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Cataract surgery is a highly successful, high‐volume surgery, hence reducing surgical complications are imperative for organizations to deliver cost‐effective, high‐quality services that meet the needs of patients. This paper aims to describe 18‐month results of a sustainable program to maximize the safety of cataract surgery training.

Modifications to the comprehensive cataract‐training program and tested were developed in a controlled, interventional case series to evaluate their effect on trainee complication rates. Data collection and interpretation were performed in a prospective and blind manner.

Prior to intervention, PCR rates for trainee‐surgeons averaged 3.34 per cent cf international published figures of 4.6‐10 per cent. This compared with 1.89 per cent PCR rate for trained cataract surgeons (p<0.002, Mann Whitney test). Multiple interventions were introduced and enforced to maximize cataract surgery training safety. After 18 months follow‐up data were consistent with a statistically significant reduction in trainee PCR rates (1.53 per cent, p<0.007, Wilcoxon Signed Ranks test) compared with trained cataract surgeons (1.23 per cent, p<0.074, Wilcoxon Signed Ranks test). Parameters of training efficacy were improved or maintained during this period.

Limitations included using trained cataract surgeons as controls as apposed to a similar group of trainee surgeons. In addition, multiple interventions were simultaneously instituted, making identification of a single influential factor impossible to identify.

Maximally safe and effective cataract surgery training is achieved in Singapore without compromising service and quality markers. Similar training goals can be extrapolated to other surgical disciplines.

This is the first study to demonstrate maximally safe and effective cataract surgery training in a large patient group, over sustained periods.

The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year.

The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI.

The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups.

EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.

Members of an organization facing change often struggle to adapt and may create new routines. Drawing on insights from a case study of bariatric robotic surgery, the authors illustrate how a new ecology of space transforms the ostensive and performative aspect of a routine during the introduction of a new technological artifact. The authors discuss two types of space: experimental and reflective. The authors show that the reflective space through debriefings enables practitioners to discuss the new patterns of interdependent actions. Practitioners explore the different aspects of the performative struggle with new artifacts and try to integrate new actions and delineate the boundaries of this change during experimental performances. The findings of this study throw light on the role of the reflective space in addition to the experimental space in routine change, and suggest that socio-material ensembles can produce opportunities for reshaping routines.

The authors determine how the scheduling and sequencing of surgeries by surgeons impacts the rate of post-surgical complications and patient length-of-stay in the hospital.

Leveraging a dataset of 29,169 surgeries performed by 111 surgeons from a large hospital network in Ontario, Canada, the authors perform a matched case-control regression analysis. The empirical findings are contextualized by interviews with surgeons from the authors’ dataset.

Surgical complications and longer hospital stays are more likely to occur in technically complex surgeries that follow a similarly complex surgery. The increased complication risk and length-of-hospital-stay is not mitigated by scheduling greater slack time between surgeries nor is it isolated to a few problematic surgery types, surgeons, surgical team configurations or temporal factors such as the timing of surgery within an operating day.

There are four major limitations: (1) the inability to access data that reveals the cognition behind the behavior of the task performer and then directly links this behavior to quality outcomes; (2) the authors’ definition of task complexity may be too simplistic; (3) the authors’ analysis is predicated on the fact that surgeons in the study are independent contractors with hospital privileges and are responsible for scheduling the patients they operate on rather than outsourcing this responsibility to a scheduler (i.e. either a software system or an administrative professional); (4) although the empirical strategy attempts to control for confounding factors and selection bias in the estimate of the treatment effects, the authors cannot rule out that an unobserved confounder may be driving the results.

The study demonstrates that the scheduling and sequencing of patients can affect service quality outcomes (i.e. post-surgical complications) and investigates the effect that two operational levers have on performance. In particular, the authors find that introducing additional slack time between surgeries does not reduce the odds of back-to-back complications. This result runs counter to the traditional operations management perspective, which suggests scheduling more slack time between tasks may prevent or mitigate issues as they arise. However, the authors do find evidence suggesting that the risk of back-to-back complications may be reduced when surgical pairings are less complex and when the method involved in performing consecutive surgeries varies. Thus, interspersing procedures of different complexity levels may help to prevent poor quality outcomes.

The authors empirically connect choices made in scheduling work that varies in task complexity and to patient-centric health outcomes. The results have implications for achieving high-quality outcomes in settings where professionals deliver a variety of technically complex services.

Surgery is predominantly a masculine profession worldwide and has largely excluded women in leadership positions. This paper aims to examine the representation of women surgeons in leadership positions in Pakistan.

Data were drawn from larger qualitative research examining the experiences of women surgeons in Pakistani hospitals. The data comprises in-depth interviews with ten doctors working in the Rawalpindi and Islamabad cities. The participants were selected by using the purposive sampling method and data were analyzed using thematic analysis.

This study included participants from diverse surgical specialties from different stages of their career with two having leadership experience. Based on participants’ perspectives several factors are responsible for this exclusion of women in leadership positions. The most prominent among these were long working hours for surgical leaders, greater responsibilities assigned to leadership positions, gender stereotypes and work–family conflict. Due to masculine hegemony, women were considered less capable and they were expected to have masculine traits to work as successful leaders. Interestingly, some participants had internalized such stereotypes and showed a lack of interest and lack of capabilities for surgical leadership as evident from their narratives.

