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Overutilization and underutilization of operating rooms - insights from behavioral health care operations management

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Abstract

The planning of surgery durations is crucial for efficient usage of operating theaters. Both planning too long and too short durations for surgeries lead to undesirable consequences, e.g. idle time, overtime, or rescheduling of surgeries. We define these consequences as operating room inefficiency. The overall objective of planning surgery durations is to minimize expected operating room inefficiency, since surgery durations are stochastic. While most health care studies assume economically rational behavior of decision makers, experimental studies have shown that decision makers often do not act according to economic incentives. Based on insights from health care operations management, medical decision making, behavioral operations management, as well as empirical observations, we derive hypotheses that surgeons’ behavior deviates from economically rational behavior. To investigate this, we undertake an experimental study where experienced surgeons are asked to plan surgeries with uncertain durations. We discover systematic deviations from optimal decision making and offer behavioral explanations for the observed biases. Our research provides new insights to tackle a major problem in hospitals, i.e. low operating room utilization going along with staff overtime.

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Author information

Authors and Affiliations

  1. Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg (UNIKA-T), School of Business and Economics, Universität Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany

    Andreas Fügener

  2. TUM School of Management, Technische Universität München, Arcisstr. 21, 80333, München, Germany

    Sebastian Schiffels & Rainer Kolisch

Authors
  1. Andreas Fügener
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  2. Sebastian Schiffels
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  3. Rainer Kolisch
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Corresponding author

Correspondence to Andreas Fügener.

Appendix

Appendix

Instructions of the main experiment::

The instructions are translated from German and shortened since the original instructions also contain screenshots. Furthermore, they do not contain the cost values and the payment figures since they are different for the instruction of the low quantile case and the high quantile case. The instructions consist of four parts.

1. General information::

You are about to participate in an experiment in decision making. In the course of the experiment you can earn a considerable amount of money depending on your decisions. In the experiment, all monetary amounts are specified in Experimental Currency Units (ECU). They are converted according a fixed exchange rate into Euro (see payment determination) at the end of the experiment. The experiment is followed by a short questionnaire and, afterwards, you will be paid in cash. All your decisions and answers will be treated confidentially. Please read the following instructions carefully. If you have any questions, please ask.

2. Experimental task::

Consider the following simplified decision situation about planning of surgery durations. Your job is to reserve time for a surgery in the operating room. You don’t know how long the surgery will take but you know that the duration of that surgery is equally probable for any value between 100 and 200. Every reserved minute of the operating room is associated with costs. If your reserved time exceeds the duration, the remaining time can not be used otherwise. If the duration exceeds your reserved time, the additional time needed is associated with higher costs. The surgery can not be interrupted. For each minute you reserve the operating room, the costs are ECU ... (the costs per minute reserved too much correspond to ECU ...). For each minute the operating room is needed beyond the reserved time, the costs are ECU ... (the additional costs for each minute reserved too little correspond to ECU ...).

  • The cost per minute reserved time even occur if the duration is shorter than the reserved time.

  • The operation must be carried out until the end.

3. Experimental procedure::

The experiment consists of 20 rounds and the surgery duration in each round is independent of past surgery durations. Every round consists of two screens. The first screen summarizes the information already given in the instructions. Furthermore, you have to enter the minutes you want to reserve the operating room (between 100 and 200 minutes) in the red box and press the button “OK”. Please take sufficient time to make your decisions. Afterwards, the second screen appears. On the second screen, your reserved time is given again and you receive information about the realized duration. Furthermore, the resulting costs are listed. After pressing “OK”, the next round starts. You have to plan 20 independent surgeries.

4. Payment determination::

You can earn money dependent on your performance in the course of the experiment. At the end of the experiment, the costs in ECU incurred in all rounds are added together. These costs will be deducted from a fixed budget of ECU ..., which is available to fulfill the task. Your payoff is the resulting amount which is converted by a factor of ECU ... = €1. Depending on your performance, the payoff will be between €5 and €5.

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Fügener, A., Schiffels, S. & Kolisch, R. Overutilization and underutilization of operating rooms - insights from behavioral health care operations management. Health Care Manag Sci 20, 115–128 (2017). https://doi.org/10.1007/s10729-015-9343-1

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  • DOI: https://doi.org/10.1007/s10729-015-9343-1

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