Over the past months I spent 14 days in the hospital for my case study research. I met and talked to more than 50 people, directly or indirectly involved in patient surgery and watched over 20 patients who were at some stage in the process towards having or having had a surgery.
There are a lot of things that struck me. I was surprised by the variety of surgeries they do, given the fact that this what they call themselves: a production hospital. The hospital did 350 different surgeries in 2017 of which only 34% was actually done more than once a month on average. So that means that 66% of the surgeries is once a month or less. In interviews I asked hospital staff how I should interpret this. Is the variety of surgeries really that large and what does this mean for the predictability of these surgeries?
People confirm that the variety of surgeries is large, although if you look at the variety per medical specialism, this is not perceived that way by everyone. The fact that there are 9 medical specialisms in itself illustrates that. When I look at the list of surgeries, the average surgery times and variations, it seems hard to identify similar surgeries or groups with similar logistics characteristics. Outside hospitals logistical families for product types with the same characteristics are defined, but I do not know these for surgeries. When looking at the list of 350 surgeries together with people working in the hospital this complexity was somewhat put into perspective, because they know what surgeries are ‘standard’ or what are the less predictable ones. From a medical perspective ‘easy’ is seen as part of a routine, from a logistical perspective this ‘routine’ might be judged differently. And the type of surgery is not the only determinant for how the logistics should be organised. For anesthesiologists the condition of the patient determines the way he or she is treated. So even for standard surgeries, the specific case of a patient is a factor that can make the surgery less standard.
What does this mean for the logistics of surgery patients? The logistical task is to get the right patient, the right surgeon, anethesist, materials, equipment and OR nurses together, at the right place and moment. Looking at the data of all surgeries in 2017 hardly a ‘standard’ combination of resources was used for one surgery. About one third of the surgery types is performed by one specific surgeon. Looking at medical instruments, there are over 2,500 unique combinations of instrumental sets used for the 10,000 surgeries that took place in 2017. In total over 70% of all surgeries involved a unique combination of surgery type, surgeon, anesthesist and instrument sets.
This impression of surgeries being unique cases, could have multiple reasons. The variation of instrument sets could be for reasons of customization, either with regard to the patient or the surgeon. It could also be for reasons of scarcity: if instrument set A is not available instrument set B is used instead. The fact that surgeries are only performed by a small number of specific surgeons could be because this is the way it is planned – the surgeons doing the most of a specific surgery are picked first – or that surgeons are really that unique in skills or experience that this a specific surgeon is required for quality reasons. These data implicate a high degree of customizing – that every case is almost unique and requires specific scarcily available resources – requiring the logistical network to be very flexible, in order to fulfill the needs of patients. But are they really? What logistical families would there be in surgeries?