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Table 6 Low-complex elective surgery

From: Exploring types of focused factories in hospital care: a multiple case study

Unit 14 15 16 17 18
Organizational context      
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)
  1. The Herfindahl-Hirschmann Index (HHI) was used to calculate the concentration of the surgical procedures offered per specialty per unit (see organizational outcomes). Low variety corresponds with 1, high variety with 0.