Surgical Intensity and Specialization Preferences in Healthcare: An Operation- and Process-Management Perspective Using Bibliometric Analysis, Cognitive Mapping and Analytic Network Process (ANP)

Background: Surgical operations are an integral part of healthcare delivery and impose a substantial clinical and operational burden. Understanding how the operation- and process-management literature in healthcare reflects the intensity of surgical services and how this may affect the specialization preferences of healthcare professionals is important for strategic workforce planning. Methods: A bibliometric analysis was conducted on 272 academic publications obtained from the Web of Science Core Collection with the keywords “lean philosophy”, “health” and “process” to capture the operational and process-improvement perspective of healthcare services. In this work, the “lean philosophy” keyword was taken to denote the operation- and process-management view of healthcare services, not to reflect the whole literature on surgical intensity. This selection was performed due to the multiple reasons, with an example being that lean-related studies often discuss complexities of workflow, efficiency, organizational responsiveness, and quality optimization, which are aspects also directly linked to surgical operational intensity. The data were analyzed using the bibliometrix R package, R-4.6.0 to construct the keyword co-occurrence network. Based on this network, a cognitive map was designed to visualize the conceptual relationships among the themes. Thematic clusters based on the co-occurrence network were then evaluated and prioritized by using the Analytic Network Process (ANP). Pairwise comparison data were derived from seven experts (surgeons and healthcare managers), and the model was implemented in Super Decisions with consistency ratios below 0.10. Results: The findings of the co-occurrence analysis are five main thematic clusters with surgical intensity themes including Healthcare Services, Quality, Care, Health and Outcomes. The cognitive map shows that Healthcare Services and Quality have the most central positions and structural hubs in the literature, whereas Outcomes is a dimension of great importance in terms of performance. The ANP results show that Quality (limiting weight ≈ 0.21), General Topics (≈0.14) and Management and Leadership (≈0.13) are the most influential sub-themes with regard to surgical operational intensity and, indirectly, to specialization preferences. Conclusions: The findings reveal that quality management, organizational leadership and larger health policy concerns are closely associated with the intensity of operations of surgical services as depicted in the operation- and process-management literature. Healthcare workers might be inclined to relocate to job positions related to quality improvement and leadership in lieu of places with a high direct clinical burden. Such insights can guide the policies of strategic human resource planning and specialization balancing in healthcare systems.