The impact of managerial and organizational aspects on hospital wards’ efficiency: Evidence from a case study

In spite of its acknowledged relevance, the impact of managerial and organizational aspects on hospital wards’ efficiency has been so far overlooked by the literature. In order to explore this issue, this paper presents a model of the relations between the decision making process of a hospital ward and its technical efficiency. In order to test the model, a two-step approach has been adopted. In the first step the technical efficiency of wards belonging to a large Italian Hospital Enterprise has been calculated using DEA. In the second step, efficiency scores have been regressed on a set of variables capturing managerial goals and actions internal to the ward, as well as re-organizations imposed by the hospital central management. Responses to a questionnaire administered to the heads of ward were used to build the independent variables. Results show that both decisions internal to the ward and exogenous re-organizations affect the ward’s efficiency, and suggest that these variables are more significant in explaining efficiency than environmental ones.     

Efficiency and equity in private and public education: A nonparametric comparison

We present a nonparametric approach for (1) efficiency and (2) equity evaluation in education. Firstly, we use a nonparametric (Data Envelopment Analysis) model that is specially tailored to assess educational efficiency at the pupil level. The model accounts for the fact that typically minimal prior structure is available for the behavior (objectives and feasibility set) under evaluation. It allows for uncertainty in the data, while it corrects for exogenous ‘environmental’ characteristics that are specific to each pupil. Secondly, we propose two multidimensional stochastic dominance criteria as naturally complementary aggregation criteria for comparing the performance of different school types (private and public schools). While the first criterion only accounts for efficiency, the second criterion also takes equity into consideration. The model is applied for comparing private (but publicly funded) and public primary schools in Flanders. Our application finds that no school type robustly dominates another type when controlling for the school environment and taking equity into account. More generally, it demonstrates the usefulness of our nonparametric approach, which includes environmental and equity considerations, for obtaining ‘fair’ performance comparisons in the public sector context.     

Estimating the technical efficiency of health care systems: A cross-country comparison using the directional distance function

Economic activity produces not only desirable outputs but also undesirable outputs. Undesirable outputs are usually omitted from efficiency assessments (i.e., applications of Data Envelopment Analysis) which fail to express the true production process. The directional distance function model has been used for handling asymmetrically both desirable and undesirable outputs in the assessment process. In the present paper, we apply a generalized directional distance function to measure the efficiency of the health systems of 171 countries. We incorporate both desirable and undesirable outputs into the efficiency assessment without transforming the latter type of outputs into inputs or into their inverse form, as is done in most of the extant studies that deal with the measurement of health efficiency. The methodology that we apply introduces a modified definition of the efficiency score which yields results consistent with those obtained from radial DEA models. In addition, our results are independent of the length of the direction vector.     

Efficiency and effectiveness of Spanish football teams: a three-stage-DEA approach

In this paper, we apply a three-stage-DEA model to the Spanish Professional Football League, which means separating the teams’ economic behaviour into three components: operating efficiency—of the offence and defence—athletic or operating effectiveness, and social effectiveness. The results showed that the technical inefficiency of the defence is greater than that of the offence, both being caused by aspects linked to the poor management of players’ abilities and by the football team’s size. Teams showed a favourable evolution of their offensive and defensive efficiency during the 2004/2005 season and to a lesser extent in the season before. The point system assigned by the professional football league regulations evaluates the teams’ athletic effectiveness, but we detected that the teams with the most experience perform athletically in a more effective manner. Their social effectiveness is strongly related to the level of play in itself and to factors linked to their PFL ranking: participation in international competitions for important football teams; or the struggle of minor football teams to stay in the first division.     

Efficiency of the medical care industry: Evidence from the Italian regional system

What might be the relation between clinical research and efficiency of medical care suppliers? Is the hypothesis of a positive relation consistent? Considering efficiency as the supplier’s ability to maximize the number of patients hospitalized in a mobility process among regions (i.e. mobility balance), this work aims at highlighting the existence of a positive externality of pharmaceutical clinical research on that kind of efficiency. In other words, an externality is able to affect the patients’ perception of good/bad quality of outputs supplied by the medical care industry, leading their mobility process. Taking Italy and the mobility of patients among regions into account, an Operational Research study will be performed in order to support this assumption.The goal of this work is to show an alternative way to increase the efficiency of medical care suppliers on the market of health care, that is to say, through their competitiveness on the market of human experimentation.     

