From: Exploring types of focused factories in hospital care: a multiple case study
Unit | 14 | 15 | 16 | 17 | 18 |
---|---|---|---|---|---|
Organizational context | Â | Â | Â | Â | Â |
Focusing decisions/operations strategy | No clear strategy The day-surgery clinic evolved as result of a hospital wide cost reduction program | Strategy to improve efficiency and timeliness of elective surgery All low-complex elective surgery was concentrated in one center for elective surgery | Strategy to improve efficiency and timeliness of elective surgery A center for elective surgery in day care and short stay was developed | Strategy to improve efficiency and timeliness of day-surgery | Strategy to improve efficiency and timeliness of elective surgery |
Standardized procedures | Protocols for most treatments and standardized discharge letters | Protocols for most treatments | Protocols for most treatments | Protocols for most treatments | Protocols for most treatments |
Dedicated lay-out | OR's and ward located on the same floor to reduce transportation times. OR applied a holding and recovery to minimize delays | OR's and wards located in the same building on separate floors. Dedicated transportation elevators were used to reduce transportation times and delays | OR's and wards located on the same floor to reduce transportation times. OR applied a holding and recovery to minimize delays | OR's and ward located on the same floor to reduce transportation times. OR applied a combined holding/recovery to minimize delays | The day-surgery clinic integrated the OR's, ward, holding and recovery into one unit. Patients 'walk' to the OR, reducing transportation times |
Planning routine | Preoperative assessments on appointment Surgical planning made by planning specialty | Preoperative assessments on appointment Surgical planning made by planning department or MDs (depending on specialty) | Preoperative assessments on appointment and open access Surgical planning made by planning department | Preoperative assessments on appointment Surgical planning made by planning specialty | Preoperative assessments on appointment Surgical planning made by planning specialty |
Team composition | Frequent changes in team composition | Frequent changes in team composition | Frequent changes in team composition | Fixed team compositions | Fixed team compositions |
Degrees of focus | Â | Â | Â | Â | Â |
Product focus | 44% | 44% | 44% | 44% | 44% |
Process focus | 72% | 66% | 66% | 66% | 75% |
Operational performance | Â | Â | Â | Â | Â |
Average duration of surgery (min) | Â | Â | Â | Â | Â |
- General surgery | 54 | 56 | 24 | - | 58 |
- ENT surgery | 11 | 37 | 18 | 59 | 21 |
- Orthopedics surgery | 32 | 52 | 21 | 46 | 47 |
- Plastic surgery | - | 68 | 26 | 57 | 21 |
HHI per specialty (hospital total) | Â | Â | Â | Â | Â |
- General surgery | 0.068 (0.016) | 0.093 (0.024) | 0.170 (0.024) | - | 0.148 (0.025) |
- ENT surgery | 0.222 (0.057) | 0.096 (0.093) | 0.154 (0.057) | 0.337 (0.014) | 0.109 (0.014) |
- Orthopedic surg. | 0.433 (0.092) | 0.097 (0.065) | 0.211 (0.027) | 0.261 (0.072) | 0.362 (0.072) |
- Plastic surgery | - | 0.047 (0.324) | 0.067 (0.083) | 0.155 (0.091) | 0.985 (0.091) |