UPSC MainsMANAGEMENT-PAPER-II202215 Marks
Q7.

Hospital Waiting Times: Statistical Significance Analysis

A city administration conducted a study of the waiting time in the emergency wings of three hospitals. These hospitals are located in three zones of the city far away from each other. The administration is interested in reducing the waiting time at the emergency wings. To study this, a random sample of 10 emergency wing cases at each hospital was selected on a particular day and the waiting time was measured. The results are recorded in the following table. At 0.05 level of significance, is there evidence of a difference in the average waiting times in the three hospitals?

How to Approach

This question requires a statistical hypothesis testing approach – specifically, an ANOVA (Analysis of Variance) test. The answer should demonstrate understanding of the test's principles, calculations (though detailed calculations aren't expected in a Mains answer, the logic must be clear), and interpretation of results. The structure should include stating the null and alternative hypotheses, explaining the ANOVA logic, outlining the decision rule, and finally, drawing a conclusion based on the given information (or assumed results if actual calculations aren't feasible within the exam setting). Focus on demonstrating conceptual understanding rather than precise numerical computation.

Model Answer

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Introduction

Effective healthcare delivery hinges on efficient resource allocation and minimizing patient wait times, particularly in emergency situations. Long waiting times in emergency wings can lead to adverse patient outcomes and decreased satisfaction. City administrations increasingly utilize statistical analysis to identify areas for improvement in healthcare services. This question presents a scenario where a city administration aims to determine if there's a statistically significant difference in average waiting times across three hospitals' emergency wings, employing a hypothesis testing framework to guide resource allocation and intervention strategies. Understanding and applying statistical methods like ANOVA is crucial for evidence-based public health management.

Understanding the Problem and Hypotheses

The city administration wants to ascertain if the average waiting times in the emergency wings of the three hospitals are equal or if there's a significant difference. To address this, we employ a one-way ANOVA test. This test is appropriate because we are comparing the means of three independent groups (the three hospitals).

Null Hypothesis (H0): The average waiting times are equal across all three hospitals (μ1 = μ2 = μ3).

Alternative Hypothesis (H1): At least one of the average waiting times is different from the others.

The Logic of ANOVA

ANOVA works by partitioning the total variance in the data into different sources of variation. It compares the variance *between* the groups (hospitals in this case) to the variance *within* the groups. If the between-group variance is significantly larger than the within-group variance, it suggests that the group means are different.

ANOVA Calculation (Conceptual Outline)

While a full calculation isn't expected in an exam setting, the core steps are:

  • Calculate the Grand Mean: The average waiting time across all hospitals and all sampled cases.
  • Calculate the Sum of Squares Between Groups (SSB): Measures the variability between the hospital means and the grand mean.
  • Calculate the Sum of Squares Within Groups (SSW): Measures the variability within each hospital's sample.
  • Calculate the Degrees of Freedom: dfbetween = k-1 (where k is the number of groups/hospitals), dfwithin = N-k (where N is the total number of observations).
  • Calculate the Mean Squares: MSB = SSB/dfbetween, MSW = SSW/dfwithin
  • Calculate the F-statistic: F = MSB/MSW

Decision Rule

The F-statistic is compared to a critical F-value obtained from the F-distribution table, using the chosen significance level (α = 0.05) and the degrees of freedom calculated above.

Decision Rule:

  • If F > Fcritical, reject the null hypothesis (H0). This indicates a statistically significant difference in average waiting times.
  • If F ≤ Fcritical, fail to reject the null hypothesis (H0). This indicates insufficient evidence to conclude a difference in average waiting times.

Applying the Decision to the Scenario

Without the actual calculated F-statistic and the corresponding F-critical value, we must assume a hypothetical outcome. Let's assume, for the sake of illustration, that after performing the ANOVA test, the calculated F-statistic is 4.5. With α = 0.05 and degrees of freedom (dfbetween = 2, dfwithin = 27), the F-critical value is approximately 3.35 (this value would be obtained from an F-distribution table).

Since 4.5 > 3.35, we would reject the null hypothesis.

Conclusion

Based on this hypothetical outcome, there is evidence at the 0.05 level of significance to conclude that there is a statistically significant difference in the average waiting times in the emergency wings of the three hospitals. The city administration should investigate the reasons for these differences and implement targeted interventions to reduce waiting times in the hospitals with longer averages. This could involve resource reallocation, process improvements, or staff training.

Conclusion

In conclusion, the application of ANOVA provides a robust statistical framework for evaluating differences in average waiting times across the three hospitals. Rejecting the null hypothesis suggests that the city administration's concern about varying waiting times is justified. Further investigation into the specific causes of these differences is crucial for developing effective strategies to improve emergency care delivery and enhance patient outcomes. A data-driven approach, like this, is essential for optimizing public healthcare resources.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

Additional Resources

Key Definitions

ANOVA (Analysis of Variance)
A statistical test used to compare the means of two or more groups to determine if there is a statistically significant difference between them. It partitions the total variance in the data into different sources of variation.
Significance Level (α)
The probability of rejecting the null hypothesis when it is actually true. Commonly set at 0.05, meaning there is a 5% chance of making a Type I error (false positive).

Key Statistics

According to the National Hospital Ambulatory Medical Care Survey (NHAMCS), the average emergency department wait time in the United States in 2018 was 58 minutes.

Source: Centers for Disease Control and Prevention (CDC), NHAMCS, 2018 (Knowledge Cutoff: 2023)

A study by the American College of Emergency Physicians (ACEP) found that emergency department visits increased by 21% between 2000 and 2018.

Source: American College of Emergency Physicians (ACEP), 2018 (Knowledge Cutoff: 2023)

Examples

Emergency Department Overcrowding in Canada

Canadian emergency departments frequently experience overcrowding, leading to long wait times and adverse patient outcomes. Studies have shown a correlation between ED overcrowding and increased mortality rates for patients with serious conditions.

Frequently Asked Questions

What if the sample sizes at each hospital were different?

ANOVA can handle unequal sample sizes. The calculations for degrees of freedom and mean squares would be adjusted accordingly, but the underlying principles of the test remain the same.

Topics Covered

StatisticsHealthcarePublic AdministrationANOVAHypothesis TestingHealthcare Management