Reference no: EM133050716

Read Case Study 15-6: Musical Operating Rooms first and answer the following questions.

1. What is/are the problem(2) in this case?

2. What concepts discussed in this session help explain the problems identified in Question 1?

3. What would you recommend Dr. Wilkins to do?

Reading

Dr. John Wilkins sat staring at the phone message in front of him. Dr. Peter Mikelson, chief of orthopedics, had called again wanting to discuss the current system used to schedule operating room times. As chief of medicine, technically, Dr. Wilkins had the power to dictate who would use the operating resources and when. Up to now he had been reluctant to use that power, relying instead on scheduling administrators to handle the schedule for operating room use. Perhaps the time had come to review that system and implement changes if necessary.

Mercy Hospital, a not-for-profit hospital located in the Northeast, employed 1000 doctors in 30 different departments. The facility had an outstanding reputation as a teaching hospital. About 40% of its doctors were full-time faculty, while the remaining 60% were volunteer staff (those doctors who, while not employees of the hospital, worked with residents and had access to hospital resources). The hospital currently had 25 operating rooms located throughout the hospital. Operating rooms were not assigned to any particular department, but doctors tried to use the rooms closest in proximity to their department wing. In some more extreme cases, it was simply understood that the operating rooms in certain wings were to be used only by certain departments.

Dr. Wilkins decided to have some informal discussions with different department chairs to gauge how dire the situation really was. His first stop was with Dr. Steve Daly, chief of urology. "You know, John," Dr. Daly explained, "I understand urology is not a high-profile glamour specialty, but I am having a very difficult time attracting both volunteer staff and the best residents because of the trouble I have scheduling procedures. We have 20 doctors in three different departments sharing four operating rooms. I know to you this may sound like an inability on my part to plan, but let me put this in terms that may mean something to you. The operating room is where we make our money. If my doctors and I can't easily schedule time in the OR, we can't continue to build the department. I have already seen a decline in the number of referrals from primary care physicians. If this keeps up, this hospital will have a hard time maintaining this specialty at a competitive level."

Next on Dr. Wilkins's list was Dr. Jack Palmer, chief of neurosurgery. Jack Palmer was a bit of a legend in the region. This was due to a combination of the high-profile nature of his specialty, his long tenure at the hospital, and his impressive client list, which included many of the people who sat on Mercy Hospital's board of directors as well as their families and friends. As John walked through the department, he noticed that all three of the ORs in the Neurosurgery wing were not in use. When he mentioned this to the department secretary, she replied that this was always the case on Friday mornings. For as long as she could remember, Neurosurgery held a weekly teaching conference from 7:00 to 12:00 every Friday. The secretary then informed John that Jack could not free up any time to speak with him, but she did relay the message that all was fine in Neurosurgery as far as OR time.

Dr. Wilkins next spent some time with Dr. Sheehan, chief of ophthalmology. After reviewing the OR schedule for the next month, Dr. Wilkins was astounded at the number of procedures Dr. Sheehan and members of her department were scheduled to perform. Dr. Sheehan explained, "Well, John, I've actually put a little cushion in there to make sure I have the time I need. At the beginning of the month I sign up those surgeries I am sure we will perform as well as some 'phantom' patients. That way, if surgery runs over because I'm teaching the procedure to a resident, or if a patient shows up in a condition under which I cannot operate, I can easily reschedule them. Patients get quickly rescheduled, doctors' office hours aren't disrupted, and everyone is happy. The name of the game is customer service. Peter [Dr. Mikelson] is new and will learn the system like everyone else did. I'm feeling particularly charitable today. Send Peter my way and we'll see if we can't negotiate for some of my scheduled time."

Dr. Wilkins spoke with Dr. Mikelson last. Dr. Mikelson said, "John, I know I'm the new kid on the block, but this system is simply unacceptable. Six months ago when I took this position, you and the board made it very clear to me the importance of building the practice. I've done as much as I can, but my capacity analysis shows that if my growth continues, I'll need four operating rooms instead of the one I am currently allocated. The bottom line is the bottom line, and you and I both know the money Orthopedics brings into the hospital. If I have to beg and plead with Susan Sheehan every time an unexpected change in my schedule pops up or rely on the grapevine to figure out when the OR is available, I can't keep my patients happy. The game has changed, John. Unhappy patients simply go elsewhere for surgery."

Dr. Wilkins knew Dr. Mikelson was right. How would he fix the situation in a way that made everyone happy, including patients, doctors, administrators, and the board of directors? What was the proper criteria to use: longevity, political clout, fiscal impact? How was he going to allow for emergency surgeries? How much control did he really want to take away from the physicians in scheduling their procedures?