“A hospital is no place to be sick,” is a quote attributed to Samuel Goldwyn, a pioneering Hollywood producer and film studio mogul. Of course, you go to the hospital if you need to. Additionally, “Which day?” is the most important question to ask when arranging a surgical treatment.
The American College of Surgeons estimates that 15 million Americans undergo surgery annually. Due to overcrowding in many U.S. hospitals, post-operative bed shortages and procedure delays are frequent occurrences. These setbacks are expensive for hospitals, draining for physicians and nurses, and even fatal for certain patients.
For instance, a recent statewide research conducted in New York revealed that the number of scheduled procedures per day varied significantly more than the number of emergency hospital admissions per day. Elective surgery was another story. The majority of those operations took place on Mondays or Tuesdays, which led to overpopulation and overstretched care and resources.
How might this issue be resolved? Instead than adding more beds, hospitals could schedule surgeries more carefully in order to enhance “patient flow.” It has been demonstrated that spreading out the surgical schedule over the course of a week reduces hospital expenses, patient death rates, overcrowding in emergency rooms, and nursing shortages and burnout.
However, a lot of hospitals and surgeons are unwilling to adapt.
Eugene Litvak has dedicated his life to persuading surgeons and hospitals of the advantages of expedited surgical scheduling. Litvak is the president and CEO of the Institute for Healthcare Optimization, a nonprofit organization based in Boston that advocates for hospitals to adopt the same strict operational management standards that govern any successful company. He is a staunch supporter who is dedicated to improving and changing the way hospitals provide medical care. Litvak’s 2013 Wall Street Journal opinion piece, “Don’t Get Your Operation on a Thursday,” is a noteworthy illustration of his argument.
According to Litvak, who is also an adjunct professor of operations management at the Harvard School of Public Health, hospital bed occupancy varies throughout the week, experiencing highs and lows. Contrary to popular belief, scheduled admissions—primarily for planned surgery—rather than erratic patient arrivals at the emergency room are the primary cause of this bed occupancy instability.
Author Mark Taylor’s latest book, “Hospital, Heal Thyself: One Brilliant Mathematician’s Proven Plan for Saving Hospitals, Many Lives, and Billions of Dollars,” explores Litvak’s life, research, and hospital logistics. Litvak discussed why hospitals are struggling with surgical scheduling, why this specific change is essential to enhancing U.S. healthcare, and what can be done in this MarketWatch phone conversation, which has been condensed for clarity and length.
BW: It would seem obvious that this is a tried-and-true method for hospitals to serve patients while saving money. Research and case studies provide the evidence. However, there is opposition to your approaches in the healthcare sector, both public and private. Why?
Litvak: Let me state the facts first. The adoption rate is extremely slow. And I’m guessing that’s because healthcare has been cost-plus reimbursed for a very long time. In essence, money has been used to solve every healthcare issue. Many people who make decisions about health still think that way.
Let’s say you make $1 million a year. Then, it will suddenly be $200,000. You still have a $1 million attitude. At the hospitals, it is the situation. Many people still think that cost-plus reimbursement will return to its former glory.
However, the margins of many hospitals are decreasing, and many are closing. This is in a nation where hospitals are essential.
We ought to have the financial means to improve hospitals. Things would drastically alter if this issue arose in the manufacturing, banking, or airline industries. However, there are no financial incentives for the healthcare industry to do so.
BW: Based on what you’re saying, it appears that the hospital sector can only grow.
Litvak: A lot of this stems from their unwillingness to alter their perspective. To the best of my knowledge, just two sectors do not actively use operations management: education and healthcare. There are management, operations, research, and industrial engineering divisions in every other industry. Although it goes by numerous names, it is the same thing.
Because, once more, there were no financial incentives for a very long time. And I can assure you that I would be the first to invest my money in for-profit hospital systems that use this technique.
BW: Have you discovered any further implementation-related obstacles?
Litvak: They just don’t know, which is one of the reasons. I was quite aback when I spoke to folks about things they were unaware of.
