Analysis of relative efficiency measures of medical nursing units for managerial diagnosis and control

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Mohamed Onsi


Resource use, Efficiency

Subject Categories



A prospective reimbursement system was mandated in New York in 1986. Consequently, a large portion of the financial risk of patient treatment shifted from third party payers to the hospitals. To maintain financial stability, hospitals have been forced to improve operating efficiency. This study attempted to determine if selected hospital and nursing unit characteristics and nursing unit staff work profiles were associated with efficient resource utilization. Due to regulatory differences among states, only not-for-profit hospitals in New York State were included in the study. The study was conducted in two phases. Phase one involved a cross-sectional measurement of the relative technical efficiency of forty-one comparable short-term acute care medical nursing units from twenty-one participating hospitals. The results of the first phase provided the basis for further investigation in phase two. Phase two dealt with determining whether there was an association between relative technical efficiency and eleven selected nursing unit variables and three hospital characteristics. The results of phase two indicated that the three selected hospital specific characteristics; teaching status, unionization of employees, and existence of a centralized patient transportation department, were not statistically associated with the relative efficiency ratings. Only three of the unit specific characteristics were found to be significantly statistically associated with relative technical efficiency; use of rotating shifts, use of computers in the nursing care process, and use of acuity data to prepare the staff budget. Several of the selected nursing unit characteristics showed weak associations with efficiency. Numerous programs or operating strategies are implemented in the effort to improve nursing unit efficiency. Only three of the variables selected for this study showed associations with efficiency. These findings may cause hospital administrators to reconsider their reasons for implementing the related operating programs. Part of the importance of the study stems from the apparent lack of information that relates resource allocation decisions to nursing unit efficiency. While nursing units are becoming the focus in the attempt to improve hospital performance, data collection revealed that nursing unit specific data is not readily available to those that request it.


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