Performance analysis of a focused hospital unit: The case of an integrated trauma center

The concept of focus [Skinner, W., 1974. The focused factory. Harvard Business Review 52 (3), 113-121], notably operationalized in manufacturing entities like cells and focused factories, has also been adopted by the health care industry. Examples include patient-focused care systems and product/service lines. Despite its longevity, there is a paucity of studies analyzing the focus concept and its link to performance, especially in health care. This research is aimed at enhancing our understanding of how a focus-based approach to organization redesign in health care affects processes and practices, and what operational, clinical, and financial outcomes result from such a change. The research setting is a single case site within a large medical center for which costs for trauma care used to exceed income. Using a structured framework, we document the design and operation of this physically and organizationally integrated Level I trauma care center and compare it to its preceding operation. Its pre- and post-conversion performance is analyzed using symmetric event windows covering three-year periods before and after the focused hospital unit (FHU) was established. Under a sizable increase in workload, we find no change in mortality, moderate improvement in length of stay, and a large improvement in net operating margins. Surprisingly, the latter stem not from reductions in cost but in sharply increased hospital reimbursements. Previous studies of hospital restructuring involving focused patient populations have not conclusively supported a positive link between focus and outcomes. However, this investigation of a specific FHU suggests, conceptually as well as quantitatively, that focus can be an attractive element in health care system design. (C) 2008 Elsevier B.V. All rights reserved.