{
  "abstract": "Introduction Surgical systems in Southeast Asia were already experiencing significant supply shortages before the COVID-19 pandemic, which further exacerbated these deficits. With the aim of identifying modifiable factors for improvement, our study benchmarks surgical system efficiencies of eight Southeast Asian Hospital and Health Systems’ (HHS) in combating COVID-19, with an analysis spanning three levels: country, city and HHS.Methods Based on 18-month data (January 2020 to June 2021), we developed a two-stage frontier benchmarking approach that applies efficiency benchmarking techniques to evaluate how close organisations operate relative to an efficiency frontier (representing the maximum potential output achievable with a given set of inputs). Stage 1 involves data envelopment analysis, which yields monthly national efficiency scores for five countries based on country-level panel data. Stage 2 involves stochastic frontier analysis, followed by evaluating HHS-level efficiency with HHS-level data over 64 possible model configurations, adjusting for stage 1 national-level efficiency scores as well as city-level responses.Results Among the 64 possible stage 2 model configurations, two model clusters comprising 36 plausible models demonstrated superior fit to the observed data, thereby providing robust insights through majority voting. Policy measures related to access control and workplace closure were positively associated with recovery rates. Elective surgery volumes showed a negative association and emergency surgery volumes a positive association with efficiency. Our analysis indicates lags of 0–1 month between input changes and effects on the surgical system.Conclusions Insights from the benchmarking of HHS efficiencies will help inform surgical system policy and responses. Access control and workplace closure policies are associated with COVID-19 recovery rates. Emergency surgery volumes are associated with higher efficiency and elective surgery volumes with lower efficiency. System responses to policy measures can manifest with lags of up to a month. Considering insights from multiple plausible models makes these conclusions more robust.",
  "authors": [
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore",
        "Duke-NUS Medical School, Singapore",
        "Singapore Management University, Singapore"
      ],
      "name": "Sean Shao Wei Lam"
    },
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore",
        "Duke-NUS Medical School, Singapore"
      ],
      "name": "Ashish Kumar"
    },
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore"
      ],
      "name": "Yao Ge"
    },
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore",
        "Duke-NUS Medical School, Singapore"
      ],
      "name": "Sze Ling Chan"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Ahmad Reza Pourghaderi"
    },
    {
      "affiliations": [
        "Duke-NUS Medical School, Singapore",
        "Department of Anaesthesiology, Singapore General Hospital, Singapore"
      ],
      "name": "Ma Wai Wai Zaw"
    },
    {
      "affiliations": [
        "Fatima Jinnah Medical University, Lahore, Pakistan"
      ],
      "name": "Aamer Zaman Khan"
    },
    {
      "affiliations": [
        "Surgery, University of Malaya, Federal Territory of Kuala Lumpur, Malaysia",
        "University Malaya Medical Center, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "April Camilla Camilla Roslani"
    },
    {
      "affiliations": [
        "University Malaya Medical Center, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Chunying Selvakumaran"
    },
    {
      "affiliations": [
        "Universiti Kebangsaan Malaysia, Bangi, Malaysia"
      ],
      "name": "Razman Jarmin"
    },
    {
      "affiliations": [
        "Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Diep Ho Ngoc"
    },
    {
      "affiliations": [
        "Adam Malik Hospital, Medan, Indonesia"
      ],
      "name": "Dina Kumala Sari"
    },
    {
      "affiliations": [
        "Department of Research and Analytics, GNRC Hospitals Ltd, Guwahati, Assam, India"
      ],
      "name": "Dipika Dey"
    },
    {
      "affiliations": [
        "Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Dung Nguyen Thi-Ngoc"
    },
    {
      "affiliations": [
        "Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Duy Tan Dao"
    },
    {
      "affiliations": [
        "Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Duy Nguyen Vu Minh"
    },
    {
      "affiliations": [
        "Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Bangi, Malaysia"