Optimal bandwidth selection for conditional efficiency measures: A data-driven approach

In productivity analysis an important issue is to detect how external (environmental) factors, exogenous to the production process and not under the control of the producer, might influence the production process and the resulting efficiency of the firms. Most of the traditional approaches proposed in the literature have serious drawbacks. An alternative approach is to describe the production process as being conditioned by a given value of the environmental variables (Cazals, C., Florens, J.P., Simar, L., 2002. Nonparametric Frontier estimation: A robust approach. Journal of Econometrics 106, 1–25; Daraio, C., Simar, L., 2005. Introducing environmental variables in nonparametric Frontier models: A probabilistic approach. Journal of Productivity Analysis 24(1), 93–121). This defines conditional efficiency measures where the production set in the input ×$\times$ output space may depend on the value of the external variables. The statistical properties of nonparametric estimators of these conditional measures are now established (Jeong, S.O., Park, B.U., Simar, L., 2008. Nonparametric conditional efficiency measures: Asymptotic properties. Annals of Operations Research doi: 10.1007/s10479-008-0359-5). These involve the estimation of a nonstandard conditional distribution function which requires the specification of a smoothing parameter (a bandwidth). So far, only the asymptotic optimal order of this bandwidth has been established. This is of little interest for the practitioner. In this paper we fill this gap and we propose a data-driven technique for selecting this parameter in practice. The approach, based on a Least Squares Cross Validation procedure (LSCV), provides an optimal bandwidth that minimizes an appropriate (weighted) integrated Squared Error (ISE). The method is carefully described and exemplified with some simulated data with univariate and multivariate environmental factors. An application on real data (performances of Mutual Funds) illustrates how this new optimal method of bandwidth selection works in practice.     

Measuring the impacts of production risk on technical efficiency: A state-contingent conditional order-m approach

This article studies the influence of risk on farms’ technical efficiency levels. The analysis extends the order-m efficiency scores approach proposed by Daraio and Simar (2005) to the state-contingent framework. The empirical application focuses on cross section data of Catalan specialized crop farms from the year 2011. Results suggest that accounting for production risks increases the technical performance. A 10% increase in output risk will result in a 2.5% increase in average firm technical performance.     

On comparing the performance of primary care providers

In the past few years primary health care has been characterised as central to the development of the National Health Service in the United Kingdom. Furthermore, performance assessment is seen as a way of achieving care of high standards. Performance indicators and targets are being developed to assess primary care providers, and to develop financial incentives. However, the number of studies that have compared the performance of primary care providers is limited and the existing approaches to evaluation are open to improvement.     

Network data envelopment analysis: A review

Network data envelopment analysis (DEA) concerns using the DEA technique to measure the relative efficiency of a system, taking into account its internal structure. The results are more meaningful and informative than those obtained from the conventional black-box approach, where the operations of the component processes are ignored. This paper reviews studies on network DEA by examining the models used and the structures of the network system of the problem being studied. This review highlights some directions for future studies from the methodological point of view, and is inspirational for exploring new areas of application from the empirical point of view.     

Two-stage financial risk tolerance assessment using data envelopment analysis

Typical questionnaires administered by financial advisors to assess financial risk tolerance mostly contain stereotypes of people, have seemingly unscientific scoring approaches and often treat risk as a one-dimensional concept. In this work, a mathematical tool was developed to assess relative risk tolerance using Data Envelopment Analysis (DEA). At its core, it is a novel questionnaire that characterizes risk by its four distinct elements: propensity, attitude, capacity, and knowledge. Over 180 individuals were surveyed and their responses were analyzed using the Slacks-based measure type of DEA efficiency model. Results show that the multidimensionality of risk must be considered for complete assessment of risk tolerance. This approach also provides insight into the relationship between risk, its elements and other variables. Specifically, the perception of risk varies by gender as men are generally less risk averse than women. In fact, risk attitude and knowledge scores are consistently lower for women, while there is no statistical difference in their risk capacity and propensity compared to men. The tool can also serve as a “risk calculator” for an appropriate and defensible method to meet legal compliance requirements, known as the “Know Your Client” rule, that exist for Canadian financial institutions and their advisors.     

