Paper prepint on the hospital logistics social network now available

In the fast and dramatically changing circumstances we are all in at the moment due to the Corona pandemic, the process of creating and publishing process of my second scientific paper seems a bit surreal. In 2018 I did research on the social network of a Dutch hospital’s logistical system, I submitted my paper early 2019 and this was reviewed in the summer of 2019. I revised it and it has gone into a second review last week. The good news is that it is now available in preprint, so anybody can review it.

But this was all in the pre-pandemic age. Naturally, I am wondering how relevant my research is in the context of this pandemic. Since it is about hospital logistics and one of the main challenges nowadays is to match capacity with healthcare demand, I like to believe it is highly relevant. At the same time, like most people without a vital profession, I work mostly from home and am experiencing the crisis mainly through media, on my couch,  working in my study room or teaching my children at the dinner table. And most of the time I am thinking  that it would be a really bad example of the ‘ivory tower’ (although I do not live in a castle) if I started to throw around statements on this topic. So I will stick to some ‘questioning out loud’ on this, using some statements from the paper’s abstract.

“The network appears to function differently from what is assumed in literature with regard to hospitals, as the network does not reflect the formal organizational structure of the hospital and tasks are mainly executed across functional silos.” In the Corona crisis authorities and healthcare organizations need to collaborate and coordinate local, regional and national healthcare. It makes sense to do this via the formal organizational structures and control healthcare logistics through managers. But if people are used to organizing and coordinating themselves, from both medical discipline silos and accross departments, what does central control look like and how is it achieved? And will new control mechanisms that emerge in this crisis, stick around?

“Nurses and physicians perform integrative tasks and there are two agents who mainly coordinate the tasks in the network, without having a hierarchical position towards other agents.” There are few people who are experienced in coordinating a hospital’s logistics as most of the coordination is done as a side job, by nurses and doctors. It’s only a few people’s actual job. And these people have no hierarchical position, no formalized procedures or mandate. They use negotiation, persuasion and social skills to get things done. What is that like now? Is there time for all this discussion and communication? Probably not. So are new leadership styles introduced and will they change the way hospital logistics is organized? In addition to a shift in coordination power, there is a shift towards non-surgical healthcare at the moment. Many surgeons are not in the operating room now, by lack of nurses and beds for their patients. Will the balance shift back the other way as soon as the pandemic is controlled, will there be a new balance, will the traditional boundaries between surgical and non-surgical care fade away as nurses have worked in both areas?

“The Hospital Information System (HIS) does not seem to fulfill the interactional needs of agents.” Data is everywhere these days, in our papers, on TV and on social media. Hospital staff use data from their HIS, and according to them, this is not the most reliable information source. Hospital staff combine information of the HIS with information that results from social interaction in order to get the bigger picture. I am sure on a regional and national level much effort is put into getting overview on the basis of data. I am also pretty sure that this data is not sufficient or reliable at all times, so perhaps in addition new social structures are formed. Will they last and forever change hospital logistics, who knows? I am curious about what the future holds and it is probably too early to tell. If you have anything to add, please read the paper and provide your feedback!

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