Barber–Johnson Technique to Assess the Efficiency of India’s Apex Tertiary Care Hospitals

Scarcity of beds and long waiting lists is a challenge for public hospitals worldwide. This study uses the Barber–Johnson technique to analyse the efficiency of five hospitals of India’s apex medical institute. Four hospital efficiency indicators based on annual hospital statistical reports from 2005–06 to 2015–16 were studied and compared with the respective figures of other countries. Though the results reveal a high efficiency of the five hospitals, there is a high probability of poor health outcomes in future. There is thus a need to redesign processes and to innovate better care models to improve healthcare service delivery.

The authors would like to thank the reviewers for their valuable comments and suggestions.

The supply of hospital beds and their utilisation are fundamental to health economics and planning in all health systems, regardless of administration and financing methods. The addition or closing of hospital beds is one of the difficult and controversial issues in health planning and health politics (Tulchinsky and Varavikova 2000). Their supply is measured in terms of hospital beds per 1,000 population. However, this varies widely between and within countries. Currently, the bed to population ratio in Delhi is 2.76 despite increase in beds from 32,941 in 2004 to 49,969 in 2015 (Government of NCT of Delhi 2017). Hospital bed is a scarce resource.The cost of construction of a bed is usually equal to the cost of operating the bed over two to three years. The decision to build a bed obliges the health system to indefinitely fixed costs even if that bed is unused as a result of regulation or the reduced utilisation from professional or economic incentives (Tulchinsky and Varavikova 2000). Therefore, each bed should be efficiently and optimally utilised. Some of the traditional hospital performance metrics are hospital bed occupancy rate (BOR), turnover interval (TOI), turnover rate (TOR), average length of stay (ALS), and hospital throughput. These indicators are usually examined in isolation for lack of a convenient way of examining them together. B Barber and D Johnson described the eponymous Barber–Johnson diagram in 1973 to present information about patient length of stay, TOI, discharges and deaths per available bed, and percentage bed occupancy in one diagram (Barber and Johnson 1973).

Mayer et al (1994) and Premik et al (1999) compared the hospital utilisation indices for Croatia and Slovenia, respectively, in times of war and peace using the Barber–Johnson technique, which helped in evaluating decisions about hospital bed utilisation. Lastrucci et al (2016) highlighted the inefficiency of hospitals and the paradoxes between inadequate hospital bed density and low hospital bed utilisation in the Republic of Albania. Morera (2013) graphically compared the hospital bed management in eight hospitals of Costa Rica.Alternatively, the Pabón Lasso (1986) model, which is a modification of the method proposed by Massabot (1978), is used as a tool to measure efficiency of hospitals.