Scaling Performance Frontiers Across Multiple Perioperative Services

Abstract

Abstract 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 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 must be due in part to organizational differences between institutions, limited in scale due to the size of institutions; normative statements 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.