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The authors present a methodology that measures improvement in customer satisfaction scores when those scores are already high and the production process is slow and thus does not generate a large amount of useful data in any given time period. The authors used these techniques with data from a midsized rehabilitation institute affiliated with a regional, nonprofit medical center. Thus, this article functions as a case study, the findings of which may be applicable to a large number of other healthcare providers that share both the mission and challenges faced by this facility. The methodology focused on 2 factors: use of the unique characteristics of panel data to overcome the paucity of observations and a dynamic benchmarking approach to track process variability over time. By focusing on these factors, the authors identify some additional areas for process improvement despite the institute's past operational success.

Obesity is the result of complex social, behavioral, cultural, environmental, physiological, and genetic factors. Obesity is the leading modifiable risk factor contributing to early mortality; type 2 diabetes; cardiovascular disease; metabolic syndrome; breast, prostate, and colon cancer; gallbladder disease; sleep apnea; musculoskeletal disorders; and associated limitations in physical activity. Occupational therapy's holistic and unique focus on occupation and daily life activities offers structured intervention and support for the management of obesity across the lifespan regardless of ability. Adapted from the source document.

It is widely recognized that disparities in health status and the availability of health and social services exist in the United States. Experts have asserted that health disparities arise from a complex combination of social and economic factors, the physical environments, cultural beliefs and values, educational level, personal behaviors, and genetic susceptibilities. Occupational therapy is well positioned to intervene with individuals and communities to limit the effects of health disparities on participation in meaningful occupations because of practitioners' knowledge and skills in evaluating and intervening with persons who face physical, social, emotional, or cultural challenges to participation. Adapted from the source document.

Purpose - The purpose of this article is to present a case study that documents how management science techniques (in particular data envelopment analysis) can be applied to performance improvement initiatives in an inpatient physical therapy setting.Design methodology approach - The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery (at a medium-sized medical facility in the Midwestern USA) during the fiscal year 2002. Data envelopment analysis (DEA) was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using non-parametric and parametric methods.Findings - Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension.Research limitations implications - The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling: adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities (or the same disability with other outcome variables, such as Functional Independence Measure scores) may give dissimilar results.Practical implications - This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics.Originality value - DEA has not been applied to rehabilitation, especially in the case where managers have limited data available.

Purpose The purpose of this article is to present a case study that documents how management science techniques in particular data envelopment analysis can be applied to performance improvement initiatives in an inpatient physical therapy setting. Designmethodologyapproach The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery at a mediumsized medical facility in the Midwestern USA during the fiscal year 2002. Data envelopment analysis DEA was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using nonparametric and parametric methods. Findings Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension. Research limitationsimplications The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities or the same disability with other outcome variables, such as Functional Independence Measure scores may give dissimilar results. Practical implications This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics. Originalityvalue DEA has not been applied to rehabilitation, especially in the case where managers have limited data available.