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Introduction to Hospital Operations

Wallace J. Hopp and William S. Lovejoy introduce their book, which defines, explains, and applies management principles related to physical flows, decision making, quality, and human behavior of hospital operations.
Wallace J. Hopp and William S. Lovejoy introduce their book, which defines, explains, and applies management principles related to physical flows, decision making, quality, and human behavior of hospital operations.
This chapter is from the book

1.1. Stakeholders’ Perspectives

Thursday March 25, 2010, 8:46 p.m.

“#@%&*)^%#@!” Dr. Nate Greene swore as he clanged an easy layup clumsily off the rim.

Greene was an emergency physician from University Hospital who joined several of his medical colleagues to play basketball on Thursday evenings at a local elementary school gym. Because swearing was almost as rare as defense at these games, one of Greene’s teammates, orthopedic surgeon Dr. Ben Arnold, took notice. When the game ended and the players began leaving the gym, Arnold hung back with Greene.

“You okay?” he asked. “You seem a bit off tonight.”

“Aw,” Greene groaned. “My layups were just bricks tonight.”

“I don’t mean your shooting. That’s always terrible.” Arnold smiled. “But you seem kind of distracted tonight.”

Greene dropped the basketball banter and grew serious. “A woman I treated in the Emergency Department died in the hospital this morning. Bowel obstruction.”

“Mmmm.” Arnold commiserated. “That’s tough.”

“I knew her a little.” Greene continued. “She was taking care of both her elderly parents and a handicapped son. The family is completely devastated.”

“That is sad,” agreed Arnold. “But when it’s your time...”

“But that’s just it.” Greene’s voice rose. “I’m not sure it was her time to go.”

“Oh, oh. Did somebody screw up?” Arnold winced. “The surgeon?”

“No, not exactly.” Greene rubbed the basketball in his hands abstractedly. “I’ve been thinking about the case all day and I can’t put my finger on an outright error anywhere in the process. But we were slow at every step. The Emergency Department was crammed on Monday as usual, so she waited a long time. It took a while to get the CT scan and even longer to get the report. By the time we realized it wasn’t a virus, we’d already lost a day. Then the operating room was full, so it was another day before we got her on the schedule and a half day of delays after that. By the time they opened her up, there was no hope.” Greene dropped the ball and his voice. “I can’t help thinking that if we had been faster, she’d still be here.”

“Then it was the system that failed!” Arnold picked up the ball and began thumping it on the floor. “Every one of the people on the case did his or her job. So blame the hospital, not the people in it.”

“What are you talking about?” Greene grabbed the ball back and heaved up a shot that missed the rim by more than a foot. “The hospital is the people in it. We control what goes on there. So if it failed; we failed.”

“Are you kidding?” Arnold jeered, and not just about the wild shot. “Nobody controls the hospital. It’s too big, too complicated, and too set in its ways. That’s why I’m leaving.”

“What!” Greene had taken a step to retrieve the ball but stopped and turned to face Arnold. “Where are you going?”

“I’ve signed on with Andry Ortho,” Arnold replied. Nicolas Andry Orthopedic Surgery Center was a small physician-owned specialty hospital founded several years ago by a group of physicians from University Hospital. Greene was aware that the facility had undergone an expansion at the beginning of the year, right before the health care bill put a ban on further growth of physician-owned hospitals. But he didn’t know that Arnold had been considering joining them.

“Are you an owner?” Greene asked incredulously.

“Well, I have a piece,” Arnold admitted. “But it’s not the money that sold me. It’s the fact that the docs run the place. The hospital is small, simple, and new. We run on schedule. The IT system actually works. We can practice medicine instead of fighting the bureaucracy. The kind of system failure you had today won’t happen to us.”

“That does sound pretty good.” Greene recovered the basketball and flipped it to Arnold.

“You should join us.” Arnold launched a perfect jump shot that swished neatly through the center of the net. “We’ve been staffing the emergency facility with specialists, but demand has grown to the point where we could use a real Emergency Department doc. Specialty hospitals are the way of the future.”

“Hmmm...” Greene mused softly. “I’ll think about it.”

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