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Operating room management and operating room productivity: the case of Germany

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Abstract

We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

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Notes

  1. We would like to thank one of the reviewers for pointing out that readers of scheduling and anesthesiology group literature might be interested in what incision-to-closing hours per day were. We calculated an average incision-to-closing per anesthesiologist on payroll of 2.075 hours per day. It must be remembered that this does not equate either to incision-to-closing time for an individual operating room, ASA billable hours or even the anesthesia time for an anesthesiologist assigned to an OR work slot for any given day. We calculated that, simply based on the inability to staff more than one OR simultaneously and the limitation of an 8 hour workday, a German anesthesiologist is only able to conduct 57% as much anesthesia per year as his or her counterpart in a country with certified registered nurse anesthesiologists or their equivalent. The additional burden of administrative duties and the pre-operative screening requirement will further decrease this percentage.

  2. The assumption that costs for servicing the intensive care unit are a constant proportion of total anesthesiologists costs is justified by the legal and institutional environment in Germany. Hospital can neither freely choose the size of their intensive care unit nor the size of any other department or unit within the hospital. Every hospital in Germany has the duty to provide a certain level of care (Versorgungsauftrag). There are 6 different levels, and the definitions of these levels of care are very precise and explicitly address issues like which departments a hospital has to have and which size these departments are likely to have. Additionally, the compensation system in 2002 was structured such that any deviation from the specified level of care results in financial disadvantages. The correlation of different scale and scope parameters provided in Table 4 underline the static structure of the German hospital system and show that our data set is representative of the German environment. However, we acknowledge that this assumption is not appropriate for a US dataset, and, hence, repeating our analysis as described for US data would not lead to sound results.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim gGmbH, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany

    Maresi Berry & Alexander Schleppers

  2. Terry College of Business, University of Georgia, 206 Brooks Hall, Athens, GA, 30602-6255, USA

    Thomas Berry-Stölzle

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  1. Maresi Berry
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  2. Thomas Berry-Stölzle
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  3. Alexander Schleppers
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Correspondence to Thomas Berry-Stölzle.

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Berry, M., Berry-Stölzle, T. & Schleppers, A. Operating room management and operating room productivity: the case of Germany. Health Care Manage Sci 11, 228–239 (2008). https://doi.org/10.1007/s10729-007-9042-7

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