The impact of planning and communication on unplanned costs in surgical episodes of care: Implications for reducing waste in hospital operating rooms

Abstract

This ethnographic study of more than 90 surgeries (referred to as episodes of care) identifies the antecedents to operating room (OR) supply waste. The study specifically considers the role of planning instances and communication patterns among members of the surgery team on supply waste within the OR. We operationalize planning instances in terms of the number of changes to the physician preference card (PPC), the key document that is used to plan items needed for surgery. Communication patterns among members of the surgery team are captured by measuring the density of communication among the OR team members during an episode of care. The unplanned costs during an episode of care are used as a measure of OR supply waste. Hundreds of hours were spent observing episodes of care and tracking supplies. A combination of participant-observation, survey, and secondary data were analyzed to extract theoretical and practical insights. The results show that planning instances have a curvilinear relationship with unplanned costs. In particular, as the number of changes to the PPC increases, unplanned costs first increase and then decrease. Higher density of the OR team's communication network is associated with lower unplanned costs. This study has significant theoretical and managerial implications that we discuss and offer directions for future research. K E Y W O R D Seconometric analysis, ethnography, healthcare, operating room, physician preference card, planning, social network analysis, team communication, unplanned costs, waste

The impact of operational disruptions on performance in surgical settings: moderating roles of risk management infrastructure and information exchange

“…Some plans are updated frequently and with great detail, while other plans are rarely, if ever, updated such that different patients receive the same surgical plan. With greater planning, less waste and better outcomes are achieved (Dreyfus et al. , 2020).…”

“…However, disruptions in the healthcare industry may also manifest in other ways, such as natural disasters, supply and instrument shortages, and human error. One of the critical areas within the hospital setting prone to disruptions is the operating room (OR) department (Dreyfus et al. , 2020).…”

Temporal Team Mental Model and Performance: From the Perspective of Team Process

“…From previous studies, it can be found that there are relatively few studies on the influencing factors of temporal team mental models, mainly focusing on the following aspects. The first is communication, which is considered the most important way of behavioral moderation in a team (Dreyfus et al, 2019). When unconscious team behavior synchronization is impossible, team members may use the explicit team communication process to make their perceptions of time reach a consensus.…”

Editorial: Delivering effective healthcare at lower cost: Introduction to the special issue

“…Two papers describe hospital-emergency-department operations (Berry Jaeker & Tucker, 2020;Davis, Zobel, Khansa, & Glick, 2020). Two papers (Dreyfus, Nair, & Rosales, 2020;Mukherjee & Sinha, 2020) examine perioperative services. Two papers examine operations at the level of the entire hospital (Johnson, Burgess, & Sethi, 2020;Tucker, Zheng, Gardner, & Bohn, 2020).…”