Peer review from my dad

The fun thing about this blog is that I receive comments from different kind of people. Some people comment that they think my blog too long to be a blog (it turned out all individual blogs all in one long thread came accross as one (yes indeed) very long blog: if you click on the three lines on the top left, you can see blogs per month). I also received some comments from people in the case study hospital on specific results that they were surprised about. And several people working in hospitals say they find the blogs so very recognizable.

Last week my dad responded on the social network blog. First of all he indicated it was hard to understand and he wondered whether he was the actual target group. My primary reason for writing the blog was that people working in the field of hospital (logistics) would be able to read along with me, not having to wait until journal papers would be published (still waiting for the first one to come!). Secondly I don’t think many people in the field (or rather, all people outside the academic world) read journal papers. I find them hard to read myself, although after having read a couple of hundred, it becomes much easier. I wanted to offer something else and bridge the gap between academic stories and practical use of knowledge. At the moment my main focus is to get the academic story right and do a little bit of knowledge transfer through this blog.

My dad is not easily beaten though and he came up with some very good points on the blog itself. He asked what is to see in the middle of the network presented (see blog). In the middle you see a lot of blue names (GENS1, UROS1, AN1 etc.). These are surgeons and one anesthaetist who decide together what the Operating Theatre master schedule will be like. There is also one red person (CM1) and this is the OT manager. He and the OT capacity planner (OTPLAN) have a central role in this, connecting the medical staff, outpatient secretaries (the green agents called ‘SEC…’). Each surgeon acts as a bridge between this group in the middle and their own colleagues in their medical discipline. So for example one Urology surgeon (URO1) discusses the OT master schedule on behalf of the other Urology surgeons. You can see a circle around all Urology surgeons (UROS1 to UROS8) as they interact when preparing their own working schedule based on the OT master schedule. This collective scheduling is typical for hospitals I believe and not controlled in a hierarchic manner. My professor calls the OT master schedule a ‘peace agreement’. That is what it is.

My dad also mentions that it is hard to distinguish the anesthaetists from the surgeons in the network. Indeed, a legend would be useful. In short: AN stands for anesthaetist, all other blue names are surgeons, all SECGEN are secretaries, ORAS are OR assistants. But I must say that the network presented here has changed so much since this blog came out, that it would be better to explain it well once the network is final. Since then I showed all networks to the hospital people for validation, and a lot of other interactions have been added or changed. The discussion of these social networks with my research team has led to major changes in the networks also. There are now 9141 unique interactions in my database, that took place in 2017 between agents. But I am still counting.

In relation to my statement that surgeons and anesthaetists have an integrative role in this planning phase, my dad asks what I mean by this. He asks: “aren’t all stakeholders mutually dependent and responsible for the integration of the planning?” Yes, I think the mutual dependency is very clear. For as far as responsibility goes, there are issues to be explored and discussed. First of all even though there is a lot of collaborative decision making in hospitals, I doubt that all stakeholders always feel responsible for it. Decision making in a hospital (or in any large organization?) can be experienced as ‘vague’ (did we take that decision? when?). Decisions can be invisible or unconsciously taken. Sometimes there is a tendency towards something and looking back it is unclear how this or that happened. This way of doing can be part of a strategy, or it just happens, in my personal experience. Secondly, there could be alternative models for decision making with regard to allocating time and space. A central person, department or even a computer model can make a master schedule, based on forecasts on how many patients are to be expected hospital wide. Or one could not make a master schedule at all, but rather let the schedule emerge as the patient demand becomes clearer. There are several new ways of planning that are currently explored in many Dutch hospitals, under the heading of ‘Integrative Capacity Management’.

This last issue is what the paper I am working on right now is about. It addresses questions like: to what extent is the hospital network integrated, is that good or not, and most importantly what is the necessary integration? I wrote a bit about it earlier, but now I am using the theories mentioned here  to work out the case study. I will come back to that another time.




Open Kitchen Science

Today I was at a meeting with a bunch of scientists who (want to) do research in an open way, in some cases as a guest of a university, in some cases outside the university or as part of the university. It turns out that the university is not heaven on earth for everyone and competition for funds is fierce. It was estimated by this group that the time spent on applying for funds and teaching takes up to about 70 to 80% of their working time. And then there is the fierce competition between scientists that some have experienced and that stands in the way of collaboration.

I was unaware of this. I fund myself through my consultancy work and the University of Maastricht is hosting me for my PhD research. I work with a great team there and am very grateful for it. I have not experienced fierce competition or university politics, but that could be because I am almost never there. In the Open Kitchen Science group, as we call ourselves, most people are very motivated to change the research world from a closed, competitive environment into a more open, accessible and fun place to be. It is inspiring to hear their stories and I have come to realize sharing my way of doing research might be a good thing.

I have been doing PhD research since 2015. Half of my week I work for hospitals, advising them on hospitals, building (re)design, IT systems and such (see on what we do). In the other half of my week I work on the PhD research.

I have not been very outspoken about my motivations for this PhD research. In my private life not many people even know about it (or perhaps they have forgotten about it when I told them three years ago…’still doing that?’ yep). I have started it as a hobby (‘other people ride a horse, I do a PhD’) or voluntary work (because it’s useful and work, but unpaid). The main reason to do it, was that I wanted to have an intellectual challenge and work with inspiring people who share an interest in hospital logistics and management. I wanted the topic of logistics to become part of the strategic hospital agenda, because it was my impression that a lot of money is wasted in hospitals, while health care costs are increasing like crazy. I worked on numerous (re)building hospital projects with disappointing results or high cost because no attention was paid to logistics processes in the design phase. I was involved in one of the largest failures in Dutch history of implementing a hospital wide information system in the Netherlands, because the system did not meet the basic requirements of hospital processes (well, OK, history of hospital IT systems doesn’t go back ages but still..). That was frustrating. I got convinced that this was not the failure of a few silly or incompetent people, but there seemed to be a systematic and structural problem. I have worked on numerous great and successful projects as well, but nevertheless I thought that a new approach toward hospital operations, redesign and transition issues was needed and important. It should be based on principles from the field of logistics, operations research, organization theory and system theory. And the approach should include a lot of data analysis, not only because would we be able to know more about the hospital system and experiment with it in computer models, but it is the only way to make health care professionals (doctors and nurses) participate in the change. They can be convinced using data. Another thing is that these data should be easy to communicate about, so health care professionals and management would be able to quickly understand it or even better, they would be able to design their own effective hospital.

I thought, if there is little awareness for this topic in hospital boards – which was my impression -, through research I might be able to create it. And, to be honest, my ideas on how to do things differently, needed to be worked out. Once I started writing down my ideas and work out concepts, I discovered that what was on my mind, was not clear and good enough. By doing a PhD I committed myself to find out, in a more rigorous way, what hospital logistics is or should be about in relation to large scale hospital transformations.

For me it was relevant not being paid for it. Nobody offered payment, so it has not been an option either, but I see it as an advantage, because it means freedom and independence. As a consultant you are always of service to the person or institution who pays you. It is a fair deal and it surely has other rewards besides being paid for it; for example when a client is really satisfied that you have solved his or her problem. But it also limits pursuing your own ideas or answering questions that have not been asked. And like in every commercial business, time is money. I am often hired to solve a problem with the deadline being yesterday. I understand it – it’s part of consultancy life – but sometimes you want to think things through better. To me research feels like heaven in that sense.