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HCAF has published a series of papers detailing why the Reference Cost Index is a poor measure of hospital efficiency (see 'Measures of Hospital Efficiency' below). Refer to the HRG folder for additional detail regarding the limitations of the HRG tariff.




   Hospital Efficiency





Care Pathways


Mortality from # NOF


Measures of Hospital Efficiency


Process Control Charts


Efficiency & Costs of Maternity Services


Cost of a day stay in hospital



Hospital Efficiency Series


British Journal of Healthcare Management (BJHCM)


Jones R (2009) Length of stay efficiency. BJHCM 15(11):

563-564. Read Me

Jones R (2009) Crafting efficient bed pools. BJHCM 15(12): 614-616. Read

Jones R (2010) Benchmarking length of stay. BJHCM 16(5): 248-250 Read

Jones R (2010) Health care costs and the HRG tariff. BJHCM 16(9):

451-452 Read

Jones R (2010) Emergency assessment tariff: lessons learned. BJHCM 16(12): 574-583 Read

Jones R (2010) Impact of the A&E targets in England. BJHCM 17(1):

16-22  Read

Jones R (2010) Costs of paediatric assessment. BJHCM 17(2):

57-63 Read

Jones R (2013) A guide to maternity costs and why smaller units have higher costs. British Journal of Midwifery 21(1): 54-59. Read

Jones  R (2013) Average length of stay in hospitals in the USA. BJHCM  19(4) 16-191.  Read




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Healthcare Analysis & Forecasting

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The expression of hospital efficiency is multi-factorial. Often the benchmarks for assessing efficiency are flawed. This page gives a few examples of how efficiency measures can have hidden flaws and gives alternate ways to measure efficiency or process blockages.


In particular, the behaviour of the average length of stay over time is poorly understood throughout the health service. HCAF can offer the benefit of the most up to date national and international research in this important area.


Refer to the 'Hospital Beds' folder for details regarding efficient bed management and allocation and to the 'Capacity Management' folder for ways to allocate resources to match arriving demand. The 'HRG/PbR/PBC' folder contains additional material regarding the limitations of the HRG tariff.


The published version of all BJHCM articles can be obtained from Those working in the NHS can use their Athens login.