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Table 4 Overview of included redesigns, continued

From: Towards an organisation-wide process-oriented organisation of care: A literature review

  Leicester Royal Infirmary (LRI) Policlinico A. Gemelli (PG)
Setting A > 1,000-bed university hospital in Leicester, United Kingdom A 1,500-bed teaching hospital in Roma, Italy
Aim redesign To improve hospital performance in all areas (including hospital costs, patient process times, length of in-hospital stay) dramatically To introduce a new patient-oriented mentality; to reduce costs
Study design Uncontrolled before-after study and a process evaluation Uncontrolled before-after study
Evaluation period 1995 to 1998 1995 to 1998
Redesigned services All patient services (outpatients' and clinical care) All patient services (outpatients' and clinical care)
Applied approach Coordination mechanism approach Coordination mechanism approach
Measures to change working procedures Process management Not reported
Outcomes in general The impact of redesign on hospital services, costs and organisation was not as dramatic as initially anticipated (initial targets were ambitious); The overall efficiency was not transformed (as assessed through a quantitative evaluation of its performance) Positive results for the introduction of the DC and reorganisation of surgical wards; Results of the medical wards are positive but have to be further improved to reach goals of the redesign
Outcomes on indicators   
Finances Output per £ (in comparison with other teaching Trusts), some examples: No quantitative figures reported
  - Weighted activity per £ of operating costs: ↑ (from £44 million to £55 million cheaper than average).  
  - Weighted activity per staff numbers (staff productivity): ↑ (from 21% to 41% better than average).  
  N.B. At macro level it is not possible to directly attribute the efficiency improvements to re-engineering - a number of other driving forces were also having influence.  
Operational efficiency LRI used a lot of measures, some examples: Length of stay:
  - Length of stay: ↓ (from 4.93 to 4.68) - Preoperative hospital stay of surgical patients: ↓ (from 57 to 4.1 days)
  - Bed throughput: ↑ (from 66 to 78). - Preoperative hospital stay of medical patients: ↓ (from 10 to 9.6 days).
  - Total admissions per bed (a year): ↑ (89 to 108)  
  - Percentage of bed occupancy: remained stable around 80%  
Patient Satisfaction Patient satisfaction surveys among 'walking wounded' patients: no change No quantitative figures reported
Patient Safety No quantitative figures reported No quantitative figures reported
Factors for success Not reported Not reported
Challenges To mobilise enough commitment to reengineer while clinical involvement in laboratories was low; To ignore the need for tailoring of interventions to clinical situations; To manage divergent views about nature and purpose of services between reengineers and clinicians; To manage changes that crossed specialty and directorate boundaries; To have the right ambition (results may not be at expense of learning or generate cynicism instead of interest and enthusiasm) To manage changes that involve more hospital departments. For example, in surgical wards, the activity as a whole is conditioned by the operating rooms, while in medical wards, functioning is very complex and interacts with the entire hospital