Performance culture in hospitals: if you are good in one dimension you'll probably will be good in the rest

Nils Gutacker and Andrew Street using a sample of 95955 patients treated in 252 hospitals during  april 2009 and march 2012 on hip replacement surgery in the English National Health Service, explored the performance of the hospitals. They use four performance indicators: 1) Post operative health status (post OHS); 2) Length of stay (LOS); 3) Waiting time >18 weeks; 4) 28-day emergency readmission.

Using a multidimensional model and a dominance criteria they show us that there are a significance correlation between them.

• Hospitals with shorter LOS also realise better post operative health status (the fast track or enhanced recovery).
• Hospitals that have a lower proportion of patients waiting more than 18 weeks to be admitted also have a shorter LOS
• Hospitals with better post OHS also tend to have a lower proportion of patients waiting for more 18 weeks
• The emergency readmission within 28 days has a negative impact on health status

They also classified the hospitals in three categories: dominant (perform well), dominated (perform poorly) and non-comparable in overall performance effects: All dominant hospitals are private Independent Sector Treatment Centres (ISTCs), and all dominated hospitals are public NHS.

• Volume outcome are not important in explaining overall performance differences between them. 
• Dominant providers operates in a more competitive markets (in a quality competition in-price regulated market). 
• Dominant providers have economies of scope. Good overall performance is associated with more concentrated delivery system. 
• ISTCs don't cherry pick healthier cases to treat or “dump” complex cases back into the NHS.

Providers to perform better in one dimension have an excellent performance on another. This means that some providers have a better performance culture than others and this are better for patients.

Access to the article (pdf): Multidimensional performance assessment of public sector organisations using dominance criteria (Health Economics 2017)

photo: Light: (*) Photosolde.
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