Operational Efficiency in Teaching Hospitals

Background: Improving the efficiency of teaching hospitals is a growing concern in health systems worldwide. These institutions face unique challenges due to their dual role in delivering care and training professionals. This review synthesizes recent international evidence on strategies to improve teaching hospital efficiency. Methods: A structured literature search was conducted in the PubMed, EMBASE, and Cochrane Library databases for English-language articles published between 2015 and 2024. Articles were selected based on predefined inclusion and exclusion criteria. Eligible studies were analysed and thematically synthesized. Results: Five studies met the inclusion criteria. The most common analytical method was Data Envelopment Analysis (DEA) (n=3), with one study each using DEA combined with PROMETHEE, DEA with propensity score matching, and stochastic frontier analysis. Key efficiency drivers identified included fixed-price payment systems, hospital closures, centralized bed and waitlist management, outpatient service prioritization, and resource optimization. Teaching hospitals were generally found to be less efficient than non-teaching ones, largely due to greater operational complexity. Conclusion: A variety of strategies and hybrid analytical methods are being used internationally to enhance efficiency in teaching hospitals. Structural reforms and operational innovations, particularly those related to centralized management and financial incentives, appear to be most effective. Partnerships between public and academic hospitals may improve efficiency through better resource sharing. However, findings are limited to a small number of countries. Further research is needed to assess the long-term impacts of these strategies across diverse healthcare contexts.