Efficiency Analysis of Surgical Services by Combined Use of Data Envelopment Analysis and Gray Relational Analysisby Nuray Girginer, Tunç Köse, Nurullah Uçkun

J Med Syst



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Efficiency Analysis of Surgical Services by Combined Use of Data

Envelopment Analysis and Gray Relational Analysis

Nuray Girginer & Tunç Köse & Nurullah Uçkun

Received: 18 November 2014 /Accepted: 2 March 2015 /Published online: 13 March 2015 # Springer Science+Business Media New York 2015

Abstract The aim of this study was to determine the efficiency of surgical services offered by a public hospital, to rank efficient services and to determine important factors on efficiency of services. DEA (to determine efficiency of services) and GRA (to rank efficient services and ranking of important variables in efficiency) were used in this study. DEA showed that all services were observably efficient except Cardiovascular and

Plastic surgery. GRA showed that the services of

Ophthalmology, Otorhinolaryngology (ENT) and

Paediatric Surgery shared the first three ranks in order of decreasing frequency. Findings obtained from GRA, the most important variables in the performances of surgical services were found to be the number of patients and healthcare personnel. Findings obtained from this study are thought to help inefficient services to attain an efficient structure. When the importance of this issue regarding hospitals and the government is considered, similarly designed studies should be continually updated and revised in line with changing circumstances. When shortcomings in the existing literature are taken into account, this could be considered to be a pioneer study that will contribute to the literature and promote future studies to be conducted on this issue.

Keywords Efficiency . Health policy . Hospital administration . Data envelopment analysis . Gray relational analysis


Access to healthcare facilities has been greatly facilitated thanks to recent developments in health policies. However, this phenomenon has simultaneously increased public expenditures. The acquisition of epidemiological data has become crucial in the planning and budgeting of health services which gain importance because of increasing public expenditures.

Instead of a data-handling concept that focuses only on controlling public expenditures, the employment of an outcomeoriented planning approach necessitates the qualitative evaluation of health expenditures in addition to quantitative assessments This context places emphasis on finding the most efficient way to analyse and plan scarce medical resources.

Efficiency is generally defined as refraining from wasting resources and using the least amount of inputs while fulfilling a task. The most frequently used method in the measurement of efficiency is Data Envelopment Analysis (DEA). DEA has become a frequently used benchmarking criterion in various fields, including hospitals, universities, the manufacturing industry, logistic firms, banks and sports. In addition, as a decision-making method, Gray Relational Analysis (GRA) has been increasingly reported in the literature. This analytical decision-making tool has taken its place in the literature under the main heading of Gray System Theory.

The definition of outputs of public hospitals differs according to their relevant purposes of production. Hospitals produce very diverse outputs, as measured by numbers of outpatient examinations, operations, days of hospitalization and childbirths, bed occupancy rates can be identified. Therefore,

DEA, which measures efficiency using more than one input and output without paying any importance to diversities among measurement units are a preferred method of assessing activities performed in public hospitals. Although DEA provides important information about improvements required for the inefficient units to become efficient units, it does not rank

This article is part of the Topical Collection on Patient Facing Systems

N. Girginer : T. Köse (*) :N. Uçkun

Eskisehir Osmangazi University, Eskisehir, Turkey e-mail: tunckose@gmail.com

J Med Syst (2015) 39: 56

DOI 10.1007/s10916-015-0238-y the units with established efficiencies Thus, in many studies cited in the literature. GRA has been used in the ranking of the performances of efficient units determined as result of DEA [1–3].

The DEA technique has been successfully used in many research studies within the health sector [4–10]. In recent years DEA has been used in increasingly higher number of studies related to efficiency analysis in Turkey [11–18].

The literature review did not yield any integrated approaches that used DEA to determine the efficiencies of public hospitals and services in Turkey in combination with the use of GRA to rank the performances of those efficient hospitals and services. In recent years, multivariate statistical analyses and DEA-like techniques have been used more frequently.

Surgical services in public hospitals require and use a greater number of resources when compared with other units.

Owing to these characteristics, the efficient use of resources by surgical services directly affects the performance of hospitals. Within this context, these services should be subjected to detailed efficiency analyses, which are critical to the determination and interpretation of the overall performance of hospitals and the individual performances of these services.

In this study, we aimed to determine and analyse efficiency status of surgical services in a public hospital. This study analysed the efficiency status of 10 surgical services of a public hospital using a DEAmodel that targeted the maximization of relative efficiencies with respect to 4 inputs (bed turnover, total number of physicians and other health care personnel, bed occupancy rate) and 2 outputs (total number of operations and hospitalized-discharged patients). GRAwas used to rank the performances of efficient services. As an outcome of

GRA, factors impacting the performances of efficient services were determined and these factors were ranked based on their degree of effectiveness. This study is anticipated to provide important information, particularly for hospital administration regarding the evaluation of the performances of surgical services and the determination of valid efficiency measures for these services.