Some Origins of Operations Research in the Health Services

Several apparently independent events around the year 1952 formed the nucleus of what is now almost half a century of operations research in the health services as I have known it. In England, Norman Bailey published “Operational Research in Medicine” in the June 1952 issue of Operational Research Quarterly (Bailey 1952), and almost simultaneously in the Lancet, a paper on appointment systems in outpatient departments (Welch and Bailey 1952). His work was part of an operational research effort supported by the Nuffield Provincial Hospitals Trust that was influential in the development of Britain’s National Health Service. In that same year publication of the Journal of the Operations Research Society was launched, and would soon provide an outlet for communication of similar work in America. In the United States the Hill-Burton legislation of 1945 to fund innovation, construction, and renovation of hospitals created an extramural research and development program aimed at the provision of technical assistance and guidelines for design, construction, and management of hospitals and health facilities. This created the opportunity for operations research to participate in a multidisciplinary effort that became the nucleus for the soon-to-emerge field of health services research. The development in both intragovernmental and extramural research was led by the Assistant Surgeon General for Hospital and Medical Facilities, Dr. J. R. Haldeman. His vision extended beyond the design and management of the physical infrastructure of facilities to the determination of community needs and resources and the integration of services, concerns that would in time dominate the directions of health services and research centered on them. These events are indicative of the post World War II changes in the role of government in the health services: in Britain the commitment to universal coverage of care, and in America a responsibility for funding of needed medical care facilities in the aftermath of the war and the years of economic depression that preceded it. In both countries the need for support of research and education was recognized and implemented, opening the door to forms of inquiry not widely accessible to the health services in the past. Closer to home, and also in 1952, Dr. Ellis Johnson, director of the Operations Research Office of the Johns Hopkins University (ORO)—actually the program and staff of the U.S. Army Operations Research Office, administered by the University under contract—authorized the creation of an informal seminar in operations research, conducted on the University campus and organized by an ORO historian, Joseph McCloskey, who edited the collected seminar papers into two volumes entitled Operations Research for Management (McCloskey and Trefethen 1954, McCloskey and Coppinger 1956). The seminar had a dual purpose, first the enlightening of the faculty and students about operations research, which was not a well-known topic in civilian life at that time, and second, searching for an academic home for OR in the departmental structure and curriculum of the University. I recall that a place in engineering was not the first choice of an academic home for much of the ORO staff, with its mix of educational backgrounds— something in the humanities would have been preferable— but it was fortunate that the Dean of Engineering, Robert H. Roy, an articulate and experienced manager, a student of organizational behavior and author of several books on administration, saw in the substance of operations research a complementary element in his already multidisciplinary Department of Industrial Engineering. The relationship between ORO and the School of Engineering was formalized, and in time the name of the department would become Operations Research and Industrial Engineering. In the Johns Hopkins Medical Institutions in 1952, Russell A. Nelson, M.D., a skilled clinician and administrator, was appointed Director of the Johns Hopkins Hospital while maintaining for a while his position as adjunct lecturer in the Department of Public Health Administration in the School of Hygiene and Public Health, where he had been developing an educational program in hospital administration. In a few years he would become president of the American Hospital Association and would chair the Advisory Committee on Hospital Facilities and Services of the U.S. Public Health Service. At the time all this was taking place, I was a graduate student in Dean Roy’s department, and was one of his advisees. I was in the throes of doctoral research and some