Configurations associated with the efficiency of the ophthalmology departments in public hospitals of Central South China

Background: Improving the efficiency of ophthalmology service is a global challenge to fight vision impairment, yet there is little concrete evidence of the current efficiency status. This study aimed to examine the efficiency of ophthalmology departments in the Hunan Province, China, and determine the associating factors of low-efficiency and high-efficiency ophthalmology departments. Methods: This cross-sectional study included a province-level survey of ophthalmology departments of public hospitals. All the ophthalmology departments of public hospitals in Hunan Province were invited to complete an online survey on ophthalmic competence resources. Bootstrap Data Envelopment Analysis was conducted to describe the service efficiency status of the ophthalmology departments using Maxdea (version 8.0) software. Then, we employed Fuzzy Set-Qualitative Comparative Analysis to explore the recipes of low-efficiency and high-efficiency ophthalmology departments using Fs-QCA (version 3.0) software. Results: One hundred and ninety-five ophthalmology departments (87 in tertiary and 108 in secondary public hospitals) completed the survey. The mean efficiency score was 0.78 for ophthalmology departments in tertiary hospitals and 0.82 for secondary hospitals. The number of ophthalmologists and equipment positively contributed to the efficiency of ophthalmology departments in tertiary and secondary hospitals. While increasing the bed capacity was not always beneficial to improving the efficiency of ophthalmology departments in secondary hospitals. For ophthalmology departments in tertiary hospitals, simply increasing the number of nurses did not universally increase efficiency unless there were enough ophthalmologists and equipment to support the nurses’ work. This study also revealed 2 configurations for ophthalmology departments in secondary hospitals and 5 configurations for those in tertiary hospitals that could guide their efficiency improvement efforts. Conclusions: Moderate efficiency levels in ophthalmology departments at both tertiary and secondary hospitals were found. Prioritizing the number of ophthalmologists and equipment was recommended to achieve high efficiency for ophthalmology departments in tertiary and secondary hospitals. We also proposed that blindly increasing the number of beds and nurses was meaningless, and ophthalmology departments should flex the bed capacity and number of nurses after premising having high numbers of ophthalmologists and equipment.