VA Boston Healthcare System and Boston University School of Public Health, Boston, Massachusetts.
J Healthc Manag. 2024;69(3):178-189. doi: 10.1097/JHM-D-23-00106. Epub 2024 May 10.
A lack of improvement in productivity in recent years may be the result of suboptimal measurement of productivity. Hospitals and clinics benefit from external benchmarks that allow assessment of clinical productivity. Work relative value units have long served as a common currency for this purpose. Productivity is determined by comparing work relative value units to full-time equivalents (FTEs), but FTEs do not have a universal or standardized definition, which could cause problems. We propose a new clinical labor input measure-"clinic time"-as a substitute for using the reported measure of FTEs.
In this observational validation study, we used data from a cluster randomized trial to compare FTE with clinic time. We compared these two productivity measures graphically. For validation, we estimated two separate ordinary least squares (OLS) regression models. To validate and simultaneously adjust for endogeneity, we used instrumental variables (IV) regression with the proportion of days in a pay period that were federal holidays as an instrument. We used productivity data collected between 2018 and 2020 from Veterans Health Administration (VA) cardiology and orthopedics providers as part of a 2-year cluster randomized trial of medical scribes mandated by the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018.
Our cohort included 654 unique providers. For both productivity variables, the values for patients per clinic day were consistently higher than those for patients per day per FTE. To validate these measures, we estimated separate OLS and IV regression models, predicting wait times from the two productivity measures. The slopes from the two productivity measures were positive and small in magnitude with OLS, but negative and large in magnitude with IV regression. The magnitude of the slope for patients per clinic day was much larger than the slope for patients per day per FTE. Current metrics that rely on FTE data may suffer from self-report bias and low reporting frequency. Using clinic time as an alternative is an effective way to mitigate these biases.
Measuring productivity accurately is essential because provider productivity plays an important role in facilitating clinic operations outcomes. Most importantly, tracking a more valid productivity metric is a concrete, cost-effective management tactic to improve the provision of care in the long term.
近年来生产力增长缓慢，其原因可能是生产力的衡量不够精确。医院和诊所可以从外部基准中受益，这些基准可以评估临床生产力。工作相对价值单位长期以来一直是实现这一目标的通用货币。通过将工作相对价值单位与全职当量（FTE）进行比较来确定生产力，但 FTE 没有通用或标准化的定义，这可能会导致问题。我们提出了一种新的临床劳动力投入衡量标准——“诊所时间”，作为替代使用报告的 FTE 衡量标准。
在这项观察性验证研究中，我们使用来自一项集群随机试验的数据比较了 FTE 和诊所时间。我们以图形方式比较了这两种生产力衡量标准。为了验证，我们估计了两个单独的普通最小二乘法（OLS）回归模型。为了验证并同时调整内生性，我们使用工具变量（IV）回归，以薪酬期内联邦假日的天数比例作为工具变量。我们使用 2018 年至 2020 年期间退伍军人健康管理局（VA）心脏病学和骨科提供者收集的生产力数据，这些数据是作为 2018 年退伍军人事务部维护内部系统和加强综合外部网络（使命）法案强制实施的医疗抄写员两年集群随机试验的一部分。
我们的队列包括 654 名独特的提供者。对于两种生产力变量，每位诊所日的患者数量始终高于每位 FTE 日的患者数量。为了验证这些措施，我们分别估计了 OLS 和 IV 回归模型，从两种生产力衡量标准预测等待时间。OLS 回归的两个生产力衡量标准的斜率为正且幅度较小，但 IV 回归的斜率为负且幅度较大。诊所时间的患者数量的斜率远远大于每位 FTE 日的患者数量的斜率。目前依赖 FTE 数据的指标可能存在自我报告偏差和报告频率低的问题。使用诊所时间作为替代方法是减轻这些偏差的有效方法。
准确衡量生产力至关重要，因为提供者的生产力在促进诊所运营结果方面发挥着重要作用。最重要的是，跟踪更有效的生产力衡量标准是一项具体的、具有成本效益的管理策略，可以长期改善护理服务的提供。
