Researchers: Shuli Brammli-Greenberg¹, Ziv Gil^2,3

Background: The main mission of hospital department managers is to improve the quality of care in their departments. To accomplish their mission, managers – often senior physicians – need managerial tools and guidance on how to apply them to improve performance and outcomes.

Objectives: To develop and implement a management algorithm in a hospital department, in order to improve performances and quality of care.

Method: The study consists:
1)Establishing theoretical framework and building a departmental management algorithm
2)Retrospective study in a pilot department to validate the algorithm among 11,245 patients during 2008-2016
3)Prospective study in an intervention department (12,349 patients; 2014-2019), and control department (35,351 patients; 2016-2019).
4)Synthesis of the findings.
Methods included: qualitative components (in-depth interviews, review and evaluation of more than 100 indices), and quantitative components (quasi-difference-in-difference analysis, time series analysis and multievent study).

Findings: The first outcome of the study was the construction of the D.R.E.E.M method that consists of five consecutive steps: Define; Rank; Enumerate; Establish; Monitor and adjust actions. Once department-specific Key-Performance-Indicators (KPIs) have been identified (steps 1-4), the processes for improving departmental performance can begin (Step 5). Both the retrospective and prospective study revealed desirable changes in KPIs (compare to the control department). This was due to main actions in the managerial-departmental level, constitute of better allocation of resources (time, place, staff), direct and regular involvement of the department management and clear guidelines and prior approvals for challenging actions. While implementing the method other meaningful clinical, and non-clinical were taken by the department management.

Conclusions: The study highlights the importance of a managerial method for accompanying department management to promote efficiency.

Recommendations: The D.R.E.E.M. method showed promise in yielding greater operational performance without requiring additional resources. It is therefore recommended, in our view, to test the method in different departments in other hospitals and additional hospitals.

Research end date: 12/2021