Perception of turnovers may be influenced less by actual turnover times per se than by a mental model of factors influencing turnover times.METHODS:
A survey was performed at a U.S. academic hospital in 2010. Each of the 78 subjects estimated characteristics of his/her turnover times in 2009. Responses were compared with the actual times.RESULTS:
Numbers of comments were not proportional to actual total waiting times experienced. Surgeons with 2 or more comments (n = 10) averaged the same numbers of turnovers as did surgeons who made 1 or no comments (n = 13) (P = 0.62). Four of the 10 surgeons with 2 or more comments averaged <2 turnovers per month (“very few turnovers”). Perceptions of turnover times were influenced by opinion about team activity during shift change. Most (>79%) subjects thought that the time of the day with the subject's largest number of prolonged (>45 minutes) turnovers was at least 2 hours later than actual (P < 0.0001). Although most prolonged turnovers occurred around noon, 8 surgeons mentioned shift change qualitatively, and most (68%, P = 0.002) subjects estimated a time overlapping with shift change. Surgeons overall overestimated their observed percentage of prolonged turnovers (P = 0.020), and anesthesiologists' estimates were overall unbiased. Surgeons' bias cannot be explained by knowing times of a longer interval such as “skin to skin,” because the other surgeons, with very few turnovers, had responses that were essentially identical (P ≥ 0.87). When we corrected for each subject's actual mean turnover time, surgeons' estimates for their averages were longer than were anesthesiologists' estimates (P = 0.002). Responses were again essentially indistinguishable from those of subjects with very few turnovers (P ≥ 0.23).CONCLUSIONS:
Managers should not rely on surgeons or anesthesiologists for their expert judgment on turnover times. Managers should also not interpret comments about turnover times as literally referring to the time, but instead as factors perceived as contributing to the time (e.g., attitude about the facility and the activity of its personnel).