In the series of blogs on who is running the hospital, so far I have talked about nurses , surgeons and anesthesiologists. They all have coordinative tasks. Besides these agents, there are three people in the hospital with perhaps the most important position of all. Let’s call them John, Anne and Nikky. It does not feel very ‘scientific’ to write about three specific people, but since they are the most important people when it comes to integrating the hospital’s operational system, I think it’s good to write about them. Who are they?
John is the Operating Theatre (OT) day coordinator. He makes sure that every day all planned and unplanned surgeries are executed, without delay. In preparation to this day, he makes sure that materials are ordered with suppliers, schedules all OR nurses and nurse anesthetists for the day program of the OT. When people call in sick, he reschedules, when emergency patients arrive, he puts them into the OT schedule, when equipment needs maintenance, he decides when this is best done, when he foresees surgeries running late, he discusses the options with anesthesiologists and surgeons, when a Radiology image needs to be made during surgery he arranges this with the Radiology department. He is the control centre of the OT with a time horizon of 2 weeks before surgery until (and including) the day of surgery. He is in touch with all OR nurses, nurse anesthetists, holding nurses, surgeons, anesthesiologists, outpatient secretaries, OT manager, OT team leaders, central sterilization and radiology staff. He is the most central agent in the network.
Ann is the OT capacity planner. She has a similar job as the OT day coordinator but her time horizon is larger. She is involved in making the OT master schedule, the clinical bed plan, in planning patients from 6 months until 2 weeks before surgery takes place. She checks whether all conditions for surgeries are met, from preoperative screening to the number of MRSA patients on a surgery day (plus hundreds of other conditions). She decides on the order of surgeries for one day, but is also the one who can shift OT sessions from one medical discipline to another, like a sort of trader. She interacts with outpatient secretaries, surgeons, anesthesiologists and is the link between outpatient, clinical departments and the Operating Theatre. She also has a central position in the network and works closely together with John.
Nikky is the clinical bed plan boss. That is not really a formal function, people just call her that way. She is a secretary of a nursing department who wanted to help out making things work better. She took up the task of controlling the clinical bed plan of all nursing departments. This means that she has to make sure that no one takes a bed that is not meant for them and when someone is short of a bed, she arranges it. She is in touch with the outpatient secretaries and the nursing department team leaders. But, most importantly, she works closely together with the OT capacity planner, who does have a larger reach in the network. Since this month her job has become formalized, after having practically invented it in the past year.
One of the things these three people have in common is that they do not have any formal authority towards others. Their effectiveness depends on persuasion, negotiation, being liked or feared – whatever works best -, on how well they debate with or educate people, continuously following different strategies for different surgeons, nurses or anesthesiologists. They have no mandate, sometimes to their own frustration, but on the other hand they can act somewhat under the radar and influence the network as a lot of information flows via them. They are not invisible, but do not draw all the attention (and resistance) because they are approachable. They are not ‘the big boss’. In social network analysis terms, they are the brokers (if you like you can read social network for dummies here to explain a bit more about social networks). It requires special skills, that (I guess) can hardly be trained.