC, AC, and CC with statistical significance. Gender predicted CC; none of the independent variables (IVs) predicted NC. Directions for future research are offered.

Impact of merger on efficiency and productivity : a case study of commercial banks in Malaysia

1970 ◽  
Vol 5 (1) ◽  
pp. 77
Author(s):  
Mahadzir Ismail ◽  
Saliza Sulaiman ◽  
Hasni Abdul Rahim ◽  
Nordiana Nordin
Keyword(s):  
Efficiency Score ◽  
Malmquist Productivity Index ◽  
Productivity Index ◽  
Data Envelopment ◽  
Master Plan ◽  
Before And After ◽  
Domestic Banks ◽  
The Impact ◽  
Efficiency And Productivity

The Financial Master Plan (2001- 2010) aims to enhance the capacity of banking industry so that higher effic iency and productivity can be reaped in the future. This study seeks to determine the impact of merger on the efficiency and productivity ofcommercial banks in Malaysia for the period 1995 until 2005. The study uses a non-parametric approach, nam ely DEA (data envelopment analysis?) to estimate the efficiency scores and to construct the Malmquist productivity index. To enable this estimation, three bank inputs and outputs are used. Amongst the findings are those banks exhibit higher efficiency score after the merger and thefo reign banks are more efficient than the local banks. Productivity of the banks is calculated in both periods, before and after the merger: The results show that, it is the local banks that have improved the most after the merger. The main source of productivity is technical change or innovation. The findings support the existing policy of having larger domestic banks in term of size.

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