Identifying performance indicators of hospitals operating rooms: A scoping review - Payesh (Health Monitor)
Tue, May 19, 2026
OPEN ACCESS
Volume 25, Issue 3 (May-June 2026)                   Payesh 2026, 25(3): 349-361 | Back to browse issues page

Ethics code: IR.SBMU.REC.1403.094


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Gandomkaran M, Shams L, Yyavari M, Dehnavi H. Identifying performance indicators of hospitals operating rooms: A scoping review. Payesh 2026; 25 (3) :349-361
URL: http://payeshjournal.ir/article-1-2773-en.html
1- Department of Health Policy and Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Department of Hand Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract:   (60 Views)
Objective (s): Operating rooms are vital components of hospitals where their performance directly impacts patient health, staff efficiency, and the optimization of hospital resources. Given the importance of operating rooms and the lack of comprehensive studies in this field, this scoping review identifies and classifies key performance indicators (KPIs) for operating rooms.
Methods: Following Arksey and O’Malley Framework, a scoping review (2011–2023) was conducted across PubMed, Web of Science, EMBASE, and major Persian databases (SID, MagIran, IranDoc, IranMedex). Eligible Persian- and English-language studies reporting operating room performance indicators were screened and thematically analyzed. Following an initial screening of titles and abstracts, the selected studies were assessed for full-text eligibility. Data regulating operating room performance evaluation indicators were extracted, and a thematic analysis was performed.
Results: Among 837 records, 56 full texts were assessed after removing duplicates and irrelevant records, and finally 23 studies meeting the inclusion criteria were selected predominantly from the United States and Iran. Extracted KPIs clustered into five domains: operational support, intraoperative processes, continuous education, staff satisfaction, patient satisfaction, and financial and economic factors.
Conclusion: The findings of this study demonstrate that identifying and standardizing OR performance evaluation indicators can play a fundamental role in improving the efficiency and quality of services in this department. Developing an integrated method for calculating these indicators could contribute to the development of a standardized OR performance evaluation system and serve as a basis for management decision-making in hospitals
 
Full-Text [PDF 1166 kb]   (28 Downloads)    
type of study: Systematic Reviw | Subject: Helath Services Management
Received: 2025/01/6 | Accepted: 2025/11/23 | ePublished ahead of print: 2026/05/6 | Published: 2026/05/6

