Factory Focus in Hospital‐owned Ambulatory Surgery

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Abstract
Uses a professional services setting to study the concept of factory focus. The rapid growth in the US of ambulatory surgery centres (surgicentres) provides an evolving illustration of focused factories in services. Because of the pressures of cost containment, most hospitals have segmented their surgical market, but have adapted their operations in a variety of ways. Some keep the inpatient and outpatient survery integrated in the same facility, while others choose a plant‐with‐a‐plant or a separate facility. Information concerning costs, organizational structure, achievement of the advantages and disadvantages of differentiation from inpatient surgery, service times, waiting times, customer services offered, and future plans were provided by 54 hospital‐owned ambulatory surgery centres. Despite a variety of structural arrangements, the responses were effectively classified by whether or not they shared operating rooms with inpatient surgery. Those who shared operating rooms reported significantly less achievement of the advantages and avoidance of the disadvantages of outpatient surgery. The shared facilities also reported longer waiting times, less patient contact and higher average facility charges, despite no significant differences in length of procedure nor volume of the seven most frequent procedures. Among the centre directors is the OR group, and 53 per cent favoured separation of the two surgical settings. All the directors with separated facilities favoured continued separation. The reasons given to justify integration emphasized economies of scale and safety, while those given for separation were customer‐service‐oriented.

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