ﺗﺤﻠﯿﻞ ﮐﺎراﯾﯽ و ﺗﺨﺼﯿﺺ ﻣﻨﺎﺑﻊ ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ ﺑﺎ اﺳﺘﻔﺎده از روش ﺗﺤﻠﯿﻞ ﭘﻮﺷﺸﯽ داده ﻫﺎي ﻣﺘﻤﺮﮐﺰ

Efficiency Analysis and Hospital Resource Allocation Using Centralized Data Envelopment Analysis

ﭼﮑﯿﺪه: اﯾﻦ ﻣﻘﺎﻟﻪ، ﮐﺎراﯾﯽ و ﺗﺨﺼﯿﺺ ﻣﻨﺎﺑﻊ ﺑﻪ ﺑﺨﺶ ﻫﺎي ﻣﺨﺘﻠﻒ ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ را ﺑﺎ اﺳﺘﻔﺎده از روش ﺗﺤﻠﯿـ ﻞ ﭘﻮﺷﺸﯽ داده ﻫﺎي ﻣﺘﻤﺮﮐﺰ ﺑﺎ ﻓﺮض ﺑﺎزده ﻣﺘﻐﯿﺮ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓـﺰار ﻣﺘﻠـﺐ ﺗﺤﻠﯿـﻞ ﮐـﺮده اﺳـﺖ. داده ﻫـﺎي ﻣﺪﻧﻈﺮ از واﺣﺪ آﻣﺎر، واﺣﺪ ﺣﺴﺎﺑﺪاري و واﺣﺪ ﮐﻨﺘﺮل ﻋﻔﻮﻧﺖ ﺑﯿﻤﺎرﺳﺘﺎن اﻟﺰﻫﺮاي اﺻﻔﻬﺎن، ﺑﺮاي ﺗﺨﺼـ ﯿﺺ ﺗﺨﺖ ﺑﻪ 31 ﺑﺨﺶ درﻣﺎﻧﯽ در ﺳﺎل 1390ﺟﻤﻊ آوري ﺷﺪ. ﺷﺎﺧﺺ ﻫﺎي ورودي، درﺑﺮدارﻧـﺪة ﺗﻌـﺪاد ﺗﺨـﺖ، ﺗﻌﺪاد ﭘﺰﺷﮑﺎن، ﺗﻌﺪاد ﭘﺮﺳـﺘﺎران، ﻓﻀـﺎ ي اﺧﺘﺼـﺎص داده ﺷـﺪه ﺑـﻪ ﻫـﺮ ﺑﺨـﺶ و ﺷـﺎﺧﺺ ﻫـﺎ ي ﺧﺮوﺟـ ﯽ، درﺑﺮدارﻧﺪة ﺗﻌﺪاد ﺑﯿﻤﺎر ﭘﺬﯾﺮش ﺷﺪه، ﭼﺮﺧﺶ ﺗﺨﺖ، درﺻﺪ اﺷﻐﺎل ﺗﺨﺖ و ﺗﻌﺪاد ﻣﺸﺎوره ﻫـﺎي اﻧﺠـﺎم ﺷـﺪه اﺳﺖ. ﯾﺎﻓﺘﻪ ﻫﺎ ﻧﺸﺎن داد ﻣﺠﻤﻮع ﺗﻌﺪاد ﺗﺨﺖ ﻓﻌﺎل از 739 ﺑﻪ 343/99، ﻣﺠﻤـﻮع ﺗﻌـﺪاد ﭘﺰﺷـﮑﺎن از 399 ﺑـﻪ 391/51، ﻣﺠﻤﻮع ﺗﻌﺪاد ﭘﺮﺳﺘﺎران از 1258 ﺑﻪ 1239/21 و ﻣﺠﻤﻮع ﻓﻀﺎي ﺗﺨﺼﯿﺼﯽ ﺑﻪ ﺑﺨﺶ ﻫـﺎ از 19010 ﺑﻪ 15668/69 ﻣﺘﺮ ﻣﺮﺑﻊ ﺗﻐﯿﯿﺮ ﭘﯿﺪا ﮐﺮده اﺳﺖ. ﻫﻤﭽﻨﯿﻦ، ﻣﯿﺰان ﻣﺠﻤﻮع ﮐﺎﻫﺶ ورودي ﻫﺎي ﺑﻪ دﺳـﺖ آﻣـﺪه از ﻣﺪل ﻣﺘﻤﺮﮐﺰ، ﺑﯿﺸﺘﺮ از ﻣﯿـ ﺰان ﮐـﺎﻫﺶ ﻣﺠﻤـﻮع ورودي ﻫـﺎي ﺑـ ﻪ دﺳـﺖ آﻣـﺪه از ﻣـﺪل ﻫـﺎ ي ﮐﻼﺳـ ﯿﮏ ﺑـﻮد . ﻣﺤﺪودﯾﺖ ﻫﺎي اﺿﺎﻓﻪ ﺷﺪه ﺑﻪ ﻣﺪل ﻣﺮﺑﻮط ﺑﻪ ﻣﻨﺎﺑﻊ ﻧﯿﺰ ﺗﺤﻘﻖ ﯾﺎﻓـﺖ . ﻣﻄـﺎﺑﻖ ا ﯾـ ﻦ ﻧﺘـﺎ ﯾﺞ، ﻣﺠﻤـﻮع ﻣﺼـﺎرف ورودي ﺑﺨﺶ ﻫﺎ ﮐﺎﻫﺶ ﯾﺎﻓﺘﻪ اﺳﺖ؛ در ﺣﺎﻟﯽ ﮐﻪ ﻣﺠﻤﻮع ﺗﻮﻟﯿﺪات ﺧﺮوﺟﯽ ﮐﺎﻫﺶ ﻧﯿﺎﻓﺘﻪ اﺳﺖ.

