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This paper sets out to investigate whether demand for gynaecological theatre time could be described in terms of the time required to undertake elective operations booked for surgery, and so help match the capacity to this.

A questionnaire assessed the estimates for total operation time for seven common operations, sent to surgeons, anaesthetists and nursing staff in one tertiary referral and one district general hospital (total 49 staff; response rate 58 per cent), and estimates were obtained from theatre computer logs. Average timings for each operation were then applied to cases added from clinics to the waiting list at the district general, to yield the mean demand for elective surgery, and were also applied to emergencies to estimate emergency workload. Finally these demand estimates were compared with the theatre capacity available.

The paper found no difference between the estimates of the three staff groups or between these and the theatre logs (p=0.669), nor did it find that estimates differed between the two centers (p=0.628). Including emergencies, the mean (95 per cent confidence intervals) demand at the district general was 2,438 (1,952‐2,924) min/week.

Although the paper modelled the variation in demand using the relevant variation in operation times, any additional variation caused by differences in booking rates from clinics over time was not nodelled. The minimum period over which data should be collected was not established.

The paper finds that the existing capacity of 1,680 min/week did not match these needs and, unless it was increased, a rise in waiting lists was predictable.

The paper concludes that time estimates for scheduled operations can be better used to assess the need for surgical operating capacity than current measures of demand or capacity.

The high variability in cardiac surgery length – is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open‐heart surgery operating theatre productivity.

A discrete operating theatre event simulation model with empirical operation time input data from 2,603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time.

A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work.

A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open‐heart surgery.

The challenge in scheduling two open‐heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired.

A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

Weekend surgery carries higher mortality than weekday surgery, with complications most commonly arising within the first 48 hours. There is a reduced ability to identify complications at the weekend, with early signs going undetected in the absence of thorough early patient review, particularly in the elderly with multiple co-morbidities. Weekend working practices vary amongst UK hospitals and specialties. The weekend effect has been a prominent feature in the literature over the past decade. The purpose of this paper is to identify the number of patients undergoing weekend surgery who receive a Day 1 post-operative review and improve this outcome by implementing an effective change.

It was observed that not all patients undergoing surgery on a Friday or Saturday at the authors’ District General Hospital were receiving Day 1 post-operative review by a clinician. A retrospective audit was carried out to identify percentage of patients reviewed on post-operative Day 1 at the weekend. A change in handover practice was implemented before re-audit.

In Phase 1, 54 per cent of patients received Day 1 post-operative reviews at the weekend against a set standard of 100 per cent. A simple change to handover practice was implemented to improve patient safety in the immediate post-operative period resulting in 96 per cent of patients reviewed on Day 1 post-operatively at re-audit.

This study confirms that simple changes in handover practices can produce effective and translatable improvements to weekend working. This further contributes to the body of literature that acknowledges the existence of a weekend effect, but aims to evolve weekend working practices to accommodate improvement within current staffing and resource availability by maximising efficiency and communication.

Operating theaters are considered as the most sensitive health department within hospital centers due to their significant cost/necessity for patients and their economic benefits for hospitals. In this paper, the authors consider patients that may require more than one surgery on the same day in the surgery scheduling problem which is a major technology enhancement in the health industry.

The surgery scheduling includes both the preoperative and the postoperative units of the operative stage. Two objectives are considered in a lexicographic way: the minimization of the makespan while prioritizing the patients having two surgeries and the total completion time to perform. An adapted tabu-search algorithm is used to tackles this NP-hard scheduling problem.

The proposed schedule is more relevant for operating theaters as it integrates all stages of the surgical procedure and considers patients with more than one operation during the same day.

This paper is original as it considers patients who need more than one operation, which responds to real challenge faced by decision-makers' in hospitals. The application of the time lags between stages of the surgical procedure generates a good utilization of the hospital resources and makes the scheduling task more flexible.

Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.

41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.

After the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.

Interviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes are explored in a hospital in terms of integration (the coordination and alignment of tasks), differentiation (the extent to which tasks are segmented into subsystems), rules, coordination mechanisms and hospital performance.

A case study was conducted examining the hospital’s social network, rules, coordination mechanisms and performance both before and after the introduction of the HPC. All planning and execution tasks for surgery patients were studied using a naturalistic inquiry and mixed-method approach.

After the introduction of the HPC, the overall network structure and coordination mechanisms and coordination mechanisms remained largely the same. Integration and certain rules changed for specific planning tasks. Differentiation based on medical discipline remained. The number of local rules decreased and hospital-wide rules increased, and these remained largely in people’s minds. Coordination mechanisms remained largely unchanged, primarily involving mutual adjustment and standardization of work both before and after the introduction of the HPC. Overall, the hospital’s performance did not change substantially. The findings suggest that integration seems to “emerge” instead of being designed. Hospitals could benefit, we argue, from a more conscious system-wide approach that includes collective learning and information sharing.