      ],
      "name": "Farhana Raduan"
    },
    {
      "affiliations": [
        "Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Giang Vu Son"
    },
    {
      "affiliations": [
        "Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Hoang Le"
    },
    {
      "affiliations": [
        "Adam Malik Hospital, Medan, Indonesia"
      ],
      "name": "Inke Nadia Diniyanti Lubis"
    },
    {
      "affiliations": [
        "General Surgery, Fatima Jinnah Medical University, Lahore, Pakistan",
        "Health Professions Education, College of Physicians and Surgeons Pakistan, Karachi, Pakistan"
      ],
      "name": "Kamran Khalid"
    },
    {
      "affiliations": [
        "Universiti Kebangsaan Malaysia, Bangi, Malaysia"
      ],
      "name": "Khamsiah Nawawi"
    },
    {
      "affiliations": [
        "University Malaya Medical Center, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Koong Jun Kit"
    },
    {
      "affiliations": [
        "Regional Institute of Medical Sciences, Imphal, Manipur, India"
      ],
      "name": "Laisham Trinity Meetei"
    },
    {
      "affiliations": [
        "Department of General Surgery, Fatima Jinnah Medical University, Lahore, Pakistan"
      ],
      "name": "Mariam Fatima"
    },
    {
      "affiliations": [
        "Department of Obstetrics & Gynecology, Adam Malik Hospital, Medan, Indonesia"
      ],
      "name": "Muhammad Fahdy"
    },
    {
      "affiliations": [
        "Department of Pharmacology and Therapeutics, University Sumatera Utara Faculty of Medicine, Medan, Indonesia"
      ],
      "name": "Muhammad Ichwan"
    },
    {
      "affiliations": [
        "Department of Plastic Surgery, Regional Institute of Medical Sciences, Imphal, India"
      ],
      "name": "Nehar Sinam"
    },
    {
      "affiliations": [
        "Department of Plastic Surgery, Regional Institute of Medical Sciences, Imphal, India"
      ],
      "name": "Sanjib Singh Nepram"
    },
    {
      "affiliations": [
        "Universitas Lambung Mangkurat, Banjarmasin, Indonesia",
        "Ulin General Hospital, Banjarmasin, Indonesia"
      ],
      "name": "Nia Kania"
    },
    {
      "affiliations": [
        "Department of General Surgery, GNRC Hospitals Ltd, Guwahati, Assam, India"
      ],
      "name": "Nipanka Goswami"
    },
    {
      "affiliations": [
        "Department of Neurology, GNRC Hospitals Ltd, Guwahati, Assam, India"
      ],
      "name": "Nomal Chandra Borah"
    },
    {
      "affiliations": [
        "Universitas Lambung Mangkurat, Banjarmasin, Indonesia",
        "Ulin General Hospital, Banjarmasin, Indonesia"
      ],
      "name": "Pandji Winata Nurikhwan"
    },
    {
      "affiliations": [
        "University of Malaya, Tuebingen, Germany"
      ],
      "name": "Mei Yen Phang"
    },
    {
      "affiliations": [
        "Department of Research and Analytics, GNRC Hospitals Ltd, Guwahati, Assam, India"
      ],
      "name": "Purabi Sarkar"
    },
    {
      "affiliations": [
        "Intensive Care Department, Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Duc Thanh Bui"
    },
    {
      "affiliations": [
        "Department of Military Science, Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Thanh Do Pham Nguyet"
    },
    {
      "affiliations": [
        "Department of General Planning, Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Van Thanh Nguyen"
    },
    {
      "affiliations": [
        "Intensive Care Department, Military Hospital 175, Ho Chi Minh City, Vietnam"
      ],
      "name": "Quoc Viet Tran"
    },
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore"
      ],
      "name": "Zhenzhi Chen"
    },
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore",
        "Duke-NUS Medical School, Singapore"
      ],
      "name": "Vijaya Rao"
    },
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore",
        "Duke-NUS Medical School, Singapore",
        "Singapore General Hospital, Singapore",
        "National Cancer Centre Singapore, Singapore"
      ],
      "name": "Pierce K H Chow"
    },
    {
      "affiliations": [
        "Singapore Health Services Pte Ltd, Singapore",
        "Duke-NUS Medical School, Singapore",
        "Singapore General Hospital, Singapore",
        "National Cancer Centre Singapore, Singapore"
      ],
      "name": "Hiang Khoon Tan"
    }
  ],
  "title": "Comparative efficiency of Asian surgical systems in COVID-19 response: a multi-level longitudinal benchmarking study",
  "uid": "07e974b8-7f72-567a-8f1a-a9f3ed874478"
}