Smaller hospitals have higher risk of inefficiency, study finds

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 virtual hospital.

Professor Filar said at first sight, simulations might appear much like a video hospital game.

“But they are based on careful modeling 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 organizational structures, it would be unrealistic, costly and risky for hospitals to conduct field experiments to test the effects of any major organizational change.

“Mathematical modeling 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 said.

The researchers mathematically modeled 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 modeling and computer simulations to model patient flow and waiting times in a large Queensland regional hospital, Nambour General Hospital.