The problem of operating-room scheduling: exploring the gap between theory and practice

Purpose Analytical decision-support methods hold significant promise for enhancing planning and control in complex service organizations. Yet, many of these technically sophisticated solutions struggle to gain traction in practice. We study the planning and scheduling of operating rooms (ORs), central to the management of operations in hospitals. Using research methodology and theoretical lenses in operations management (OM), we study the gap between technical theory on OR scheduling and the complex realities of healthcare practice. Design/methodology/approach We construct the theoretical perspective from a synthesis of the scheduling literature in Management Science and Operations Research (MS/OR), identifying its core premises. The practical perspective is obtained from an elaborate case study in nine hospitals. We find six key discrepancies between scheduling theory and healthcare practice, which we subsequently interpret through the lenses of the Theory of Swift and Even Flow and related OM theory. Findings The basic problem structure assumed in the scheduling literature was validated in practice. However, the complex and ambiguous goal structure, dynamic operating conditions and underdefined constraints complicate the optimization logic and ex ante planning approaches predominant in the scheduling literature. We develop propositions to strengthen alignment between scheduling theory and practice, grounded in OM perspectives on coordination and flow, continuous improvement, satisficing and flexibility in complex service systems. Originality/value Our study offers an empirically grounded, OM-centered analysis of the conditions and design principles under which algorithmic scheduling approaches may be effectively deployed. In doing so, we connect OM and MS/OR, two related fields studying healthcare operations from distinct angles.