Comparative Study Of Applicating DEA,TOPSIS And Other Analysis Methods To Diagnostic Evaluating The Efficiency Of General Hospital Clinical Departments

The purpose of this study is to analyze the health resource inputs, outputs, andthe disposition of the 15 clinical departments( which from the affiliated hospital ofDalian university )during last 5 years, and to choose the key efficiency indexes thatpossess the important, representative, attainable characteristics and can be used toevaluate the relative efficiency of the clinic department.The efficiency and benefit ofthe clinical departments were evaluated by the methods of TOPSIS, Factor Analysis,Principal Component Analysis and DEA (Data Envelopment Analysis) respectively,furthermore, the correlations of the results obtained with the different methods wereanalyzed. Construction of evaluating indexes systerm,selection of evaluatingindexes,comparing DEA with other methods and establishing rewards regulation onthe basis of evaluating efficiency and benefit of the clinical departments were probeinto in order to provide more scientific,objective,fair and reasonable evidences forevaluation.Data and MethodsThe objects of this study are 15 clinic departments of a general hospital. Thedate related the human resource, material resource, medical service quality,department scale, service income and expenditure and the ratio of drug income tototal income during 2001 to 2005, were obtained mainly from the annual statistics review of finance,facility and human resource and also from the questionnaire ofgeneral hospitals efficiency and benifit.The main methods for this study are literature method and statistical methods.Iterature method: A lot of research paper available in English and Chinese werereferred to understand the progress in this field. The efficiency and benefitsevaluating indexes of clinical departments were selected by the utilization ofthese literatures.Statistics methods: The method of DEA (Data Envelopment Analysis), TOPSIS,Factor Analysis, Principal Components Analysis were used to evaluate the efficiencyand benefits of clinical departments. Meanwhile, the cluster analysis, correlationanalysis and coefficient of variation were applied to screen the DEA evaluationindiexes.ResultsThe evaluating system suitable for TOPSIS,Factor Analysis and PrincipalComponents Analysis methods, which was made up with 20 indexes wereconstructed, according to the principal of the sensitive, important, representative,attainable characteristics.Using cluster analysis, correlation analysis and coefficientof variation methods, 8 input and 6 output indexes for the DEA evaluation werechosen from the 20 indexes.The efficiency and benefits of target clinicaldepartments in five consecutive years were evaluated by the methods of TOPSIS,Factor Analysis, Principal Component Analysis and DEA (Data EnvelopmentAnalysis); Correlation of the results evaluated by four methods were analyzed,Themain results are showed: The results ranking of DEA evaluation:Tablel, The annual DEA evaluating result in different clinical departments(descending) The results ranking of TOPSIS evaluation:The results ranking of Factor analysis: The various sections Principal Component Evaluation Results RankingCorrelation Analysis of TOPSIS, factor analysis, principal component analysis andDEA evaluating results.From the DEA evaluating results, the efficiency of different clinical departments atthe same year can be observed as follow:. DiscussionIn the former evaluative studies on relative efficiency of clinical departmentsless statistics methods were used to analyze and screen indexes, but the subjectivemethods were used in more studies which will affected the credibility, authenticityof the evaluated results. The evaluating indexes used in the relative efficiencyevaluation of Clinical departments usually include some aspects related with thescale, quality, effectiveness and efficiency of clinical department ect. Someevaluating indexes usually possess same or different characteristics, the choice forindexes also are varied according to the purpose of the evaluation. Therefore,evaluators must identify the corresponding evaluating indexes system and methodsin accordance with different purpose to guarantee the objectivity and impartiality ofevaluation methodologically and technically. With the requirements of evaluatingpurpose, indexes systerm integrity and evaluating methods, the coefficient correlation, cluster analysis, coefficient of variation were applied at first time toscreen the suitable evaluating indexes for TOPSIS, Factor Analysis and PrincipalComponent Analysis or DEA methods.A evaluating systerm composed of 20 indexes for TOPSIS, Factor Analytic andPrincipal Components Analytic methods and a evaluating systerm composed of 12indexes(5 input indicators, 7 outputs indicators) for DEA were established. Twoevaluation systems include the input indexes of human resources, material and fundand the output indexes of the quantity and quality of the medical service, the benefitand efficiency of clinic department administration. They not only have themeasurable amount indexes but also the constructive indexes reflecting the scaledifference among the departments; not only the indexes related economic benefit,management efficiency and department's