Efficiency improvement example:
improving patient capacity for child ear infections by ENT doctors

Planned Improvement

Reduction of 70% of placement of ear tubes, by intensively involving parents in the decision making process.


The reduction of placement of ear tubes will result in one extra 10 min. outpatient visit and substantially reduced operating theater time (60 min per avoided placement).


The total mix will result in increased patient capacity.

Actual improvement

The number of ear tube operations was reduced by 60%. With the same doctor capacity and operating theatre time shifted to more complex operations, the total patient capacity for treating child ear infections increased by 40%, while lowering cost per unit. This resulted in an increase in revenue for the ENT department of €80k on a total of €1,4m (6%).


An additional outcome improvement was a reduction in the complications which can arise when placing ear tubes.



•Ear tubes are used to treat children who have frequent ear infections, so fluid buildup can be alleviated.

•There is widespread discussion about the actual efficacy of operating as a treatment option in all but the most serious cases, since the operation has complication risks (e.g. scarring, permanent ear drum perforation).

•By adopting a “deciding together” approach where parents are intensively involved in the pros and cons of operating, the hospital needed one extra outpatient visit but substantially reduced operating theatre time. Since the operation procedure is relatively quick and simple it took up valuable operating theatre time, which can be used for more high value complex operations.