Table 6 Low-complex elective surgery

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

Product focus

44%

44%

44%

44%

44%

Process focus

72%

66%

66%

66%

75%

Operational performance

Average duration of surgery (min)

- 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)

- 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)