Efficiency decomposition in network data envelopment analysis: A relational model

Traditional studies in data envelopment analysis (DEA) view systems as a whole when measuring the efficiency, ignoring the operation of individual processes within a system. This paper builds a relational network DEA model, taking into account the interrelationship of the processes within the system, to measure the efficiency of the system and those of the processes at the same time. The system efficiency thus measured more properly represents the aggregate performance of the component processes. By introducing dummy processes, the original network system can be transformed into a series system where each stage in the series is of a parallel structure. Based on these series and parallel structures, the efficiency of the system is decomposed into the product of the efficiencies of the stages in the series and the inefficiency slack of each stage into the sum of the inefficiency slacks of its component processes connected in parallel. With efficiency decomposition, the process which causes the inefficient operation of the system can be identified for future improvement. An example of the non-life insurance industry in Taiwan illustrates the whole idea.     

The impact of tourist destination on hotel efficiency: A data envelopment analysis approach

This paper evaluates the impact of location on hotel efficiency using a sample of 400 Spanish hotels, the novel aspect being that location is considered at the tourist destination level. Moreover, for the first time, the location variables are based on the main theoretical models concerning location in the hotel sector, namely geographical positioning models, agglomeration and urbanization economic models and competitive environment models. The methodology consists of a four-stage data envelopment analysis (DEA) model that decomposes super-efficiency in the portion attributable to the tourist destination and the portion attributable to hotel management. Then, managerial efficiency is regressed against hotel characteristics, while tourist destination efficiency is explained by the characteristic of each location. The findings highlight the importance of tourist destinations, providing novel empirical support for the propositions of the main location models. Indeed, the tourist destination is the main cause of differences in the level of efficiency among hotels. The occupancy level, degree of seasonality and market concentration are the variables with the greater impact on efficiency.     

Efficiency measurement using independent component analysis and data envelopment analysis

Efficiency measurement is an important issue for any firm or organization. Efficiency measurement allows organizations to compare their performance with their competitors’ and then develop corresponding plans to improve performance. Various efficiency measurement tools, such as conventional statistical methods and non-parametric methods, have been successfully developed in the literature. Among these tools, the data envelopment analysis (DEA) approach is one of the most widely discussed. However, problems of discrimination between efficient and inefficient decision-making units also exist in the DEA context (Adler and Yazhemsky, 2010). In this paper, a two-stage approach of integrating independent component analysis (ICA) and data envelopment analysis (DEA) is proposed to overcome this issue. We suggest using ICA first to extract the input variables for generating independent components, then selecting the ICs representing the independent sources of input variables, and finally, inputting the selected ICs as new variables in the DEA model. A simulated dataset and a hospital dataset provided by the Office of Statistics in Taiwan’s Department of Health are used to demonstrate the validity of the proposed two-stage approach. The results show that the proposed method can not only separate performance differences between the DMUs but also improve the discriminatory capability of the DEA’s efficiency measurement.     

Modeling undesirable factors in data envelopment analysis

Data envelopment analysis is a mathematical programming technique for identifying efficient frontiers for peer decision making units with multiple inputs and multiple outputs. These performance factors (inputs and outputs) are classified into two groups: desirable and undesirable. Obviously, undesirable factors in production process should be reduced to improve the performance. In the current paper, we present a data envelopment analysis (DEA) model in which can be used to improve the relative performance via increasing undesirable inputs and decreasing undesirable outputs.     

Efficiency decomposition in two-stage data envelopment analysis: An application to non-life insurance companies in Taiwan

The efficiency of decision processes which can be divided into two stages has been measured for the whole process as well as for each stage independently by using the conventional data envelopment analysis (DEA) methodology in order to identify the causes of inefficiency. This paper modifies the conventional DEA model by taking into account the series relationship of the two sub-processes within the whole process. Under this framework, the efficiency of the whole process can be decomposed into the product of the efficiencies of the two sub-processes. In addition to this sound mathematical property, the case of Taiwanese non-life insurance companies shows that some unusual results which have appeared in the independent model do not exist in the relational model. In other words, the relational model developed in this paper is more reliable in measuring the efficiencies and consequently is capable of identifying the causes of inefficiency more accurately. Based on the structure of the model, the idea of efficiency decomposition can be extended to systems composed of multiple stages connected in series.     

