The Office of the Auditor General’s investigation of hospital efficiency, a comparison of the organisation of hip operations, Document No. 3:3 (2003-2004), was submitted to the Storting on 14 November 2003.
There are big differences in efficiency between the 28 hospitals covered by the investigation. Even if the calculation must be treated with some caution, excessive length of stay may be up to 35%. Experience with good organisational solutions should, in the Office of the Auditor General’s opinion, be to a greater degree transferred between hospitals, so that the least efficient can learn from the most efficient.
The most efficient hospitals have more continuity in patient treatment as a result og improved coordination of the treatment activity. These hospitals are aware that the interval between the outpatient examination and admission for the operation must be brief, to avoid changes in the patient’s medical condition and so that the patients have been completely evaluated before admission. This leads to fewer cancelled operations and shorter stays both before and after the operation. The most efficient hospitals also make use of the rehabilitation institutions as an integrated part of the treatment.
The investigation also shows that it is the organisation and planning of surgical operations, and not theatre capacity, that in many hospitals causes the operating theatre to be a bottleneck. The most efficient hospitals exploit the theatres more efficiently through early start-up, quick turnaround between operations and also a flexible end to the day.
The investigation shows further that in the period 1998 to 2001 there has been a change as regards hip operations, from re-operations (second operations) to primary operations (first operations), which the hospitals perceive as more profitable. This has led to the waiting time for re-operations growing, whereas it has been falling for primary operations. The Office of the Auditor General would emphasise the significance of the establishment of internal management and follow-up systems that can reveal whether the financing system has unintended effects on the hospitals’ prioritisation of patients.
The Ministry of Health states that the Storting demands a considerable rationalisation in the hospitals, and that this will be followed up in the policy documents for the regional health enterprises for 2004. The Ministry of Health and Social Affairs emphasises vis-à-vis the health enterprises that patient prioritisation must be done on the basis of the rules and guidelines contained in statutes and regulations.
The document is available in Norwegian from the Office of the Auditor General’s website – www.riksrevisjonen.no -- or can be ordered from the University bookshop Akademika, tel. +47 22 11 67 70.