The findings of this paper are drawn from the perspectives of ten women surgeons working in Islamabad and Rawalpindi cities of Pakistan who were selected using a convenient sampling method. Hence, the results cannot be generalized to the larger population of women surgeons working in other cities of the country. Nevertheless, this study is unique in the sense that it provides useful insight into the experiences of the women surgeons and their perspectives on surgical leadership in Pakistani hospitals. Academically, it contributes to the global debates on surgical leadership by providing empirical evidence from Pakistan.

This paper contributes to the larger debates on the under-representation of women in leadership positions in surgery by unveiling the experiences of female surgeons from Pakistan. It calls for the need for structural changes in health management and policy to accommodate women surgeons. Organizational efforts could minimize some hurdles and encourage more women to take on more formal leadership roles. The authors also call for an increasing number of women in surgery to pave the way for creating new leadership opportunities.

The purpose of this paper is to generate a daily operating theater schedule aiming to minimize completion time and maximum overtime while integrating real-life surgeon constraints, such as their role, specialty, qualification and availability.

The paper deals with complete surgery process using multi-objective surgery scheduling approach. Furthermore, the combinatorial nature of the studied problem does not allow to solve it to optimality. Therefore, the authors developed two approaches embedded in a tabu search metaheuristic, namely, weighted sum and e-constraint, to minimize completion time and maximum overtime.

The integration of the upstream and downstream services of an intervention and the consideration of the specific constraints related to surgeons are very essential to obtaining more closed schedules to the realty.

The paper includes implications for the development of efficient schedules for a significant number of operations coming from different specialties throughout its complete surgery process under multi-resource constraints.

The paper can help hospital managers and decision makers to well manage the budget by minimizing the overtime cost and by offering efficient daily operating theater schedule.

The results of the paper will help hospital managers and decision makers to well manage the budget by minimizing the overtime cost and offering efficient daily operating theater schedule.

Minimally invasive surgery (MIS) is a cost‐effective alternative to the open surgery whereby essentially the same operations are performed using specialized instruments designed to fit into the body through several tiny punctures instead of one large incision. The EndoBots (Endoscopic Robots) described here are designed for collaborative operation between the surgeon and the robotic device. The surgeon can program the device to be operated completely manually, collaboratively where motion of the robotic device in certain directions is under computer control and in others under manual surgeon control, or autonomously where the complete device is under computer control. Furthermore, the robotic tools can be quickly changed from a robotic docking station, allowing different robotic tools to be used in an operation.

Focuses on a simple question: should Zimmer develop a gender-specific artificial knee? The decision is complicated because while the idea seems to make sense, there is little clinical evidence that a gender-specific knee produces superior patient outcomes, and orthopedic surgeons are likely to be skeptical of the innovation.

To teach new product strategy and growth strategy, and introduce students to the medical device industry.

In this chapter I explore how conflicting discursive claims made by the medical community are consequential for bariatric weight loss surgery patients. Bariatric surgery has become increasingly common in the United States since the 1990s, with over 177,000 Americans undergoing surgery in 2006. Despite the surgery's growing popularity, the US medical community does not wholeheartedly endorse the surgery. Rather, different members of the medical community espouse contradictory evaluations of weight loss surgery. I broadly characterize this intra-medical community controversy and, then, discuss how conflicting claims have helped shape the bariatric surgery industry's discursive conception of an “ideal patient.” Next, I analyze actual patients’ negotiations of the ideal patient archetype, and find that patients’ responses follow three paths: embracing the ideal, having a mixed response to the ideal, and strategically complying with the ideal. As patients are compelled to grapple with the ideal archetype in order to access surgery, I conclude that the ideal archetype acts as a discursive frame connecting individual patients to broad bariatric surgery discourses.

While attempting to persuade surgeons to accept their health technology, sales representatives for medical devices face daily challenges in the operating room. Surgeons exhibit cognitive complexity (abstractness vs. concreteness) when accepting any form of health technology. Surgeons choose technologies on behalf of their patients, taking patient priorities and expectations into account. Prior research has focused on cognitive complexity in the context of health technology adoption, but the issue of technology acceptance has not been addressed. The purpose of this study to use the construal level (CL) theory to determine the role of behavioural abstraction levels in the acceptance of surgical health technology.

On the basis of 556 min of seminar-based data and semi-directive interviews, the surgeons’ experiences regarding the acceptance of health technology were analysed. A non-directive observational method was used to permit the spontaneous emergence of CL dimensions in a natural environment. A categorization model was used for data coding, and MAXQDA, in addition to traditional multidimensional scaling and hierarchical cluster analysis, was used to generate results with joint displays.

Effort expectancy, learning curve, performance risk, habit, patient clinical condition, clinical outcome expectancy, technology setting and social influence were construed at a low construal level (LCL). On the other hand, patient paying capacity, technology cost, price value, financial risk and patient performance expectation were construed at a high construal level (HCL). The study also reveals duality-based factors which showed proximity to HCL but intersected at LCL, and vice versa. Duality-based factors such as effort expectancy, surgical technique, trust and perceived risk intersected at HCL, whereas performance expectancy, relative advantage, time expectancy, perceived value, physical risk and peer group influence intersected at LCL.

This is one of the early studies that presented the impact of behavioural abstraction on behavioural intention to accept health technology for surgeries.