Mapping the Service Process to Enhance Healthcare Cost-Effectiveness: Findings from the Time-Driven Activity-Based Costing Application on Orthopaedic Surgery

The main goal for any healthcare delivery system is to improve the value delivered to patients. Particularly, to properly manage value, both outcomes and costs must be measured at the patient level; this requires the engagement of physicians, clinical teams, administrative staff and finance professionals in designing the process maps and estimating the costs involved in treating patients over the care cycle. Moreover, many scholars stated that Activity-Based Costing (ABC) strategies represent valid support in the decision-making process on healthcare management, by fostering corrective actions in the case of an inefficient process or low-quality outcomes. Accordingly, the goal of this work is to demonstrate how mapping processes, using the Time-Driven ABC approach, is a key for the improvement of the value created in health care, both in terms of better outcomes and cost reduction. To achieve this goal, a multi-centre experimental case study has been run on the field of orthopaedic surgery (hip and knee arthroplasty). The case study was designed on empirical observation, data collection and face-to-face interviews within three Italian Hospital Organizations. Findings confirm that mapping the surgery process allows clinical management to understand: (i) the whole clinical pathway (from pre to post patient’s surgical path) and the associated resource consumption; (ii) which clinical activities require more resources and time; and (iii) how phases of the surgery process could be improved in order to obtain best practice outcomes according to the NHS’ necessity to lower costs and increase service quality.