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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.

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.

Previous studies approach surgery scheduling mainly from the mathematical modeling perspective which is often hard to apply in a practical environment. The aim of this study is to develop a practical scheduling system that considers the advantages of both surgery categorization and newsvendor model to surgery scheduling.

The research was carried out in a Finnish orthopaedic specialist centre that performs only joint replacement surgery. Four surgery categorization scenarios were defined and their productivity analyzed by simulation and newsvendor model.

Detailed analyses of surgery durations and the use of more accurate case categories and their combinations in scheduling improved OR productivity 11.3 percent when compared to the base case. Planning to have one OR team to work longer led to remarkable decrease in scheduling inefficiency.

In surgical services, productivity and cost‐efficiency can be improved by utilizing historical data in case scheduling and by increasing flexibility in personnel management.

The study increases the understanding of practical scheduling methods used to improve efficiency in surgical services.

The purpose of this paper is to present simulation modelling to reconfigure a 700-bed Hong Kong hospital’s master surgery schedule (MSS), aiming to improve patient flow, capacity management and resource allocation through levelling bed occupancy within the hospital.

A discrete-event simulation model was developed to understand how changes to the MSS would affect bed occupancy, thereby providing business intelligence for short- and long-term hospital planning. A decision tool was subsequently developed for hospital managers to test different scenarios.

Simulation modelling showed that significant bed occupancy levelling could be achieved through small and practicable changes to the MSS. Optimisation routines conducted using the simulation model then gave additional insights into how the schedule should be revamped for the long term.

The authors show how operations research methods are useful for guiding hospital operational planning. The authors show that a data-driven and evidence-based model enables hospital managers to critically explore various scheduling changes, while also providing a scientific common ground for discussion among important stakeholders. It is a crucial step forward when adopting advanced analytics for Hong Kong hospital operational planning.

The authors provide a robust method for evaluating the relationship between Hong Kong hospital’s MSS and its bed occupancy. Through simulating various changes to the surgical schedule, valuable and practicable insights were made available for hospital managers to make short- and longer-term changes that enhance the system’s overall efficiency and service quality.

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.

Overall equipment effectiveness (OEE) is a performance indicator that is been used to measure manufacturing productivity. The purpose of this paper is to propose the operating room effectiveness for hospital operating rooms (ORs), adapted from the OEE, to measure performance and identify losses based on lean health-care principles.

The present study is an exploratory, descriptive and applied research work. Literature review, documents of the hospital, observation and interviews with employees of a large university hospital in southern Brazil were analyzed to organize the proposed effectiveness indicator. After that, historical data of the ORs was collected and the usefulness of the indicator was analyzed. The indicator was applied for 10 months and validated with an expert committee from the hospital.

The present study describes an adaptation of a performance indicator to ORs of hospitals, allowing to classify its types of operational losses in a lean health-care context. The application of this indicator and the development of improvement actions to a university hospital, resulted in operational efficiency gains of 12 per cent and estimated annual savings of US$400,000.

ORs are a critical service for hospitals. This paper presents a new way to measure the performance of ORs and identify their main types of wastes. It also shows how to implement it and the potential gains of its application. The main research limitations are related to technical analysis of care data from doctors and nurses involved.

This paper fulfills the need to study how ORs performance can be measured and its operational wastes can be identified. In addition, this paper classifies the planning, performance and quality related losses, which can be used by researchers and practitioners to improve the performance of operation rooms.

The purpose of this paper is to carry out the business process re‐engineering (BPR) of a surgical ward in a hospital in order to improve the efficiency of the ward.

This work was developed using a case study on a surgical ward. In this type of ward, in which scheduled and unscheduled operations often have to coexist and be managed, ways to minimise patient inconvenience need to be studied. A framework based on event‐driven process chains (EPCs) methodology, the entity‐relationship model and discrete event simulation is presented to define and analyse the current state of a surgical ward and design a future system. The modelling of the processes, activities and sub‐activities, which took up a great amount of ward resources, allowed a what‐if analysis to be developed which simulates various scenarios and assesses their performance.

Using Delphi methodology, it was possible to identify a number of areas for improvement: number of operating sessions, preparation of the operating rooms for each operation, availability of specific surgical instruments. Moreover, the discrete event simulation approach led to an understanding of the most efficient management choices.

The decision to use Delphi methodology for the information collection stage before starting the BPR process is not found in other studies in the literature. Moreover, the use of models based on EPCs methodology allowed the panel of experts to develop models to examine and understand the resource requirements of medical assessment units and to provide a framework or develop standards that hospital developers and clinical managers can consult.

The purpose of this paper is to present the effect of the introduction of cross-functional team (CFT)-based organization, rather than, on planning and performance of OR teams.

In total, two surgical departments of the Radboud University Nijmegen Medical Center (RUNMC) in the Netherlands were selected to illustrate the effect on performance. Data were available for a total of seven consecutive years from 2005 until 2012 and consisted of 4,046 OR days for surgical Department A and 1,154 OR days for surgical Department B on which, respectively 8,419 and 5,295 surgical cases were performed. The performance indicator “raw utilization” of the two surgical Departments was presented as box-and-whisker plots per year (2005-2011). The relationship between raw utilization (y) and years (x) was analyzed with linear regression analysis, to observe if performance changed over time.

Based on the linear regression analysis, raw utilization of surgical Department A showed a statistically significant increase since 2006. The variation in raw utilization reduced from IQR 33 percent in 2005 to IQR 8 percent in 2011. Surgical Department B showed that raw utilization increased since 2005. The variation in raw utilization reduced from IQR 21 percent in 2005 to IQR 8 percent in 2011.

Hospitals need to improve their productivity and efficiency in response to higher societal demands and rapidly escalating costs. The RUNMC increased their OR performance significantly by introduction of CFT-based organization in the operative process and abandoning the so called functional silos.

The stepwise reduction of variation – a decrease of IQR during the years – indicates an organizational learning effect. This study demonstrates that introducing CFTs improve OR performance by working together as a team.

Millions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness.

Data for this qualitative study were collected through 48 semi-structured interviews with operating theatre staff in France (n = 20) and Australia (n = 28). Transcripts were coded using a theory-driven thematic analysis to characterise sources of waste in operating theatres and the tactics used to address them.

The study confirmed the prominence of seven types of waste in operating theatres commonly found in industry and originally identified by Ohno, the initiator of lean: (1) underutilised operating rooms; (2) premature or delayed arrival of patients, staff or equipment; (3) need for large onsite storage areas and inventory costs; (4) unnecessary transportation of equipment; (5) needless staff movements; (6) over-processing and (7) quality defects. The tactics used to address each of these types of waste included multiskilling staff, levelling production and implementing just-in-time principles.

The tactics identified in this study have the potential of addressing the chronic and structurally embedded problem of waste plaguing health systems' operating theatres, and thus potentially improve access to surgical care. In a global context of resource scarcity, it is increasingly necessary for hospitals to optimise the ways in which surgery is delivered.

Current thinking about “patient safety” emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of normal accidents to extend this analysis and better understand the “organisational factors” that threaten safety.

Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North‐West of England.

The work of the operating department is determined by inter‐dependant, “tightly coupled” organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as “breakdowns” within inter‐departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely.

Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured “real world” situation of service delivery is shaped by inter‐department and organisational factors that are perhaps beyond the scope of departmental management.