References
1. World Health Organization. Hospitals [Internet]. Geneva: World Health Organization; 2019 [cited 2025 April 18]. Available from: https://www.who.int/health-topics/hospitals#tab=tab_1
2. World Health Organization. District hospitals: guidelines for development. 2nd Edition. Geneva: World Health Organization; 1996
3. Harders M, Malangoni MA, Weight S, Sidhu T. Improving operating room efficiency through process redesign. Surgery 2006;140:509-16 [DOI:10.1016/j.surg.2006.06.018]
4. El Chaar M, Michaud A, Stoltzfus J, Alvarado LA. Improving operating room efficiency of robotic-assisted metabolic and bariatric surgery through standardization. Obesity Surgery 2023;33:3411-21 [DOI:10.1007/s11695-023-06850-6]
5. Baltera RM. How to Run a Cost-Effective Operating Room: Opportunities for Efficiency and Cost-Savings. Hand Clinics 2024;40:495-513 [DOI:10.1016/j.hcl.2024.06.007]
6. Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. Journal of the American Medical Association Surgery 2018;153:e176233 [DOI:10.1001/jamasurg.2017.6233]
7. Ting NT, Moric MM, Della Valle CJ, Levine BR. Use of knotless suture for closure of total hip and knee arthroplasties: a prospective, randomized clinical trial. The Journal of Arthroplasty 2012; 27: 1783-8 [DOI:10.1016/j.arth.2012.05.022]
8. Brown JK, Campbell BT, Drongowski RA, Alderman AK, Geiger JD, Teitelbaum DH, et al. A prospective, randomized comparison of skin adhesive and subcuticular suture for closure of pediatric hernia incisions: cost and cosmetic considerations. Journal of Pediatric Surgery 2009; 44: 1418-22 [DOI:10.1016/j.jpedsurg.2009.02.051]
9. Michelin L, Ricci B, Barbagallo V, Perger P, Padovani E, Giardina F, et al. Can Operating Room Efficiency be Increased by Applying the Lean Six Sigma Models? Archives of Clinical and Medical Case Reports 2021; 5: 549-58 [DOI:10.26502/acmcr.96550391]
10. Cunningham AJ. Improving operating room productivity and efficiency-are there any simple strategies? Romanian Journal of Anaesthesia and Intensive Care 2017; 24: 87-8 [DOI:10.21454/rjaic.7518.242.cnn]
11. Bach A. Anforderungen an das System OP-Organisatorische Voraussetzungen/Kosten. Zentralbl Chir 2001; 126: 336
12. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine .Washington (DC): National Academy Press; 2000
13. Donabedian A. The quality of care. How can it be assessed? Journal of the American Medical Association Surgery 1988;260:1743-8 [DOI:10.1001/jama.1988.03410120089033]
14. Phieffer L, Hefner JL, Rahmanian A, Swartz J, Ellison CE, Harter R, et al. Improving operating room efficiency: first case on-time start project. The Journal for Healthcare Quality (JHQ) 2017;39:e70-8 [DOI:10.1097/JHQ.0000000000000018]
15. Pasquer A, Ducarroz S, Lifante JC, Skinner S, Poncet G, Duclos A. Operating room organization and surgical performance: a systematic review. Patient Safety in Surgery 2024;18:5 [DOI:10.1186/s13037-023-00388-3]
16. Rothstein DH, Raval MV. Operating room efficiency. Seminars in Pediatric Surgery 2018;27:79-85 [DOI:10.1053/j.sempedsurg.2018.02.004]
17. Schouten AM, Flipse SM, Van Nieuwenhuizen KE, Jansen FW, Van Der Eijk AC, Van Den Dobbelsteen JJ. Operating room performance optimization metrics: a systematic review. Journal of Medical Systems 2023;47:19 [DOI:10.1007/s10916-023-01912-9]
18. Arksey H, O'malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 2005;8:19-32 [DOI:10.1080/1364557032000119616]
19. Takkouche B, Norman G. PRISMA statement. Epidemiology 2011;22:128 [DOI:10.1097/EDE.0b013e3181fe7999]
20. Ryan D, Rocks M, Noh K, Hacquebord H, Hacquebord J. Specific factors affecting operating room efficiency: an analysis of case time estimates. The Journal of Hand Surgery 2024;49:492.e1-9 [DOI:10.1016/j.jhsa.2022.08.025]
21. Ezzat A. Improving planning efficiency in operation theatre by using Lean Thinking 2014;4:513-9
22. Abbou B, Tal O, Frenkel G, Rubin R, Rappoport N. Optimizing operation room utilization-a prediction model. Big Data and Cognitive Computing 2022;6:76 [DOI:10.3390/bdcc6030076]
23. Leonard H. Operating room efficiency: time is money [Master's thesis]. Boiling Springs (NC): Gardner-Webb University; 2023. Available from: https://digitalcommons.gardner-webb.edu/nursing-msn/44
24. Jintarax A. Analysis of factors affecting the productivity of operating room nurses during office hours at Suranaree University of Technology Hospital. Journal of the Thai Medical Informatics Association 2021;7:47-54
25. Kravitz M. Comparative analysis of the leading methods for optimizing operating room efficiency and cost effectiveness [PhD thesis]. Pittsburgh (PA): University of Pittsburgh 2022
26. Ghasemi S, Aghsami A, Rabbani M. Data envelopment analysis for estimate efficiency and ranking operating rooms: a case study. International Journal of Research in Industrial Engineering 2021;10:67-86[Persian]
27. Mitteregger M, Köhler G, Szyszkowitz A, Uranitsch S, Stiegler M, Aigner F, et al. Increasing operating room efficiency with shop floor management: an empirical, code-based, retrospective analysis. Journal of Medical Systems 2020;44:168 [DOI:10.1007/s10916-020-01640-4]
28. Sonmez V, Pintelon L. A survey on performance management of operating rooms and a new KPI proposal. Quality and Reliability Engineering International 2020;36:2595-609 [DOI:10.1002/qre.2739]
