BackgroundThe Operating Room (OR) is a key resource of all major hospitals, but it also accounts for up 40 % of resource costs. Improving cost effectiveness, while maintaining a quality of care, is a universal objective. These goals imply an optimization of planning and a scheduling of the activities involved. This is highly challenging due to the inherent variable and unpredictable nature of surgery.MethodsA Business Process Modeling Notation (BPMN 2.0) was used for the representation of the “OR Process” (being defined as the sequence of all of the elementary steps between “patient ready for surgery” to “patient operated upon”) as a general pathway (“path”). The path was then both further standardized as much as possible and, at the same time, keeping all of the key-elements that would allow one to address or define the other steps of planning, and the inherent and wide variability in terms of patient specificity. The path was used to schedule OR activity, room-by-room, and day-by-day, feeding the process from a “waiting list database” and using a mathematical optimization model with the objective of ending up in an optimized planning.ResultsThe OR process was defined with special attention paid to flows, timing and resource involvement. Standardization involved a dynamics operation and defined an expected operating time for each operation. The optimization model has been implemented and tested on real clinical data. The comparison of the results reported with the real data, shows that by using the optimization model, allows for the scheduling of about 30 % more patients than in actual practice, as well as to better exploit the OR efficiency, increasing the average operating room utilization rate up to 20 %.ConclusionsThe optimization of OR activity planning is essential in order to manage the hospital’s waiting list. Optimal planning is facilitated by defining the operation as a standard pathway where all variables are taken into account. By allowing a precise scheduling, it feeds the process of planning and, further up-stream, the management of a waiting list in an interactive and bi-directional dynamic process.

This article outlines the results of a three-month-long community letter-writing and letter-sharing project called “Viral Epistolary” (VE), which we completed online in Italy during the first wave of COVID-19 lockdowns. In it, we collected 340 digital letters from all over the country and connected thousands of people through epistolary exchanges. We used the genre of letters as a mediating, meaning-making, and (auto)biographical tool whereby people could share their experiences of domestic isolation and physical distancing, thus creating a community of support. Based on a well-documented understanding of meaning-making as a core human endeavor, especially in times of social disruption and personal crisis, this article frames sense-making as a transcendental and even spiritual process that yields broad principles for organizing life. Thus, the research adopts a psychosocial perspective on spirituality and applies thematic analysis to qualitatively analyze written narratives. The results reveal that many respondents underwent a three-part, not-necessarily-sequential process of collapsing, self-distancing, and transcending during lockdown, which allowed them to rearrange themselves according to the new total social fact of the pandemic. Through this process, respondents negotiated themes of semiotic crisis, striving for meaning, and beyond meaning (the essential). Finally, the article discusses the role of meaning as a transcendental component of psychosocial meaning-making coping processes and tries to highlight how shared writing experiences can stimulate personal and communal healing processes in the wake of social crises.

Background: Ostracism is a negative experience that has been studied primarily in laboratory settings. This study extends current research by investigating ostracism in daily life, analyzing the transition from social death to social resurrection of Catholic partners who suffered ostracism both in the couple (with the consequent divorce) and in the religious community they belong to (ban from religious practices). Therefore, we introduce the notion of ‘cumulative ostracism’. Method: Data are composed of the biographical narratives of n = 25 participants in a religious experience group in a period of 7 months. A narrative analysis was used within the framework of the temporal need–threat model. Results: Participants’ narratives are consistent with the temporal need–threat model. The ostracism experience, both in the couple and in the religious group, is characterized by the sequence: immediate stage, coping stage and resignation stage. Moreover, the cumulative ostracism suffered by the participants presents an analogy with the cumulative trauma that occurs in intra-family abuse. Social resurrection occurs through the encounter with a new religious group that allows ostracized people to experience a Catholic religious affiliation again. Conclusions: Our findings reflect the existing theory and add to the existing laboratory research by capturing ostracism-unique dynamics in real life.