Peer review from my dad

The fun thing about this blog is that I receive comments from different kind of people. Some people comment that they think my blog too long to be a blog (it turned out all individual blogs all in one long thread came accross as one (yes indeed) very long blog: if you click on the three lines on the top left, you can see blogs per month). I also received some comments from people in the case study hospital on specific results that they were surprised about. And several people working in hospitals say they find the blogs so very recognizable.

Last week my dad responded on the social network blog. First of all he indicated it was hard to understand and he wondered whether he was the actual target group. My primary reason for writing the blog was that people working in the field of hospital (logistics) would be able to read along with me, not having to wait until journal papers would be published (still waiting for the first one to come!). Secondly I don’t think many people in the field (or rather, all people outside the academic world) read journal papers. I find them hard to read myself, although after having read a couple of hundred, it becomes much easier. I wanted to offer something else and bridge the gap between academic stories and practical use of knowledge. At the moment my main focus is to get the academic story right and do a little bit of knowledge transfer through this blog.

My dad is not easily beaten though and he came up with some very good points on the blog itself. He asked what is to see in the middle of the network presented (see blog). In the middle you see a lot of blue names (GENS1, UROS1, AN1 etc.). These are surgeons and one anesthaetist who decide together what the Operating Theatre master schedule will be like. There is also one red person (CM1) and this is the OT manager. He and the OT capacity planner (OTPLAN) have a central role in this, connecting the medical staff, outpatient secretaries (the green agents called ‘SEC…’). Each surgeon acts as a bridge between this group in the middle and their own colleagues in their medical discipline. So for example one Urology surgeon (URO1) discusses the OT master schedule on behalf of the other Urology surgeons. You can see a circle around all Urology surgeons (UROS1 to UROS8) as they interact when preparing their own working schedule based on the OT master schedule. This collective scheduling is typical for hospitals I believe and not controlled in a hierarchic manner. My professor calls the OT master schedule a ‘peace agreement’. That is what it is.

My dad also mentions that it is hard to distinguish the anesthaetists from the surgeons in the network. Indeed, a legend would be useful. In short: AN stands for anesthaetist, all other blue names are surgeons, all SECGEN are secretaries, ORAS are OR assistants. But I must say that the network presented here has changed so much since this blog came out, that it would be better to explain it well once the network is final. Since then I showed all networks to the hospital people for validation, and a lot of other interactions have been added or changed. The discussion of these social networks with my research team has led to major changes in the networks also. There are now 9141 unique interactions in my database, that took place in 2017 between agents. But I am still counting.

In relation to my statement that surgeons and anesthaetists have an integrative role in this planning phase, my dad asks what I mean by this. He asks: “aren’t all stakeholders mutually dependent and responsible for the integration of the planning?” Yes, I think the mutual dependency is very clear. For as far as responsibility goes, there are issues to be explored and discussed. First of all even though there is a lot of collaborative decision making in hospitals, I doubt that all stakeholders always feel responsible for it. Decision making in a hospital (or in any large organization?) can be experienced as ‘vague’ (did we take that decision? when?). Decisions can be invisible or unconsciously taken. Sometimes there is a tendency towards something and looking back it is unclear how this or that happened. This way of doing can be part of a strategy, or it just happens, in my personal experience. Secondly, there could be alternative models for decision making with regard to allocating time and space. A central person, department or even a computer model can make a master schedule, based on forecasts on how many patients are to be expected hospital wide. Or one could not make a master schedule at all, but rather let the schedule emerge as the patient demand becomes clearer. There are several new ways of planning that are currently explored in many Dutch hospitals, under the heading of ‘Integrative Capacity Management’.

This last issue is what the paper I am working on right now is about. It addresses questions like: to what extent is the hospital network integrated, is that good or not, and most importantly what is the necessary integration? I wrote a bit about it earlier, but now I am using the theories mentioned here  to work out the case study. I will come back to that another time.




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