Scientific peer review

Two weeks ago I received the comments on my first article, in which the results of the scoping study on logistical parameters were presented. The journal was positive about the topic of hospital logistics but reading the critical comments made me feel discouraged for a moment. If these were film critics, I would’nt get a five star rate – and that is an understatement.

Luckily I was on a course in October – the Heuvelland course, a very good course on writing scientific papers, that, although located in The Netherlands, is open to an international audience since it’s given in English. The review on journal articles was also one of the topics on the program and it was introduced with a funny video. After watching this it was clear to me that reviews are not meant for pleasure and that it is a common human reaction to act disappointed (or angry, or sad or whatever).

The interesting thing was that having read all the comments I started to think and new ideas and thoughts came to me. I will share some of these here.

One of the main questions the reviewers asked what was the use of having these logistical parameters identified and what were the implications of that finding. When you see that there are 106 logistical parameters in hospitals, you could do two things to make sense of it, in my opinion.

The first thing you can do is to structure these parameters into clusters or develop a framework of some sort to help managers or other practicioners with useful tools. That has been done to some extent, although I must say that this is usually done for the benefit of a subsystem of the hospital, either a department, a patient group or a specific process. On emergency departments there is quite substantial research, but besides that there are numerous subsystems of hospitals on which only one or two studies have been done. I found logistical studies specifically focussed on laboratory departments, outpatient department, radiology department, orthopedic patients, trauma patients, chemotherapy department, cardiosurgical patients, stroke patients, endoscopy department, gynaecology patients, pregnant women, head and neck cancer patients, inpatient departments, neurosurgery patients, patient transport and so on. How on earth could be put that all into one framework? Is it even sensible to do so? Are these subsystems in any way comparable?

The second option is accept to the complexity and don’t try to structure it into one big logical model and control it from there, because it is simply impossible, as suggested in one of my previous blogs. Perhaps we should look at hospitals in a different way. Should we redefine the hospital as a collection of agents interacting with one another, not controlled centrally top down but letting it control itself as a multi-agent system? Should we plea for smaller hospitals so that the self management between the different subsystems becomes easier? Can we identify parts of the hospital that perhaps don’t need to be part of the hospital because there is no connection (required) with other parts of the hospitals? What would ‘a hospital’ look like if we structured it from a logistical perspective? Would that lead to a network of departments or patient centres that use different (and smaller) sets of logistical parameters relevant to their business, based on what is important to them and the stakeholders in and around those departments?

All these thoughts would not have been there if it wasn’t for the reviewer’s comments. I think I am starting to understand how sciences works and I like it. Until the next review..

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