29. Moons K, Waeyenbergh G, Pintelon L, Timmermans P, De Ridder D. Performance indicator selection for operating room supply chains: An application of ANP. Operations Research for Health Care 2019;23:100229 [DOI:10.1016/j.orhc.2019.100229]
30. Souza TA, Roehe Vaccaro GL, Lima RM. Operating room effectiveness: a lean health-care performance indicator. International Journal of Lean Six Sigma 2020;11:973-88 [DOI:10.1108/IJLSS-12-2017-0141]
31. Neriz L, Ramis F, Bull MT, Concha P, Silva D, Bustamante H. Measuring key performance indicators for operating room management [Internet] 2020 [cited 2025 May 18]. Available from: https://www.academia.edu/80823917/Measuring_Key_Performance_Indicators_for_Operating_Room_Management [DOI:10.6036/9759]
32. Madni TD, Imran JB, Clark AT, Arnoldo BA, Phelan HA, Wolf SE. Analysis of operating room efficiency in a burn center. Journal of Burn Care & Research 2017;39:89-93 [DOI:10.1097/BCR.0000000000000572]
33. Ezzat A, Hamoud HS. How to assess the productivity of operating rooms. Int J Health Sci Res 2014;4:261-7
34. Oh HC, Phua TB, Tong SC, Lim JFY. Assessing the performance of operating rooms: What to measure and why? Proceedings of Singapore Healthcare 2011;20:105-9 [DOI:10.1177/201010581102000206]
35. Mousavi SR, Sepehri MM, Najafi E. An agent-based model of patient flow to improve operating room efficiency. Journal of Decisions and Operations Research 2023;8:478-91 [Persian]
36. Eskandari H, Bahrami M. Multi-Objective Operating Room Scheduling Using Simulation-based Optimization. Journal of Advances in Industrial Engineering 2017;51:1-13 [Persian]
37. Ebrahimi P, Bayat S, Abutorabi A. Efficiency Assessment of Operating Rooms of Teaching Hospitals of Shiraz University of Medical Sciences, Using Data Envelopment Analysis: 2012-2014. Journal of Health Administration 2018;21:55-63 [Persian]
38. Vafaee-najar A, Ebrahimipour H, Houshmand E, Zomorrodi-niat H. Identification and Prioritization of Hospital Performance Evaluation Indices by Combination of Balanced Scorecard and Delphi (Montaserieh Hospital). Navid No Journal 2018;21:1-11 [Persian]
39. Ebrahimipour H, Hosseini SE, Mahmoudian P, Vafaee Najar A, Zomorodi Niat H, Emamian H, et al. Evaluating the performance of family physician in rural health centers, Bardaskan, 2013. Journal of Student Research Committee (BEYHAGH) 2015;20:26-34 [Persian]
40. Tabibi SJ, Delgoshaei B, Nikfard M. The effect of scheduling on operating room utilization at an affiliated hospital of Shahid Sadoughi University of Medical Sciences in Yazd. Journal of Toloo-e-Behdasht 2019;18:81-95 [Persian] [DOI:10.18502/tbj.v18i2.1266]
41. Husseinzadeh Kashan A, Rahmani A, Ostadi B. Revenue Management Under Variable Resource Capacity Requirements and Importance Factor for Patient Classes in Hospitals. Journal of Modeling in Engineering 2018;16:257-65 [Persian]
42. Dexter F, Epstein RH, Marcon E, de Matta R. Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms. Journal of PeriAnesthesia Nursing 2005;20:92-102 [DOI:10.1016/j.jopan.2005.01.001]
43. Fong AJ, Smith M, Langerman A. Efficiency improvement in the operating room. Journal of Surgical Research 2016;204:371-83 [DOI:10.1016/j.jss.2016.04.054]
44. Parmar D, Woodman M, Pandit JJ. A graphical assessment of emergency surgical list efficiency to determine operating theatre capacity needs. British Journal of Anaesthesia 2022;128:574-83 [DOI:10.1016/j.bja.2021.10.033]
45. Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, Aldecoa C, Abad-Motos A, Logroño-Egea M, et al. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study. Journal of the American Medical Association Surgery 2019;154:725-36 [DOI:10.1001/jamasurg.2019.0995]
46. Howie EE, Ambler O, Gunn EG, Dias RD, Wigmore SJ, Skipworth RJ, et al. Surgical sabermetrics: a scoping review of technology-enhanced assessment of nontechnical skills in the operating room. Annals of Surgery 2024;279; 973-84 [DOI:10.1097/SLA.0000000000006211]
47. Herrera CA, Rada G, Kuhn-Barrientos L, Barrios X. Does ownership matter? An overview of systematic reviews of the performance of private for-profit, private not-for-profit and public healthcare providers. Plos one 2014;9:e93456 [DOI:10.1371/journal.pone.0093456]
48. Wright JG, Menaker RJ. Waiting for children's surgery in Canada: the Canadian Paediatric Surgical Wait Times project. Canadian Medical Association Journal 2011;183:E559-64 [DOI:10.1503/cmaj.101530]
49. Boet S, Burns JK, Brehaut J, Britton M, Grantcharov T, Grimshaw J, et al. Analyzing interprofessional teamwork in the operating room: An exploratory observational study using conventional and alternative approaches. Journal of Interprofessional Care 2023;37:715-24 [DOI:10.1080/13561820.2023.2171373]
50. Vedula SS, Ishii M, Hager GD. Objective assessment of surgical technical skill and competency in the operating room. Annual Review of Biomedical Engineering 2017;19:301-25 [DOI:10.1146/annurev-bioeng-071516-044435]
51. Marwan Y, Luo L, Toobaie A, Benaroch T, Snell L. Operating room educational environment in Canada: perceptions of surgical residents. Journal of Surgical Education 2021;78:60-8 [DOI:10.1016/j.jsurg.2020.07.010]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and Permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 All Rights Reserved | Payesh (Health Monitor)

Designed & Developed by : Yektaweb