Hospital Case Study

BACKGROUND: hospitals are always looking for cost reduction solutions, improving financial assets, and increasing patient’s satisfaction and quality (1). A ward in a hospital, which needs to be paid attention specifically is the surgical ward since these facilities are the largest cost and income centers of a hospital and impact on the performance of the entire hospital (2). In addition, management of surgery department is so difficult not only for various preferences of stakeholders, but also for insufficient resources in developing countries (3, 4). In addition, health managers should anticipate the impact of the aging population on increased demand for surgical services (5, 6). The above factors clearly show the importance of having an efficient

Constraints and problems arising from root causes which were inducted by interviews:

2.1. Disproportion of workforce, equipment and facilities to the number of surgeries

2.2. Disproportion of working hours dedicated to surgeons to number of their surgeries in a specific day.

2.3. Physician's order for a surgery would not be provided to the hospital in advanced. Patients are referred to the hospital after getting the physician's orders for hospital admission (without pre-coordination with the hospital)

2.4. Some patients have two orders from two surgeons for admission simultaneously

2.5. Increased number of on-call physicians would cause induced cost for hospital due to the increased number of patients in a day.

2.6. Head nurse of the surgery ward would not be informed of causes of physician delay or absence in the allocated days. So, surgical bed and workforce don’t have enough efficiency at those hours.

2.7. Possible delays in the operating rooms don’t consider when admitting patients.

2.8. There are no plans and schedules for patient referred from private sector patients against public sector

Establishing a registry system for surgeries in HIS. The system should have specific user and password for each surgeon. So, they can register their surgeries in advance.

2. Improving surgeon’s payment methods both based on fee for services and salary.

3. Development an Electronic Waiting List in which a surgical case duration can be predicted (based on V.S of patient, time needed for anesthesia before incision, the time needed to place a catheter in the bladder, or the wake-up time from anesthesia, previous experiences for each surgeries and standards/ nonstandard surgeries). The FDG members preferred to apply designs developed in foreign countries.

4. Developing guidelines on scheduling according to five following criteria. That’s the responsibility of the director of operating rooms and educational deputy to determine key indicators in the form of dashboard management tool. The aim is to indicate status of operating room at the moments. In addition, dashboard management tool should be run in HIS system.

- Patient’s