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MEASURING HOSPITAL PRODUCIXVITY - - A ~bte Neil R. Scheier A brief survey of the recent literature on measuring hospital productivity reveals the evolution of ~ a t has cane to be an acceptable definition of hospital output e.g. patient care, education and research. The purpose of this note is to add a fourth conmor~t, nanely availability, w h i r ~ffects the import of cost analyses economists are nc~ deriving from productivity studies. It is interesting to note that defining the hospital's output has been, in a sense, a cyclical process. In 1914, Codm~ (3) termed the hospital's objectives as (a) care of the sick and injured, (b) medical education as well as the m~ntenance of medical standards in the commmity, (c) disease prevention and the promotion of health, and (d) medical research. Several decades later, Sloan (6) reiterated these four objectives. In 1974, Ruchlin and Leveson (5) further refined the definition of hospital output to that noted in my first sentence i.e. patient care, education and research. It is this latter definition which current day productivity analysts have utilized in their measurenents. One must note, though, that its acceptance is not universal, as exemplified by a 1976 paper by Astolfi (1). The demand for productivity measurement is an outgrowth of recent political and economic pressures for cost accounting in the health care industry. In our collective researching we have noted certain facilities within ti~e hospital wherein equipment and personnel necessary for operation evidence little relationship to different levels of utilization. Examples of such areas are laundry, purchasing, pharmacy and, most importantly for purpose of this note, the emergency room. At some point in each hospital day there stends idle a fully equipped emergency room, staffed by expensively tr~!ned medical personnel, as ~mll as the clerks and technicians necessary for its operation. Does this situation suggest a measurement of zero productivity? I think not, for the health care consumer is more than willing to subsidize this operation in the event that its usage becomes necessary. Hence, availability of the service must be incorporated into any definition of output; preparedness on the part of all concerned is the function being performed and availability is the output. Some may argue that perhaps availability is more an output of the non-profit institution than of the private hospital. If this is true, it suggests a need for still more thought with reference to a universally acceptable measurermmt of hospital output, or perhaps it simply evidences the incomparability between the different sectors of the health care industry.

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~~CES I.

Astolfi, Adrienne A., '~ust We Really ImProve Productivity?" in Hospital Financial ~ana~ement , Volume 31, #2, February 1977.

2.

Berki, Sylvester E., Hospital Eccmon~ics, lexington, Massachusetts: D.C Health & Co., 1972.

3.

Codman, E. A., "~he Product Of A Hospital" in Surgery, Gynecology, and Obstetrics, Japery - June 1914.

. Eberhard, Michael et. al., '~!he HRU - Measuring Input to Find Productivity", in Hospital Financial ~m~%Kement, Volu~e 30, #2, Feb~mTy 1976. 5.

Ruchlin, Hirsch S. and Irving Leveson, '~easuring Hospital Productivity", in Health Services Research, Volute 9, ~,~, Winter 1974.

6.

Sloan, R. P., This Hospital Business Of Ours, New York:

Putnam, 1952.