potential ability to develop, and also theindexes of social effects. Especially, the ratio of human resources cost to totalexpenditure, the ratio of equipment expenditure to total expenditure and the ratio ofdrugs income to total income, which are related to the management efficiency andsocial effects directing to the social problem such as "too difficult to see doctors, andtoo expensive to see doctors", haven't been reported in the former studies yet.In this study, concering the relative efficiency and benefit among 75 units basedon the results of diagnostic end evaluation, the applicable value and possibility inpractice of DEA were compared with that of TOPSIS, Factor Analysis andPrincipal Components Analysis methods.Data envelopment analysis (DEA) is an approach of non-parametric and non-statistics, it doesn't require any assumption of data random characteristic likedistribution and has great advantage to handle multiple input and multiple outputmodels. Each unit is evaluated as a decision-making unit (DMU), through inputs andoutputs ratio analysis to structure objective function and ascertain the front edge ofeach DMU, and according to the distance of each DMU with production frontcondition to determine whether the DMU has effective or not and find the low efficiency origin. Because DEA can judge the efficiency and definite indexes weightsby the process of optimization, DEA can provid more objectivily managementinformation wich can be used as evidences for managers to adjust and guidepractical work. TOPSIS (-Technique for Order Preference by Similarity to IdealSolution) is a method commonly used in limited plan multi- goals decision-makinganalysis. It doesn't need strict limit to data distribution type, sample content,correlativity or numbers of indexes, and can eliminate the influence of indexeshaving different dimension and give each indexes same weight. Its ranking result canreflect the superior and inferior degree of the evaluated units in direct-viewing,reliable way. Factor Analysis is a statistical data reduction technique used to explainvariability among observed random variables in terms of fewer unobserved randomvariables called factors. It reduces a large number of variables to a smaller numberof factors for modeling purposes, where the large number of variables precludesmodeling all the measures individually. As such, factor analysis is integrated instructural equation modeling (SEM), helping confirm the latent variables modeledby SEM, finally attain the goal of eliminating influence within relevant indexes andsimplify appraise process. Principal Components Analysis (PCA) is a technique usedto reduce multidimensional data sets to lower dimensions for analysis. It is designedto capture the variance in a dataset in terms of principle components. In effect, it istrying to reduce the dimensionality of the data to summarise the most important (i. e.defining) parts whilst simultaneously filtering out noise. In the Factor Analysis andthe Principal Components Analysis methods, each synthesis factor's weight isdecided according to the contribution rate. So it can overcome the limitation ofman-made, make the evaluation results exclusive, objective and reasonable.Considered the model of four methods and the target of diagnostic evaluation,TOPSIS, Factor Analysis, Principal Components Analysis methods can reveal thedifference between the score of some indexes and factors, but difficult to know howto adjust the indexes value to improve the relative efficiency base on the same investment. The results of DEA can reflect the indexes ideal value matched withinput and output and the relative efficiency value of each evaluated unit, at sametime, it can point out the amount shoud be augmented or reduceded in the inefficientunits yet. So the results can help the inefficient units improve relative efficiency baseon the scientific evidence. In some significance, the DEA method is more reliable,clear and useful than TOPSIS and Factor Analysis method on the aspect ofinformation that they can supply.The evaluation targets, indexes and original data involved in this study are allor mostly suitable for the prerequisite of these four methods application, therefore,the evaluation results has extremely remarkable or remarkable relevance. Based onthis, it also may mutually verify the evaluation results of the scientific, objective andfair, simultaneously, it can mutually make up their limitation.The rank of correlation analysis for TOPSIS, Factor Analysis, PrincipalComponents Analysis and DEA showed that the tendency of these four evaluationresults is same. But the correlation coefficient between DEA result and other threeresults is far less than the correlation coefficient between the former three results,and this difference is significant. For example, the results of TOPSIS, Factoranalysis and Principal Components Analysis indicate that the departments like 05D₆, 05 D₉ and so on are located yearly latter five all the time, meanwhile, theyactually belong to the effective units in the DEA analysis. Although the departmentslike 05 D₁₂ 04D₈ and so on in TOPSIS, Factor Analysis and Principal ComponentsAnalysis appraisal results are throughout located yearly first five, but they actuallyare effective units in the DEA analysis. The reasons for the above differencesbetween these evaluation results of four methods are in the following areas: 1,TheTOPSIS, Factor Analysis and Principal Components Analysis methods allhighlighted the influence of scale factor. Among eight factors or components thefirst four together hold 68.1% or 75.6% weights with "the scale". 