Big hospitals are more efficient, study shows
Tuesday, 5 December 2017
Size matters when it comes to a hospital’s operational efficiency and smaller hospitals have a higher risk of
inefficiency, a study has found.
When deciding on a hospital’s optimal size, managers need to consider the clinical functions it will offer, according to
researchers from The University of Queensland, Flinders University
and Sunshine Coast Hospital and Health Service
UQ School of Mathematics and Physics’ Professor Jerzy Filar
said the study used known data, statistical analyses and simulations of various scenarios to generate outcomes in a
Professor Filar said at first sight, simulations might appear much like a video hospital game.
“But they are based on careful modelling of patient data and judicious extrapolation of observed trends to hypothetical
hospitals, scaled by size,” he said.
“The difference is that this study aims to help healthcare planners by testing how hospital efficiency relates to size,
as hospitals operate under different conditions.
“Due to their complex organisational structures, it would be unrealistic, costly and risky for hospitals to conduct
field experiments to test the effects of any major organisational change.
“Mathematical modelling and computer simulations offer an effective and risk-free approach to assess likely impacts of
any proposed change.”
Flinders University senior lecturer Dr Shaowen Qin
said simulation model findings suggested that smaller hospitals had a higher probability of being overcrowded, which
could result in an inability to service newly arrived patients and/or provide an adequate level of treatment.
She said the research suggested that large hospitals had better ability to absorb spikes in arrivals.
“This may mean the provision of additional ‘surge’ capacity may be required when commissioning smaller facilities,” she
The researchers mathematically modelled alternative scenarios including changing the mix of ambulance and walk-in
arrivals, and the proportions of patients needing different forms of treatment.
“Essentially we were exploring a facility planning problem: given a set of conditions, what could be done to help in
planning operational services while avoiding excess capacity, the cost of which would need to be met by taxpayers.”
Dr Qin said the study replicated and extended an original study reported last year for Flinders Medical Centre in South
Australia, with the latest study using mathematical modelling and computer simulations to model patient flow and waiting
times in a large Queensland regional hospital, Nambour General Hospital.
Findings of the study, co-authored by Tim Bogomolov, Jerzy Filar, Ruth Luscombe, Yoni Nazarathy, Shaowen Qin, Piotr
Swierkowski and Ian Wood, were presented at the 22nd International Congress on Modelling and Simulation in Hobart last