These bullet points correspond to my experience. The last one is closely related to the points highlighted in my previous response regarding the role of stakeholders.
Original Message:
Sent: 05-24-2025 11:12
From: Alexander Kolker
Subject: Encyclopedia of Business Analytics and Optimization. Chapter: Management Science for Healthcare Applications.
Satkar Karki,
thank you for your appreciation of my chapter "Management Science for Healthcare Applications". Your question regarding the most significant barriers currently preventing broader adoption of discrete event simulation (DES) and other advanced management science (MS/OR) methodologies in hospital operations is typical, and it is frequently asked. Based on my experience working in hospitals with my "skin in the game," I would summarize my answer as follows (a discussion of this issue is also included in Chapter 1 of my recent book, "Healthcare Management Engineering in Action," Springer, 2024).
It is well known that various individuals in management roles within a healthcare organization might have various objectives and personal agendas. Management decisions of various individuals in a structurally rigid organization are not weighted equally. All organizations have a power structure in which the influence and opinion of some members are much stronger than that of others. Therefore, the implementation of MS/OR solutions depends on the position of the key stakeholders, no matter how well these solutions are justified from the MS/OR standpoint. Upper-level administrators and medical leaders such as the CEO, COO, CMO, VP of quality, Chief of Surgery et al have veto power as the key stakeholders. Any management decision, especially a high-level one, needs their approval to get implemented. If any key stakeholder perceives a proposed solution as conflicting with his/her goal or personal opinion, that stakeholder may block or alter the action. Hospitals tend to have more key stakeholders than other types of organizations. Any hospital's key stakeholder could potentially prevent or delay the implementation of changes going forward. For a change to be implemented (no matter how well it is justified) all key stakeholders must perceive themselves to be better off with the change than without it. Successful implementation of a well-justified MS/OR solution requires that (i) a convincing need for change is effectively communicated within the organization, (ii) the reservations and concerns of all key stakeholders are recognized and addressed, and (iii) an implementation plan is properly executed and is sustainable. That's why a change within a department (say, the Emergency Department or ICU alone) is easier than a systemic change within the entire organization because organizational change involves more diverse key stakeholders.
Thus, even a well-justified MS/OR solution is not enough to make it practically implementable. If the implementation of a solution (or change) makes at least one key stakeholder better off and makes no other key stakeholder worse off, then the solution is called Pareto efficient. As a consequence, a Pareto-efficient solution has the highest chance of being implemented. Not taking this fundamental principle into account is, perhaps, one of the main reasons for the slow implementation of MS/OR methodology for decision-making in healthcare settings (along with the educational and technical reasons outlined in the Preface of my above-mentioned book).
I am not sure that I answered your question convincingly. The issue is complex and is worth a thorough discussion in INFORMS forum to get other people's views.
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Alexander Kolker
ge healthcare
MILWAUKEE WI
Original Message:
Sent: 05-23-2025 21:03
From: Satkar Karki
Subject: Encyclopedia of Business Analytics and Optimization. Chapter: Management Science for Healthcare Applications.
Thank you, Dr. Kolker, for this exceptionally thorough and insightful chapter. Your analogy of treating a hospital as a "patient" and using management science as the diagnostic and treatment framework is particularly powerful-it underscores the critical need for systematic, data-driven approaches in healthcare management. I also appreciated the practical articulation of the "flaw of averages" and how overlooking variability leads to flawed decisions. This point especially resonated as I've seen it play out in operational planning contexts.
Question:
In your view, what is the most significant barrier currently preventing broader adoption of discrete event simulation (DES) and other advanced management science methodologies in hospital operations? Is it a lack of technical capacity within organizations, resistance to change from traditional management culture, or something else?
Thank you again for advancing this important conversation.
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Satkar Karki
University of South Dakota
Vermillion SD
Original Message:
Sent: 05-16-2025 16:54
From: Alexander Kolker
Subject: Encyclopedia of Business Analytics and Optimization. Chapter: Management Science for Healthcare Applications.
The main goal of this chapter is to provide an overview of business analytics and management science methodology for healthcare and summarize some general management principles that play the role of laws of physics in natural sciences.
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Alexander Kolker
MILWAUKEE WI
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