Purpose: This paper aims to illustrate the use of centralized data envelopment analysis with the variable return to scale in resource allocation at different wards of hospitals based on efficiency. Design/methodology/approach: Data were collected from the statistics unit, accounting unit and the hospital infection unit for 31 clinical wards in Alzahra hospital, Isfahan, Iran, in the last quarter of 2011. The input sets represented by the number of beds, number of physicians, number of nurses and the physical space allocated to the ward, are used in the analysis. Three output sets consisted of the number of inpatients, beds turnover, beds occupancy ratio, and the number of consultants provided by the ward to represent the performance and activity of the ward. The radial centralized DEA based on the input-oriented and variable return to scale model was applied using MatLab software, to find out how to reallocate the hospital resources to the wards. Findings: The values of inputs and outputs obtained from the centralized DEA model helps the centralized decision-maker to take the right remedial actions for continuous improvement. The findings indicated that in this study the total number of active beds is proposed to be decreased from 739 to 343.99, the total number of physicians from 399 to 391.51, the total number of nurses from 1258 to 1239.21, and the total allocation of space to the wards from 19010 to 15668.69 square meters. Research limitations/implications: The proposed approach is rather simple and it can easily be extended in different directions, allowing, for example, the consideration of joint constraints, goals, bounds on the changes of inputs and outputs, or on the allocated resources, but then one must be aware that such constraints are specifically defined for the case study and may be different in other hospitals. In this study, two constraints were considered to control the number of allocated nurses to two wards: ED and ICU, based on the current standards. Also, the proposed model was based on the criteria for which the data was available. It is clear that a centralized resource allocation approach implies a subordination of the behaviour of individual units to the goals of the system as a whole. Practical implications: The results of the proposed centralized DEA model based on the performance criteria provide useful managerial implications for the resource allocation of hospital wards. The study proves the usefulness of centralized DEA as a decision-making tool in the health sector. Also, instead of reducing the inputs of any ward, the total input consumption of the wards is reduced, and as it is guaranteed, the total output production does not decrease. Social implications: Public health and way to provide health care is an important issue in all countries, and health care providers trying within an existing resource, to provide the highest quality care. Allocating the resources in hospital wards based on the proper criteria increases the quality of the care and the efficiency of the healthcare sector. Originality/ value: Many prior DEA studies have focused on health care efficiency. This paper is probably one of the first attempts that use a centralized model to analysis different hospital wards efficiency. Since resource allocation mechanisms can be influenced by the behaviour of the organization, the optimal allocation of a resource based on the needs is an important task of the health system. Furthermore, selecting the most appropriate set of input and output criteria is an important step in any efficiency measurement study.