2,The evaluationtropism of TOPSIS, Factor Analysis and Principal Components Analysis methods belong to "more input-more output", which is unsuitable for the evaluation of therelative efficiency from technical aspect. However, the DEA method emphasizes theevaluation of the relative efficiency for evaluated units, whose mode is "properinput-maximal output".3,In calculating the rank correlation coefficient among theresults of these four methods, there are 37 effective units with score 1 in the DEAevaluation results (close to 50% of the total), and the arrangement is same. So, DEAcan't show the tiny difference from the efficient units, which lead to fewercorrelation coefficient between DEA result and other three results than that ofbetween the former three results the coefficient correlation of DEA far less than thatof other 3 methods.Among these four methods, TOPSIS, Factor Analysis and PrincipalComponents Analysis results focused primarily on department's comprehensivestrength, development potential and the greater efficiency by increase investment.DEA method can objectively reflect operating efficiency in the hospital clinicaldepartments, product the disparity between actual value and the ideal value (relaxesvalue) and Simultaneously point out the reasons and adjusting amount for theinefficient units. For hospital managers, the DEA method has more feasible andrealistic guiding significance than other three methods have.The tendency of clinical departments development can be reflected byintegrating with the evaluation results of TOPSIS, Factor Analysis, PrincipalComponent Analysis and DEA (Data Envelopment Analysis) methods. Take D₅(neurology department)as example: in the evaluationl results of TOPSIS, FactorAnalysis and Principal Component Analysis methods, the D₅ is respectively locatedthe yearly first, three and five in 2001-2002 and occupied preceding two, three in2003-2005 year, which indicated its comprehensive benefit has been rising gradually.In the DEA evaluation results, D₅ is located in reciprocal first of all ineffectiveunits during 2001-2002, its place ranked the fourth count down in 2003. In2004-2005, it eventually become an effective unit which meets the requirement of "proper inputs-the maximal output". Although used different methods, theirevaluation results indicate whether the comprehensive benefit or relative efficiencyof D₅ showed a marked increase in its development trend.The construction and development of clinical department often needs thecertain cycle, the matching output cannot be obtained during the initial period ofincreasing investment. But, if the development direction is correct, its ideal deliverswill be allowed to obtain through a certain running period. Whereas, if passedthrough the essential cycle and the target units still remain ineffective, administratorsshould timely analyze the reasons for the shrinking demand, improper direction oftechnology development or insufficient capacity of leaders and other aspects. Somanagers can identify the crux and carry on the adjustment as soon as possible.This study indicates that combining DEA, TOPSIS, Factor Analysis andPrincipal Component Analysis methods can set fair and reasonable evaluationindexes and make a contribution to establish the evaluation mechanism for balancethe economic benefit, social effects, operating efficiency and development potentialof the clinical departments. Applications combining these evaluation resultsof fourmethods can be more scientific and objective to reflect the efficiency and benefit,operational efficiency and overall development trends in clinical departments, andalso can provide more scientific, objective, fair, reasonable basis for establishinghospital clinical departments evaluation and incentives system to strengthen andimprove the clinical departments construction.Conclusions1,It makes up the multi-indexes system including the scale, quality, benefit andefficiency of the hospital clinic department, which is different from the old ones.2,It applies multi-statistical methods to choose the evaluation indexes, whichare more objective, scientific and reasonable.3,Compared with TOPSIS,Factor Analysis and Principal Component Analysismethods, DEA method is more suitable for the diagnostic syntfesis evaluating of the relative efficiency in the hospital clinic departments, and can point out the reasons ofinefficient units. For hospital managers, the DEA method has more feasible andrealistic guiding significance than other three methods have.4,Applications of the DEA method integrating with TOPSIS, Factor Analysisand Principal Component Analysis methods can reflect the efficiency and benefit,operational efficiency and overall development trends of clinical departments inmore scientific and objective way, and also can provide more scientific, objective,fair, reasonable basis for establishing hospital clinical departments evaluation andincentives system in order to strengthen and improve the clinical departmentsconstruction.