Evaluation of the performance of training and research hospitals and the effect of quality on performance

Teaching and research hospitals are strategic institutions for healthcare systems, as they not only provide quality healthcare services but also contribute to the education of healthcare professionals and lead scientific research in the field. Therefore, it is necessary to evaluate the performance and quality of teaching and research hospitals, plan and implement improvement activities based on the obtained results. The aim of this study is to evaluate the performance of teaching and research hospitals in Turkey, to determine the effect of quality on performance and to reveal the views of hospital managers on improving performance. The research was carried out on 59 A1 group general teaching and research hospitals in Turkey whose data can be accessed. In the first stage, data envelopment analysis method was used to evaluate the performance of the hospitals. Using input-oriented CCR and BCC models, the efficiency values of all hospitals between 2016-2020 were determined and the improvements that inefficient hospitals need to make in order to reach the efficiency frontier were calculated. Then, super efficiency analysis was used to rank the efficient hospitals among themselves, and Malmquist analysis was used to analyse the change between years. In the second stage, panel data analysis was used to determine the effect of quality on performance in teaching and research hospitals. As quality indicators, hospitals' SKS scores and patient satisfaction scores were used, while as performance indicators, four different models were created using the CCR efficiency scores, BCC efficiency scores, super-efficiency scores, and efficiency scorecards obtained from the Ministry of Health. In the last stage, interviews with hospital managers were conducted and analyzed in order to identify the hidden points as a result of quantitative analyses and to develop more concrete suggestions on performance and quality improvements in teaching and research hospitals. According to DEA results, it was determined that the number of inefficient hospitals is high and there is a need for performance improvement activities. It was determined that there were no major changes in the performance of teaching and research hospitals over the years, but there was a 21% decrease in 2020 due to the impact of the Covid-19 pandemic. As a result of the panel data analysis in which the effect of quality on performance is analysed, it is determined that hospitals' SKS scores and patient satisfaction scores have no effect on CCR efficiency scores, BCC efficiency scores and super efficiency scores. Only patient satisfaction scores have a weak negative effect on the efficiency scorecard scores of hospitals. As a result of the qualitative research, it was determined that the managers found performance and quality evaluations in teaching and research hospitals generally useful and necessary, while it was stated that various changes could be made in the evaluations carried out by the Ministry of Health. Suggestions were given for improving teaching and research performance, employee performance, financial performance and operational performance in hospitals. The results obtained can be used in the planning of performance and quality studies in teaching and research hospitals and in the formulation of national health policies.