The impact of department sub-division on hospital performance.

Background: Chang Gung Memorial Hospital is the first hospital in Taiwan to adopt the 'sub-division management'. The hospital sub-divided extensively growing departments into two or more similar sub-divisions. This study compared the relative performance before and after the implementation of "sub-division management".

Methods: The cardiac department of Chang Gung Memorial Hospital was subdivided into Cardiac I and Cardiac II in July 1992. This study collected the managerial information of cardiac inpatients from 1991 through 1993 in Chang Gung Memorial Hospital. By exploring the effects of the "sub-division management" and other confounding factors, we tried to find out the possible impact they brought to hospital performance.

Results: Considering a time trend effect, the results of regression indicate that 'sub-division' mechanism had little effect on departmental performance. However, the performance is different between Cardiac I and Cardiac II in the aspect of total expenditure per admission, average length of stay, and average number of discharge per physician. These differences might be affected by the characteristics of physicians' sub-specialties rather than the implementation of sub-division management.

Conclusion: The significant decrease in mortality rate of patients in the cardiology department after the implementation might suggest that the quality of care in the cardiology department increased after the introduction of sub-divisions. The long-term effects of practice behavior induced by competition within and between sub-divisions require further organizational and behavioral studies.