Waste in healthcare, specifically in acute episodes of care is an important concern in the healthcare industry. It has been estimated that 30% of the $2.6 trillion annual total of all health spending in the U.S. is wasted. This waste epitomizes the level of inefficiencies that are evident within various service encounters in the healthcare sector. Wastes can manifest in the forms of supplies, instruments, and time, yet there is a lack of clarity about the nature of waste, its causes, and ways to manage these inefficiencies within the literature. This dissertation intends to undertake a systematic and in-depth investigation of these issues by means of four essays. The first essay is a quantitative ethnographic study which analyzes participant observer data collected from over one-hundred surgeries which were performed in the operating theaters of a major teaching hospital. Observational, secondary, and survey data collected as a part of this ethnographic research will be analyzed to understand the nature of waste in the operating theater and the causes for these inefficiencies. The study specifically focuses on the role played by physician preference cards that are widely considered to be foundational for the efficiency of perioperative suites. It also examines the factors that help in keeping these physician preference cards updated. Building on the first essay and in concert with the observations in the operating theater, the second essay focuses on the issue of service disruptions. A systematic literature review of over 1,300 relevant articles identified in the literature will be undertaken to understand and synthesize the nature of these disruptions in hospitals. This synthesis provides the basis for essay three in which a more generalizable understanding of service disruptions and operational efficiencies in acute episodes of care will be examined. In particular, the third essay aims at examining the antecedents and consequences of service disruption risk in the context of acute episodes of care by means of primary survey data. Specifically drawing on the current theoretical work of supply chain disruptions, this study examines the antecedent role of system task and operational complexity. The study will further investigate the moderating roles of information exchange among acute care providers and the level of risk management infrastructure within the hospital.
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