Why do surgeons schedule their own surgeries?

Abstract

Surgery is a knowledge intensive, high‐risk professional service. Most hospitals give surgeons considerable autonomy in deciding which patients to operate on and when. In theory, this allows surgeons the operational flexibility to prioritize surgeries based on intimate knowledge of their patient's clinical needs. At odds with this strategy is the operations management literature, which favors the standardization and centralization of scheduling focused on achieving the efficient use of all resources, such as operating room capacity. Unfortunately, a little is known as to how surgeons customize their schedules and why they value such control. To this end, we conduct an exploratory qualitative study of the scheduling behavior of surgeons at a large Canadian teaching hospital. We identify significant differences between surgeons as to their priorities when scheduling. Two constructs are formative in surgeon decision‐making: the timeliness of treatment for their patients and idiosyncratic personal priorities. Our work has implications for achieving surgeon support for initiatives to standardize and centralize routines for patient scheduling. Accordingly, we formulate propositions that address the conditions under which such efforts will achieve the desired balance between flexibility and efficiency.

Integral Capacity Management & Planning in Hospitals

“…Workforce management, therefore, has great impact on the strategic course and is an important condition for ICM. Increased integration requires more centrally organized control and alignment and often means a decrease in decentralized autonomy [89,122,156]. This decreasing autonomy may raise resistance as the span of control of clinicians and nurses will be reduced [122,156].…”

“…Furthermore, staff (e.g. clinicians and nurses) are highly educated and trained and therefore have high degrees of autonomy to design processes and their own schedule [122,156]. From a CM view, this highly educated staff is a result of labor division, specialization and standardization to improve productivity [73,183].…”

“…This top-down, decentralized decision process (e.g. siloed management structure) often results in myopic optimization of resource utilization, poor alignment of interdependent resources that are adjacent in care pathways and large fluctuations in upstream and downstream departments [122]. In our opinion, this is one of the main problems of CM one we elaborate on in Section 2.3.2.…”

“…Since the nineties, it has been stated that the future challenges for CM will be to integrally manage and plan capacity (i.e. the next step of CM is ICM) [46,216] to optimize flow, thereby ensuring equitable access and optimal waiting times for all patients [122]. Organizational integration is defined as the extent to which distinct and interdependent units, departments and management levels, including business processes, people, and technology involved, share a unified purpose [18].…”

“…However, most CM decision-making processes in hospitals are focused on top-down deployment, while bottom-up feedback loops are often lacking. This may be explained by the strongly decentralized autonomy of departments and healthcare professionals [122]. As a result, problems are often not escalated to higher hierarchical levels and therefore are not solved structurally.…”