The impact of specialization of hospitals on patient access to care; a queuing analysis with an application to a neurological hospital

• Published in: Health care management science Vol. 22; no. 4; pp. 709 - 726
• Main Authors: Samiedaluie, Saied, Verter, Vedat
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2019; Springer Nature B.V
• Subjects: Business and Management; Computer Simulation; Econometrics; Health Administration; Health care access; Health care management; Health Informatics; Health Services Accessibility - organization & administration; Hospital Administration; Hospital systems; Hospitals; Hospitals, University; Humans; Length of Stay; Management; Multi-Institutional Systems - organization & administration; Neurology; Operations Research/Decision Theory; Organizational Case Studies; Patients; Quebec; Resource Allocation - methods; Resource Allocation - organization & administration; Specialization; Studies; Waiting Lists; Quebec; Specialization; Queueing networks; Hospital bed management; Multi-hospital systems
• ISSN: 1386-9620; 1572-9389
• DOI: 10.1007/s10729-018-9453-7

We study the impact of specialization on the operational efficiency of a multi-hospital system. The mixed outcomes of recently increasing hospital mergers and system re-configuration initiatives have raised the importance of studying such organizational changes from all the relevant perspectives. We consider two configuration scenarios for a multi-hospital system. The first scenario assumes that all the hospitals in the system are general, which implies they can provide care to all types of patients. In the alternative configuration, we specialize each hospital in certain level of care, which means they serve only specific types of patients. By considering an extensive number of possible settings for a multi-hospital system, we characterize the situations in which one scenario outperforms the other in terms of extending access of patients to care. Our results show that whenever the percent of patients with shorter length of stay in the system increases, specialization of healthcare services can maximize the accessibility of care. Also, if the patient load is balanced between all hospitals in the system, it seems more likely that all hospitals benefit from specialization. We conclude that the strategic decision of designing a multi-hospital system requires careful consideration of patient mix among arrivals, relative length of stay of patients, and distribution of patient load between hospitals.