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Application of "Value Engineering" to Rationalize the Cost of Cataract Surgery in Eye Clinic at Tata Main Hospital

S.P. Jakhanwal, G.B. Singh

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Topics

Functional Cost is the cost of the method chosen to perform the function. “Cost-Worth” analysis helps to find out the true value of the function and suggests those items or functions susceptible to value studies (Table:1).In other words, it is very much “worth” staying in hospital on operation day for surgery but it is not “worth” staying in the hospital for Pre and Post Operative functions

Creative Phase

Objective: To speculate alternatives through brain storming.

After number of brain storming sessions of the team members involving careful analysis of emerging data and speculation of alternatives, the following three most relevant and practical ideas were selected for further evaluation, out of other enlisted alternatives:

  1. Reduce Pre- and Post- operation stay in hospital
  2. Discharge should be made on Sundays
  3. Change the Saturday O.T. to some other week day.

Evaluation Phase

Objective: To analyse the result of Creative Phase, and through an in-depth review of various alternatives (emerging from Creative Phase) short-list the best ideas for further expansion.

Though several techniques are available, “Weighing Criteria” technique was preferred because of its practicality and appropriateness to the situation under study.

Weighing Criteria : To weigh the ideas, a set of standards or criteria are needed. To arrive at a suitable set of criteria, question asked is, “What will be affected by this idea, if implemented?” Deliberating on above lines the following criteria were selected for idea evaluation:

  1. Quality of operation
  2. Cost effectiveness
  3. Ease of implementation

Fast 2

Numerical Rating of Selected Criteria: To arrive at numerical rating of the above selected set of criteria each criterion was rated by the Team members as per usual protocol and compared against “1-10” point scale by Paired Comparison Method (Table:2).

Quality must not be sacrificed for the sake of cost reduction and least so for the sake of ease.

“Weighing” Idea against Criteria: Each alternative idea is weighed against set of chosen Criteria for final selection. Alternatives or ideas are ranked as 4 for “Excellent”; 3 for “Very Good”; 2 for “Satisfactory” and 1 for “Poor”.

A numerical score was computed by multiplying the “weight” factor (A=16; B=9; C=5) times the rank rating assigned to different alternatives as shown in Decision Matrix below: (Table:3).

Decision Matrix

Table 3 Each Idea “weighed” against each Criteria to arrive at Total Score for Each Idea

Rank Rating Criteria Weight
Excellent 4 Quality of Operation… A=16
Very Good 3 Cost effectiveness…. B = 9
Satisfactory 2 Ease of implementation… C = 5
Poor 1    

!http://www.indmedica.com/journals/images/jaha/013_002_fast3.gif (Fast 3)!

The team discussed each idea and valued each of them against selected criteria.


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