Abstract
Human technology in health care includes managerial knowledge required to marshal a health care workforce, operate hospitals and equipment, obtain and administer funds, and, increasingly, identify and establish markets. In this article, the authors focus on human technology and improvement of decision-making processes in the context of operating theatre scheduling of unplanned surgical cases. Unplanned surgery refers to unscheduled and unexpected surgical procedures in distinction to planned, elective surgery. The management of unplanned surgery is a strategic function in hospitals with potential clinical, administrative, economical, social, and political implications. Making health care management decisions is complex due to the multidisciplinary and the multifocussed nature of decision-making processes. The complexity of multidisciplinary and multifocussed decision-making is further exacerbated by perceived professional identity differences. This article presents findings from interviews with doctors and nurses about the scheduling of unplanned surgical cases. The interviews focused on current decision- making determinants, the acceptability of using a model to guide decision-making, and enablers and barriers to implementing the model. The key finding was the limited practicality of a model to guide the scheduling of unplanned surgery. While it could guide decisions around clinical determinants, logistical determinants, and ideal timeframes, it would have difficulty reshaping inter- and intra-professional dynamics.
Key Terms in this Chapter
Logistical Determinants: Practical or operational factors that influence the priority assigned to a surgical case, and in turn, influence patient health and economic outcomes. These include (but are not limited to) the availability of beds, hospital equipment, specialist instruments, surgery schedules, theatre time and space, as well as expert and support staff.
Emergency Surgery: Emergency surgery is required by a patient whose poor health requires urgent attention; this is most evident when there is risk to life, limb, or organ. An emergency is commonly understood to be an unforeseen combination of circumstances that demands immediate action, or an urgent need for assistance or relief. In the medical setting, it implies an injury or illness that poses an immediate threat to a person’s health or life. In the clinical context, however, determining the immediacy and urgency of interventions becomes the ground for discourse between health care providers within the hospital setting. Each stakeholder offers different understandings of the term, emergency (Lum & Fitzgerald, 2007).
Scheduling: “A complex activity where human schedulers tend to make use of a wide range of knowledge, heuristics, and intuition” (Bharadwaj, Sen, & Vinze, 1999, p. 322).
Non-Elective Surgery: See emergency surgery.
Unplanned Surgery: Any surgical procedure that is not scheduled and thus, unexpected. While typically referred to as emergency surgery, the term unplanned surgery is preferred because of the variable understandings associated with the term emergency surgery.
Professional Identity: An ongoing concern of the professional involving the practice of his or her work, social interactions with colleagues and patients, and his or her place within the professional institution and the professional discourse. It is thus socially bestowed, socially sustained, and socially transformed.
Human Technology: The body of information, skills, and experience developed for the production and use of goods and services.
Clinical Determinants: Physical or physiological patient characteristics that influence the priority assigned to a surgical case, and in turn, influence patient health and economic outcomes. These include (but are not limited to) degree of risk to life, limb or senses, type of wound or injury, degree of haemodynamic stability, extent of pain, patient age, and diagnostic procedure required.