Schulich research investigates implications of surgery scheduling in hospitals
New research led by Schulich Professors David Johnston and Adam Diamant, in collaboration with University of Toronto Professor Fayez Quereshy, looks at scheduling in one of the highest risk areas of patient care: surgery. The researchers conducted a qualitative study on the scheduling behaviour of surgeons at a large Canadian teaching hospital. In most Canadian hospitals decisions around scheduling surgeries are in the hands of surgeons, however operations management literature favours the standardization or centralization of scheduling to maximize resource use.
Not surprisingly, all surgeons interviewed expressed strong opinions about centralization. Some realized how poorly the system was working. One surgeon said: “How do you get the most value out of an operating room? Well, definitely not leaving it up to every surgeon to figure out how to manage what comes through the fax machine. That’s ludicrous. It’s like we’re 40 or 50 years behind…. Look at industry. No one would run a business like we run our operating rooms.”
Some surgeons said remuneration was an issue and there were no incentives for surgeons to co-ordinate and economize collectively, since they operate on a fee-per-service basis. (Surgeons are independent contractors granted “privileges” in publicly owned hospitals.) Some said their unwillingness to accept centralized scheduling was a reaction to the hospitals’ managerial deficiencies.
Professor Johnston states, “I hope these findings will trigger discussion of operational improvement in hospitals and the overall performance of the healthcare system.” He is convinced that appropriate metrics on the performance of surgery, accompanied by strong organizational support for sharing best practices, could facilitate the path to efficiencies for hospital administrators with no trade-offs for the quality of care.
The research was funded by the Schulich School of Business Research Fellowship and published in the Journal of Operations Management (2019).