This exploratory study provides in-depth insight into how a hospital works, yielding important knowledge for further research and the enhancement of hospital performance.

A key driver in the medical tourism phenomenon is the platform provided by the internet for gaining access to healthcare information and advertising. Given the pivotal role of web‐based resources, there are important questions about their role and function including: the availability and types of information provided; information provenance and reliability; and privacy protection. This paper aims to address these questions.

The paper provides the first systematic review of medical tourism sites, interrogating them for the range and quality of advice on seeking care.

A typology of sites (industry, media, professional, and consumer sites) was identified and quantitative and qualitative assessment tools were used to explore the content of information and materials.

In light of this review, the paper comments on the nature of medical tourism information available and the extent to which information asymmetry – rife in the market for healthcare – is alleviated allowing for the better functioning of the market for medical tourism.

Purpose of this paper is to identify capabilities required for healthcare service providers to provide mass personalized services and to provide directions to conduct empirical studies to understand the phenomenon of mass personalization in Indian healthcare industry.

The research is conducted by undertaking a literature review followed by field visits and interviews conducted at a leading healthcare service provider in India.

There is limited empirical research on understanding the mass personalization capabilities in healthcare setting and empirical validation of the sand cone model and theory of competitive progression in the context of healthcare. Our interviews and field visits to Narayana Hrudayalaya (NH) indicate that it is attempting to provide personalized services to a large number and variety of patients. By doing so, it is expected to improve on both resource and flow efficiencies at the same time and hence break the trade‐offs between those. Literature review coupled with field visits and interviews help us in identifying key research questions related to mass personalization of healthcare in Indian healthcare industry.

This study is one of the first attempts to understand this trade‐off between resource and flow efficiency in the context of the Indian healthcare industry and to identify areas for future research. The unique characteristics of the Indian healthcare industry provide the ideal research setting to study this phenomenon. Literature review and our exploratory study have helped us in providing directions for future research in this unexplored area.

The purpose of this paper is to understand how the introduction of a patient-centered model (PCM) in Italian hospitals affects the pre-existent configuration of clinical work and interacts with established intra/inter-professional relationships.

Qualitative multi-phase study based on three main sources: health policy analysis, an exploratory interview study with senior managers of eight Italian hospitals implementing the PCM, and an in-depth case study that involved managerial and clinical staff of one Italian hospital implementing the PCM.

The introduction of the PCM challenges clinical work and professional relationships, but such challenges are interpreted differently by the organisational actors involved, thus giving rise to two different “narratives of change”. The “political narrative” (the views conveyed by formal policies and senior managers) focuses on the power shifts and conflict between nurses and doctors, while the “workplace narrative” (the experiences of frontline clinicians) emphasises the problems linked to the disruption of previous discipline-based inter-professional groups.

Medical disciplines, rather than professional groupings, are the main source of identification of doctors and nurses, and represent a crucial aspect of clinicians’ professional identity. Although the need for collaboration among medical disciplines is acknowledged, creating multi-disciplinary groups in practice requires the sustaining of new aggregators and binding forces.

This study suggests further acknowledgment of the inherent complexity of the political and workplace narratives of change rather than interpreting them as the signal of irreconcilable perspectives between managers and clinicians. By addressing the specific issues regarding which the political and workplace narratives clash, relationship of trust may be developed through which problems can be identified, mutually acknowledged, articulated, and solved.

When using a service, customers often develop their own solutions by integrating resources to solve problems and co-create value. Drawing on innovation and creativity literature, this paper aims to investigate the influence of place (the service setting and the customer setting) on customer creativity in a health-care context.

In a field study using customer diaries, 200 ideas from orthopedic surgery patients were collected and evaluated by an expert panel using the consensual assessment technique (CAT).

Results suggest that place influences customer creativity. In the customer setting, customers generate novel ideas that may improve their clinical health. In the service setting, customers generate ideas that may improve the user value of the service and enhance the customer experience. Customer creativity is influenced by the role the customer adopts in a specific place. In the customer setting customers were more likely to develop ideas involving active customer roles. Interestingly, while health-care customers provided ideas in both settings, contrary to expectation, ideas scored higher on user value in the service setting than in the customer setting.

This study shows that customer creativity differs in terms of originality, user value and clinical value depending on the place (service setting or customer setting), albeit in one country in a standardized care process.

The present research puts customer creativity in relation to health-care practices building on an active patient role, suggesting that patients can contribute to the further development of health-care services.

As the first field study to test the influence of place on customer creativity, this research makes a novel contribution to the growing body of work in customer creativity, showing that different places are more/less favorable for different dimensions of creativity. It also relates customer creativity to health-care practices and highlights that patients are an untapped source of creativity with first-hand knowledge and insights, importantly demonstrating how customers can contribute to the further development of health-care services.