Abstract

Objective: Seeing that measures put into place up to now to achieve reduction in running costs of hospital departments have failed, we considered a new approach which is applying industrial human resource management tools to physicians to see whether this would provoke some kind of action. Methods: We performed psychological tests to evaluate the anxiety level and the professional commitment of eight senior physicians in a 32-bed intensive care department. On this basis, a project leader was chosen to apply a standard educational program and a policy of reduction in blood test ordering to see whether this would provoke an overall saving in physician-induced costs without affecting clinical outcomes. Simultaneously, we determined over one year the changes in the financial costs of blood tests, radiology investigations and drug therapy. Results: Within seven months, we achieved a 22.3% reduction in blood test prescriptions, a 13.21% decrease in drug prescription, a 42% reduction in anti-infection drug prescription and a 11.85% reduction in radiology investigations, while the same time maintaining constant admission rates with no increase in mortality or unscheduled re-admissions. Our approach of the process of prescription allowed for savings evaluated at over 900 000 Euros per year with no additional costs. Conclusion: In demanding working conditions, applying a simple policy of human resource management which endangers neither patients nor physicians, it is nevertheless necessary to take into account the psychological profile of senior physicians if any substantial and long lasting decrease in total expenditure is to be achieved.

Key-words:

Anxiety, Costs, Critical care, Physicians, Psychological profile, Savings.