OR in healthcare: A European perspective

The European Working Group “Operational Research Applied to Health Services” (ORAHS) is one of the domain specific EURO Working Groups organized by EURO - the European Association of Operational Research Societies. In this paper we report on the development of ORAHS as a platform for OR in health, and analyse the papers presented at meetings over the 35 years of its existence. We propose a two-way framework for analysis, where one dimension is the nine stages of the product life cycle: identifying consumer requirements, designing a new service to meet these requirements, forecasting demand for such a service, securing resources for it, allocating these resources, developing Programs & Plans to use these resources for delivering the service, establishing criteria for service delivery, managing the performance of the service, and finally, evaluating its performance. The other dimension is a three-level classification into broad application areas referring to processes at different levels in healthcare: Patients & Providers, Units & Hospitals, and Regional & National. We use this framework to carry out a quantitative analysis of all the papers presented during the meetings of ORAHS since its inception in 1975. We then describe developments over this period in applying OR approaches and techniques to healthcare, and present an overview of the main application areas and challenges.     

Reconciling ratio analysis and DEA as performance assessment tools

The assessment of operational performance remains a fundamental challenge both in practice and in theory. Data envelopment analysis (DEA) is one method developed in production economic theory and applied by researchers to study groups of enterprises. In practice, individual enterprises almost universally rely on simple output–input ratios. Each approach has its strengths and weaknesses, but the theoretical connection between the two has not been fully articulated. This paper uses the framework of DEA to establish a mathematical relationship between DEA efficiency scores and corresponding ratio analysis. The relationship can be expressed as a product of seven components: technical efficiency, technical change, scale efficiency, input slack factor, input substitution factor, output slack factor and output substitution factor.     

A branch-and-price approach for integrating nurse and surgery scheduling

A common problem at hospitals is the extreme variation in daily (even hourly) workload pressure for nurses. The operating room is considered to be the main engine and hence the main generator of variance in the hospital. The purpose of this paper is threefold. First of all, we present a concrete model that integrates both the nurse and the operating room scheduling process. Second, we show how the column generation technique approach, one of the most employed exact methods for solving nurse scheduling problems, can easily cope with this model extension. Third, by means of a large number of computational experiments we provide an idea of the cost saving opportunities and required solution times.     

Data envelopment analysis for environmental assessment: Comparison between public and private ownership in petroleum industry

Environmental assessment recently becomes a major policy issue in the world. This study discusses how to apply Data Envelopment Analysis (DEA) for environmental assessment. An important feature of the DEA environmental assessment is that it needs to classify outputs into desirable (good) and undesirable (bad) outputs because private and public entities often produce not only desirable outputs but also undesirable outputs as a result of their production activities. This study proposes the three types of unification for DEA environmental assessment by using non-radial DEA models. The first unification considers both an increase and a decrease in the input vector along with a decrease in the direction vector of undesirable outputs. This type of unification measures “unified efficiency”. The second unification considers a decrease in an input vector along with a decrease in the vector of undesirable outputs. This type of unification is referred to as “natural disposability” and measures “unified efficiency under natural disposability”. The third unification considers an increase in an input vector but a decrease in the vector of undesirable outputs. This type of unification is referred to as “managerial disposability” and measures “unified efficiency under managerial disposability”. All the unifications increase the vector of desirable outputs. To document their practical implications, this study has applied the proposed approach to compare the performance of national oil firms with that of international oil firms. This study identifies two important findings on the petroleum industry. One of the two findings is that national oil companies under public ownership outperform international oil companies under private ownership in terms of unified (operational and environmental) efficiency and unified efficiency under natural disposability. However, the performance of international oil companies exhibits an increasing trend in unified efficiency. The other finding is that national oil companies need to satisfy the environmental standard of its own country while international oil companies need to satisfy the international standard that is more restricted than the national standards. As a consequence, international oil companies outperform national oil companies in terms of unified efficiency under managerial disposability.