The hospital’s leadership is the second factor. Hospital CEOs typically hold their positions for five or six years. Consequently, a new CEO will be appointed.
A hospital CEO’s life is usually quite demanding. There are too many people in emergency rooms. Nurses are departing. Medical mistakes do happen. Stories about them are appearing in local publications. Therefore, after a long day, the hospital CEO is likely thinking about how lovely it would be to go fishing in Florida in a few years when they go to bed.
Thus, another barrier to adoption in this case is CEO turnover. Why should I participate in an intervention that will take a few years to complete? Furthermore, politically implementing the action is not that simple. If my successor is the only one who would get the benefits, why would I become involved?
If I were a surgeon, I would like to operate on Monday or Tuesday in order to have time to spare by the weekend. The hospital is under stress as a result.
BW: The administration of a hospital and its physicians frequently clash, both financially and professionally.
Litvak: Surgery is a hospital’s primary source of income. So let’s imagine ourselves as surgeons. Which day would I want to perform surgery if I were a surgeon? Presume that I must visit my patient the day following the procedure and possibly on a subsequent day. In order to be free by the weekend, I would want to operate on Monday or Tuesday.
At the hospital, this leads to stress. As a result, throughput is decreased overall. Additionally, because surgeons might leave the hospital with their patients, some hospital administrators are hesitant to engage in these disputes with surgeons. The board would then terminate the hospital’s CEO due to declining profits.
So where are these hospital executives mistaken? They are mistaken in their belief that manipulating surgeons is the best method to enhance hospital operations. That is just incorrect.
BW: Therefore, the administration’s goal would be to persuade surgeons to support the procedure that is actually best for them. Regarding who genuinely supports this modification to medical protocols, you have made an intriguing observation thus far. The CEO isn’t the one.
Litvak: The hospital’s top surgeons have not only encouraged but also started the majority of these surgeries.
Here are some advantages for surgeons. Let’s say you have a route and I provide you two ways to guide the vehicles. Ten cars are sent in the first, followed by 120, 50, and 90. In the other, you connect the front of one vehicle to the rear of the vehicle in front of you. In what situation would I deploy additional cars?
The second, without a doubt. Everyone would be using my road. What implications does this have for hospitals? First of all, it means that hospitals will operate as many surgeries as possible. Additionally, it would result in a higher salary for non-salaried surgeons.
The placement of patients in the appropriate bed serves as an additional motivator for surgeons. Take the instance of Lewis Blackman, a young man, from November 2000. His surgery was originally set for Monday, but it was moved to Thursday so he could spend more time with his buddies.
Despite the fact that the procedure was a huge success, hospitals were completely booked by Thursday. Lewis was so assigned to a bed in the pediatric oncology unit. He had an issue during the weekend, but the nurses there couldn’t figure it out. Lewis therefore passed away following a successful operation. He was fifteen years old.
Because they are, of course, attempting to rescue patients, and because their lives may later be wrecked, surgeons are extremely sensitive to this. In order to ensure that their patient is cared for, some surgeons have been known to stay overnight if their patient is admitted to the incorrect ward. However, that was a long time ago. Nowadays, very few surgeons spend the night in order to rescue their patients.
BW: Cincinnati Children’s Hospital in Ohio is cited in “Hospital, Heal Thyself” as an illustration of a hospital that effectively manages its surgeries. How did the management there get over the financial and professional barriers to this process?
Litvak: Cincinnati Children’s former president and CEO, Jim Anderson, is not a medical doctor. He was on the board of directors of the hospital and worked in manufacturing. It began when he received an invitation to become president and CEO.
One of the top doctors at the hospital has heard my talk before. Jim therefore asked me to assess the hospital’s patient flow and surgical scheduling practices. Jim invited me to assist the hospital in putting this strategy into practice after we presented our evaluation to him and the chiefs of surgery, anesthesia, and nursing.
“No,” I replied. In response to Jim’s question, I said, “Because those people who are smiling at me now will create roadblocks.” Jim responded, surveying the room, “All right. For this study, I am now the principal investigator. And you give me a call personally if you run into any issues.”
