Table 4.
Overview of included redesigns, continued
| Leicester Royal Infirmary (LRI) | Policlinico A. Gemelli (PG) | |
|---|---|---|
| Setting | A > 1,000-bed university hospital in Leicester, United Kingdom | A 1,500-bed teaching hospital in Roma, Italy |
| Aim redesign | To improve hospital performance in all areas (including hospital costs, patient process times, length of in-hospital stay) dramatically | To introduce a new patient-oriented mentality; to reduce costs |
| Study design | Uncontrolled before-after study and a process evaluation | Uncontrolled before-after study |
| Evaluation period | 1995 to 1998 | 1995 to 1998 |
| Redesigned services | All patient services (outpatients' and clinical care) | All patient services (outpatients' and clinical care) |
| Applied approach | Coordination mechanism approach | Coordination mechanism approach |
| Measures to change working procedures | Process management | Not reported |
| Outcomes in general | The impact of redesign on hospital services, costs and organisation was not as dramatic as initially anticipated (initial targets were ambitious); The overall efficiency was not transformed (as assessed through a quantitative evaluation of its performance) | Positive results for the introduction of the DC and reorganisation of surgical wards; Results of the medical wards are positive but have to be further improved to reach goals of the redesign |
| Outcomes on indicators | ||
| Finances | Output per £ (in comparison with other teaching Trusts), some examples: | No quantitative figures reported |
| - Weighted activity per £ of operating costs: ↑ (from £44 million to £55 million cheaper than average). | ||
| - Weighted activity per staff numbers (staff productivity): ↑ (from 21% to 41% better than average). | ||
| N.B. At macro level it is not possible to directly attribute the efficiency improvements to re-engineering - a number of other driving forces were also having influence. | ||
| Operational efficiency | LRI used a lot of measures, some examples: | Length of stay: |
| - Length of stay: ↓ (from 4.93 to 4.68) | - Preoperative hospital stay of surgical patients: ↓ (from 57 to 4.1 days) | |
| - Bed throughput: ↑ (from 66 to 78). | - Preoperative hospital stay of medical patients: ↓ (from 10 to 9.6 days). | |
| - Total admissions per bed (a year): ↑ (89 to 108) | ||
| - Percentage of bed occupancy: remained stable around 80% | ||
| Patient Satisfaction | Patient satisfaction surveys among 'walking wounded' patients: no change | No quantitative figures reported |
| Patient Safety | No quantitative figures reported | No quantitative figures reported |
| Factors for success | Not reported | Not reported |
| Challenges | To mobilise enough commitment to reengineer while clinical involvement in laboratories was low; To ignore the need for tailoring of interventions to clinical situations; To manage divergent views about nature and purpose of services between reengineers and clinicians; To manage changes that crossed specialty and directorate boundaries; To have the right ambition (results may not be at expense of learning or generate cynicism instead of interest and enthusiasm) | To manage changes that involve more hospital departments. For example, in surgical wards, the activity as a whole is conditioned by the operating rooms, while in medical wards, functioning is very complex and interacts with the entire hospital |