The Impact of Surgeon Daily Workload and Its Implications for Operating Room Scheduling

Abstract

In many service systems, an individual server’s workload can have a substantial impact on service time and quality. Such effects are particularly important in healthcare systems which often operate under resource and time constraints. In much of the literature, this effect of workload has been primarily considered at the system and instantaneous level rather than the individual and cumulative level. In this study, we investigate this relationship in the context of cardiac surgery, that is, how surgery duration and patient outcomes are affected by the individual surgeon’s daily workload. Using a detailed data set of more than 5,600 cardiac operations in a large hospital, we quantify how individual surgeon daily workload (the number of operations performed by the focal surgeon) affects surgery duration and patient outcomes. To handle the endogeneity of surgeon daily workload, we construct instrumental variables using operational factors of the cardiac surgery department, including the regular surgery schedule of surgeons. We find that high daily workload for the focal surgeon is associated with longer surgery duration as well as post-surgery length-of-stay in the intensive care unit and hospital. These results highlight the potential negative impact of high individual surgeon workload. We develop a surgical scheduling model that incorporates the estimated impact of surgeon daily workload. We solve the model by mixed-integer quadratic programing and show that our proposed schedule can substantially reduce total operating room (OR) time and post-surgery length-of-stay. Our results suggest that hospitals should take into account the effects of individual surgeon daily workload when managing their ORs. Specifically, they can substantially improve patient flow and patient outcomes by smoothing individual surgeon’s workload across days.