TDABC in an outpatient clinic environment
3.1. Research setting and data gathering process
The outpatient clinic we studied, is situated in Belgium,
has her own management and consists of 19 independent
departments (i.e., specialties). For this study we collected
data for five departments: Urology, Gastroenterology, Nose-
Throat and Ears, Plastic Surgery, and Dermatology. These
departments were chosen on the base of multiple criteria.
First, as most of these departments were characterized
by a medium to high number of patient visits and a growing
workload, the clinic’s managers argued that the overall
profitability of a department did not only depend upon
the quality of services, but also whether the gross margin
was enough to cover the cost of serving the patient.
Consequently, improved cost knowledge in these departments
became more important. Second,we chose for these
departments as most of the services they provide, comprise
a non-technical (i.e. standard) and a technical consultation.
Medical consultations are considered to be the key
activities of the outpatient clinic. We define a standard,
non-technical consultation as a formal meeting with a
physician in which the patient receives medical advice
after a medical check-up or disease examination. Next to
a standard consultation, a technical consultation might be
required. Technical consultations contain a special treatment
(for example, a PUVA at Dermatology), a technical
examination (for example, a gastroscopy at Gastroenterology)
or a surgical intervention (for example, Plastic
Surgery). As such, complexity in the service provision arises
from the potential need for a technical consultation. Third,
each of these departments was willing to provide access to
all relevant information.
Based on the differences between non-technical and
technical performances, we created two cost objects for
each department, i.e. the service costs for patients that