Abouleish A E, Zornow M H, Levy R S, Abate J, Prough D S
Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas 77555-0591, USA.
Anesthesiology. 2000 Dec;93(6):1509-16. doi: 10.1097/00000542-200012000-00024.
The ability to measure productivity, work performed, or contributions toward the clinical mission has become an important issue facing anesthesiology departments in private practice and academic settings. Unfortunately, the practice and billing of anesthesia services makes it difficult to quantify individual productivity. This study examines the following methods of measuring individual productivity: normalized clinical days per year (nCD/yr); time units per operating-room day worked (TU/OR day); normalized time units per year (nTU/yr); total American Society of Anesthesiologists (ASA) units per OR day (tASA/OR day); and normalized total ASA units per year (ntASA/yr).
Billing and scheduling data for clinical activities of faculty members of an anesthesiology department at a university medical center were collected and analyzed for the 1998 fiscal year. All clinical sites and all clinical faculty anesthesiologists were included unless they spent less than 20% of their time during the fiscal year providing clinical care, i.e., less than 0.2 clinical full-time equivalent. Outliers, defined as faculty who had productivity greater or less than 1 SD from the mean, were examined in detail.
Mean and median values were reported for each measurement, and different groups of outliers were identified. nCD/yr identified faculty who worked more than their clinical full-time equivalent would have predicted. TU/OR day and tASA/OR day identified apparently low-productivity faculty as those who worked a large portion of their time in obstetric anesthesia or an ambulatory surgicenter. tASA/OR day identified specialty anesthesiologists as apparently high-productivity faculty. nTU/yr and ntASA/yr were products of the per-OR day measurement and nCD/yr.
Each of the measurements studied values certain types of productivity more than others. By defining what type of service is most important to reward, the most appropriate measure or combination of measures of productivity can be chosen. In the authors' department, nCD/yr is the most useful measure of individual productivity because it measures an individual anesthesiologist's contribution to daily staffing, includes all clinical sites, is independent of nonanesthesia factors, and is easy to collect and determine.
衡量生产力、工作表现或对临床任务的贡献能力，已成为私人执业和学术环境下麻醉科面临的一个重要问题。不幸的是，麻醉服务的实践和计费使得难以量化个人生产力。本研究考察了以下衡量个人生产力的方法：每年标准化临床天数（nCD/yr）；每个手术室工作日的时间单位（TU/OR日）；每年标准化时间单位（nTU/yr）；每个手术室工作日的美国麻醉医师协会（ASA）总单位数（tASA/OR日）；以及每年标准化ASA总单位数（ntASA/yr）。
收集并分析了某大学医学中心麻醉科教员1998财年临床活动的计费和排班数据。纳入所有临床地点和所有临床教员麻醉医师，除非他们在该财年用于提供临床护理的时间少于20%，即少于0.2个临床全职等效时间。对被定义为生产力高于或低于均值1个标准差的异常值教员进行了详细检查。
报告了每种测量方法的均值和中位数，并识别出不同组的异常值。nCD/yr识别出工作时间超过其临床全职等效时间预期的教员。TU/OR日和tASA/OR日将明显低生产力的教员识别为那些大部分时间从事产科麻醉或门诊手术中心工作的教员。tASA/OR日将专科麻醉医师识别为明显高生产力的教员。nTU/yr和ntASA/yr是每个手术室工作日测量值与nCD/yr的乘积。
所研究的每种测量方法对某些类型生产力的重视程度高于其他类型。通过确定哪种类型的服务对奖励最为重要，可以选择最合适的生产力测量方法或测量方法组合。在作者所在的科室，nCD/yr是衡量个人生产力最有用的方法，因为它衡量了个体麻醉医师对每日人员配备的贡献，涵盖所有临床地点，独立于非麻醉因素，并且易于收集和确定。
