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Does Focus Improve Performance in Elective Surgery? A Study of Obesity Surgery in Sweden

Author

Listed:
  • Anna Svarts

    (Department of Industrial Economics and Management, KTH Royal Institute of Technology, 10044 Stockholm, Sweden)

  • Luca Urciuoli

    (Department of Industrial Economics and Management, KTH Royal Institute of Technology, 10044 Stockholm, Sweden
    Zaragoza Logistics Center, MIT International Logistics Program, 50018 Zaragoza, Spain)

  • Anders Thorell

    (Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, 18288 Stockholm, Sweden
    Department of Surgery, Ersta Hospital, 11691 Stockholm, Sweden)

  • Mats Engwall

    (Department of Industrial Economics and Management, KTH Royal Institute of Technology, 10044 Stockholm, Sweden)

Abstract

Recent studies have found positive effects from hospital focus on both quality and cost. Some studies indicate that certain patient segments benefit from focus, while others have worse outcomes in focused hospital departments. The aim of this study was to establish the relationship between hospital focus and performance in elective surgery. We studied obesity surgery procedures performed in Sweden in 2016 (5152 patients), using data from the Scandinavian Obesity Surgery Registry (SOReg) complemented by a survey of all clinics that performed obesity surgery. We examined focus at two levels of the organization: hospital level and department level. We hypothesized that higher proportions of obesity surgery patients in the hospital, and higher proportions of obesity surgery procedures in the department, would be associated with better performance. These hypotheses were tested using multilevel regression analysis, while controlling for patient characteristics and procedural volume. We found that focus was associated with improved outcomes in terms of reduced complications and shorter procedure times. These positive relationships were present at both hospital and department level, but the effect was larger at the department level. The findings imply that focus is a viable strategy to improve quality and reduce costs for patients undergoing elective surgery. For these patients, general hospitals should consider implementing organizationally separate units for patients undergoing elective surgery.

Suggested Citation

  • Anna Svarts & Luca Urciuoli & Anders Thorell & Mats Engwall, 2020. "Does Focus Improve Performance in Elective Surgery? A Study of Obesity Surgery in Sweden," IJERPH, MDPI, vol. 17(18), pages 1-16, September.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:18:p:6682-:d:413231
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    References listed on IDEAS

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    1. Jones, Hayley E. & Spiegelhalter, David J., 2011. "The Identification of “Unusual†Health-Care Providers From a Hierarchical Model," The American Statistician, American Statistical Association, vol. 65(3), pages 154-163.
    2. Vedran Capkun & Martin Messner & Clemens Rissbacher, 2012. "Service Specialization and Operational Performance in Hospitals," Post-Print hal-00715580, HAL.
    3. Antonio Vera & Pythagoras Petratos & Torsten Oliver Salge, 2018. "A widening gap? Static and dynamic performance differences between specialist and general hospitals," Health Care Management Science, Springer, vol. 21(1), pages 25-36, March.
    4. Barro, Jason R. & Huckman, Robert S. & Kessler, Daniel P., 2006. "The effects of cardiac specialty hospitals on the cost and quality of medical care," Journal of Health Economics, Elsevier, vol. 25(4), pages 702-721, July.
    5. Robert S. Huckman & Darren E. Zinner, 2008. "Does focus improve operational performance? Lessons from the management of clinical trials," Strategic Management Journal, Wiley Blackwell, vol. 29(2), pages 173-193, February.
    6. Ludwig Kuntz & Stefan Scholtes & Sandra Sülz, 2019. "Separate and Concentrate: Accounting for Patient Complexity in General Hospitals," Management Science, INFORMS, vol. 67(6), pages 2482-2501, June.
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