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Operating lists are created by rational algorithms and use of power. What can a social scientific view offer surgeons?

Abstract

Purpose

Algorithms for surgical operation planning are evidence-based. However, choices sometimes have to be made between medically equal solutions e.g. for staffing of sought-after operations. Such decisions are heavily influenced by micropolitics and power. The article examines the array of highly manipulated processes around operation theatre allocation of convenient time slots or staff, which play out in various ways in all of the world’s main regional surgical cultures.

Method

Essay supported by empiric data from an ethnographic power-analysis targeted to senior executive surgeons. Operations were categorized into “Interesting” (i.e. career-promoting) and “Uninteresting” (i.e. routine) operations.

Results

Fifty nine executives responded. Only one respondent contested the categorization of operations into Interesting and Uninteresting. The two categories were staffed according to significantly different criteria (p < 0.05). These were classified as Rational (e.g. “surgical expertise”), Social (e.g. “equity”), and Political (e.g. “status”).

For Interesting operations, Rational criteria were deemed most relevant, while for the Uninteresting operations “equity” was ranked top. Moreover, we found significant differences between surgeons’ and external observers’ (experienced clerical and nursing staff) assessments of staffing decisions, the latter ranking Political motives higher. Decisions were almost exclusively negotiated among surgeons. 33% of respondents said they used subterfuges such as withholding information, incorrect duration-statements, and barter arrangements to defuse possible conflicts.

Conclusions

Operating Lists are not merely the product of rational resource optimization. This article demonstrates the methodic feasibility of academic investigation into the typically tacit micro-political mechanisms in List-making. Developing such research further may potentially concern the practice and outcome of surgery.

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Acknowledgments

Staff mathematician Karin Rohwer-Menschig, Hannover Medical School (MHH), Germany, for expert advice regarding hospital SAP, Wendy Lynas, MA, Copenhagen and James Moran, PhD, University of Konstanz for inspired editing, Prof. Windeler, Sociology TU Berlin, for valuable advice.

Authors’ contributions

Carsten Engelmann and Dzifa Ametowobla contributed equally to this article.

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Corresponding author

Correspondence to Carsten Engelmann.

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Funding

No funding other than that from the generic hospital budgets was received for research or publication.

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval/protection of human subjects

Patients or animals were not involved such as the ethical committee said it was not concerned. The institutions’ workers’ committee and the institutions legal affairs department granted permission valid for all sites (Nr. 9510, 18.7.2013). All respondents did so voluntarily, thereby declaring consent.

Electronic supplementary material

ESM 1

Detailed methods & results of the theater list study results.pdf; 2. Original questionnaire.pdf (DOCX 1.65 mb)

ESM 2

Theatre Planning with SAP (PDF 368 kb)

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Engelmann, C., Grote, G., Geyer, S. et al. Operating lists are created by rational algorithms and use of power. What can a social scientific view offer surgeons?. Langenbecks Arch Surg 402, 187–190 (2017). https://doi.org/10.1007/s00423-016-1516-y

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Keywords

  • Power
  • Politics
  • Operating lists
  • Health IT
  • Surgical curricula