Efficiency measurement on teaching hospitals: an integrative review

Abstract

Background The complexity of hospital management drives the improvement of scientific instruments available to measure their organizational efficiency. The incorporation of financial aspects as an agenda for the improvement of models for evaluating the efficiency of hospitals, and of the quality dimension have been indicated as gaps. Particularly, teaching hospitals are less profitable than other hospitals due to their teaching and research missions. Thus, this paper presents an integrative review of the literature about measuring the efficiency of teaching hospitals from 2011 to January 2023 to outline the main achievements, challenges, and recommendations in this research field. Methods We offer an integrative review across Scopus, ScienceDirect, Web of Science, Inderscience, and Springer Link databases. The search in databases generated 384 records, after removing duplicates, and following the PRISMA guidelines, 30 studies were considered eligible for this study. Results The studies included in this review revealed the scarcity of evaluation models tailored to the reality of teaching hospitals. Data Envelopment Analysis is the most frequently used evaluation method. There is a greater occurrence of inputs related to personnel and the most frequent outputs were those related to the number of visits and surgeries. We did not identify quality-oriented inputs, but we observed outputs (service level, and medical service satisfaction). The economic-financial inputs are related to expenses and costs, and the outputs are related to revenue, profit, and Resource Intensity Weight. Conclusions This study contributed to the improvement of the research field by pointing a direction for the advance of the measurement models. It is recommendable a combination of economic-financial indicators and quality measures. Regarding the financial dimension, the recommendation is to analyze the Return on Investment, and in the scope of the quality dimension, to verify the staff inputs from the point of view of the quality of the workforce. Also, there is a broken path for future research to consider input-oriented to physical and technological structure to measure the efficiency of teaching hospitals. We recommend developing a specific model to measure the efficiency of teaching hospitals to target the limitations appointed in this study.