Master Surgical Scheduling as a Complex Feedback System: A Systems Thinking and System Dynamics Perspective

Document Type : Research Article

Authors

Mohammad Ebrahimi ¹

Ramezan Khosravi ²

¹ Department of Management, Faculty of Humanities, University of Gonabad, Gonabad, Iran

² Department of Industrial Engineering, Faculty of Engineering, University of Gonabad, Gonabad, Iran

10.22067/jstinp.2026.99579.1214

Abstract

Master surgical scheduling (MSS) is a critical tactical planning problem that determines how operating room capacity is allocated to meet surgical demand. Existing research has predominantly used optimisation-based approaches focused on capacity allocation, resource utilisation, and schedule feasibility. Although these approaches provide valuable decision-support tools, they offer limited insight into the feedback mechanisms and dynamic interactions that shape long-term surgical-system performance. This study adopts a system dynamics perspective to investigate MSS as a complex feedback system. A causal loop diagram was developed through a synthesis of the literature and validated using a two-round fuzzy Delphi process involving 12 multidisciplinary experts. The diagram captures interactions among elective and emergency demand, specialty block allocation, effective capacity, downstream bed constraints, workforce conditions, treatment quality, patient satisfaction, hospital reputation, and financial resources. The analysis identifies eighteen feedback loops, comprising seven reinforcing and eleven balancing loops, organised around four cross-system mechanisms and an additional MSS-specific block-allocation and coordination mechanism; it also explicitly maps fifteen delayed effects. The findings indicate that surgical scheduling performance is shaped by the interaction between balancing mechanisms that seek to align demand and capacity and reinforcing mechanisms that intensify system pressure through patient deterioration, workforce burnout, and quality-related effects. This systems-thinking perspective highlights the importance of workforce sustainability, downstream resource constraints, treatment quality, and long-term capacity development in the design of sustainable surgical planning policies.

Keywords

Master Surgical Scheduling

System Dynamics

Systems Thinking

Hospital Operations Management

Causal Loop Diagram

Capacity Management

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