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Measuring Efficiency

The information provided in this section is based largely in interviews with key stakeholders that were carried out in the development of the framework and on comprehensive guidelines which can be found here and here. Our guidance is not as full as those provided in the linked documents, but should be enough to get you started.

Measuring the efficiency of your service is increasingly important. It is important to highlight the benefit of your service – how are you addressing the needs of a service and doing this in an efficient way? So, for example, has the number of patients that staff see increased due to a local initiative? Or, have staff initiated telephone or web-based follow-ups instead of appointments, freeing up time to increase patient throughput? How has this made the service more efficient? The answers may seem clear to you, but unless you report it to the appropriate people, they just won’t know. It is therefore important that you report not only what you have done and what your findings were, but also how services have improved and become more efficient as a result. Where possible report your findings in line with the most current policies and strategies – this shows that you are addressing the most current issues.

Know your population
Before being able to demonstrate that your service is efficient or not, you first have to understand and be able to communicate information about the demographic of population your service covers and some information about your service in general.

Overall population
This is the overall population that your service’s area covers, not just your patient group. It is important to know this basic information as healthcare provision and requirements are likely to be different for different groups (ages, race, socio-economic status etc.). This will help you to understand your prospective patient group better, and support the planning of service provision. This information is usually available from Public Health Departments and Strategic Health Boards/Regions (Holdsworth & Webster, 2006).

Helpful information to gather includes:

  • The size of the population
  • The proportion living in urban, rural and semi-rural areas
  • Deprivation indices for the areas
  • Gender, age, ethnic breakdown of the population
  • Whether the profile and size of the population has changed in the last three years

Patient population
This is the key information that will form your service design, so it is important that you get this right. This includes:

  • The size of your service’s specific patient group
  • The proportion of patients living in urban, rural and semi-rural areas
  • Deprivation indices for these areas
  • Gender, age, ethnic breakdown of your patients
  • Whether the profile and size of the your patient group has changed in the last three years

 Frequently this is precisely the type of information that Directors of services and Board members are interested in knowing. If you cannot demonstrate the need for your service in the first place, it can be harder to argue that it is a valuable resource.


How to measure efficiency
Given that it is impossible to meaningfully measure cost in financial terms, we suggest that you concentrate on a few key factors in demonstrating how efficient your service is/is not. This information is key to many of the people who make decisions about your service’s funding. To them it is the ‘so what?’ question that really matters. A number of manageable ways to measure efficiency are outlined below.

Efficiency measures

  • The referral rate to your service – how many new patients you see (e.g., per week or month).
  • A breakdown of where the new patients were referred from (e.g., self-referred, GP, consultant).
  • Patient throughput – how long are patients on your service caseload? This can be measured by calculating the mean average and range (maximum and minimum length of time).

The above will inform you about how many patients you have on your caseload. It will also tell you where they are being referred from, whether the proportion of referrals has increased or decreased, and whether a change in the proportion of referrals is because of a change in the overall population (i.e., by looking at patient numbers and demographics in relation to your overall population numbers and demographics).


  • Your referral rate expressed as a proportion per 1000 of the population

This seems trickier to calculate but will let you know whether your service referral rate is roughly in line with what would be expected based on other similar services. This information can help you to develop a case for the requirement of service provisions. There is a helpful tool to help you calculate this information in the book ‘Patient Self Referral: a Guide for Therapists’ (Holdsworth & Webster, 2006). This is summarised below for your convenience.

Patient Self Referral Anticipated Referral Rate Calculator
1.      First calculate your present referral rate as an expression of the annual rate per 1000 of the population you serve.
2.      Classify the population in terms of its location, i.e., use national definitions; urban, semi-rural, rural

Non-physiotherapy professions should now seek similar information from your professional contacts or networks. 
Physiotherapy services can proceed as outlined

3.      Compare your present rate of referral with the mean according to the classification of location
4.    If your referral rate per 1000 is much lower, you can anticipate that you will experience an increase in the total number of referrals if you introduce self referral. However, if your present referral rate per 1000 is similar or exceeds that quoted, you can anticipate that there will no increase in the number of referrals.

(Holdsworth & Webster, 2006)


  • How many patients fail to attend their first appointment or don’t complete their course of treatment?
  • How many of your patients go on to secondary referral or surgery?

Knowing this information will help you to get to know your patients’ pathways through care. The first point, knowing how many patients don’t attend or don’t complete treatment, is important as it will let you see how your resources are being used, and where they are being lost. If you know that your service’s interventions are helping to reduce the number of patients being referred elsewhere then you should report this saving as a demonstration of efficiency. Don’t just think about your own service, but how your service impacts on others. You shouldn’t report cost savings – this is too complicated. Simply reporting the points listed above is enough.


  • How long is your waiting list?

If you can, compare your waiting list to similar services (this is why it is important to gather population information) to yours to see how you are doing. If your waiting list is long then you may want to try an initiative to address it, e.g., using a telephone consultation where possible.

  • What are your employment and absence statistics?
  • What is your staffing compliment expressed as whole time equivalents per grade?
  • Where is your service provided in terms of whole time equivalents and sessions?
  • How many students does your service accommodate?
  • How many complaints versus compliments does the service receive, and how are these distributed. This is a basic measure, but may demonstrate important information about specific areas of the service needing improvement.

This information will let you get an overview of how your service is structured. You will also get a view of staffing absences, and where service could be improved/adjusted to improve efficiency. Some of this information may only be available to your managers.


You have reached the end of the guidance for this measure.  Move onto Stage 5: Reporting Outcomes.

Or go back to Stage 3: Considering Options to review other measures.

 

© Copyright 2012 NMAHP RU, Stirling University