Some Origins of Operations Research in the Health Services
Authors: Charles D. Flagle
Venue: Operations Research (2002)

1055 W. Joppa Road, 203, Towson, Maryland 21204, cflagle@jhsph.edu INTRODUCTION Closer to home, and also in 1952, Dr. Ellis Johnson, Several apparently independent events around the year director of the Operations Research Office of the Johns 1952 formed the nucleus of what is now almost half a Hopkins University (ORO)-actually the program and staff century of operations research in the health services as of the U.S. Army Operations Research Office, administered I have known it. In England, Norman Bailey published by the University under contract-authorized the creation \"Operational Research in Medicine\" in the June 1952 issue of an informal seminar in operations research, conducted of Operational Research Quarterly (Bailey 1952), and on the University campus and organized by an ORO histo- almost simultaneously in the Lancet, a paper on appoint- rian, Joseph McCloskey, who edited the collected seminar ment systems in outpatient departments (Welch and Bailey papers into two volumes entitled Operations Research for 1952). His work was part of an operational research effort Management (McCloskey and Trefethen 1954, McCloskey supported by the Nuffield Provincial Hospitals Trust that and Coppinger 1956). The seminar had a dual purpose, first was influential in the development of Britain\'s National the enlightening of the faculty and students about opera- Health Service. In that same year publication of the Jour- tions research, which was not a well-known topic in civil- nal of the Operations Research Society was launched, and ian life at that time, and second, searching for an academic would soon provide an outlet for communication of similar home for OR in the departmental structure and curricu- work in America. lum of the University. I recall that a place in engineering In the United States the Hill-Burton legislation of 1945 was not the first choice of an academic home for much of to fund innovation, construction, and renovation of hospi- the ORO staff, with its mix of educational backgrounds- tals created an extramural research and development pro- something in the humanities would have been preferable- gram aimed at the provision of technical assistance and but it was fortunate that the Dean of Engineering, Robert guidelines for design, construction, and management of H. Roy, an articulate and experienced manager, a student hospitals and health facilities. This created the opportunity of organizational behavior and author of several books on for operations research to participate in a multidisciplinary administration, saw in the substance of operations research effort that became the nucleus for the soon-to-emerge a complementary element in his already multidisciplinary field of health services research. The development in both Department of Industrial Engineering. The relationship intragovernmental and extramural research was led by the between ORO and the School of Engineering was formal- Assistant Surgeon General for Hospital and Medical Facil- ized, and in time the name of the department would become ities, Dr. J. R. Haldeman. His vision extended beyond the Operations Research and Industrial Engineering. design and management of the physical infrastructure of In the Johns Hopkins Medical Institutions in 1952, facilities to the determination of community needs and Russell A. Nelson, M.D., a skilled clinician and adminis- resources and the integration of services, concerns that trator, was appointed Director of the Johns Hopkins Hos- would in time dominate the directions of health services pital while maintaining for a while his position as adjunct and research centered on them. lecturer in the Department of Public Health Administration These events are indicative of the post World War II in the School of Hygiene and Public Health, where he had changes in the role of government in the health services: in been developing an educational program in hospital admin- Britain the commitment to universal coverage of care, and istration. In a few years he would become president of the in America a responsibility for funding of needed medical American Hospital Association and would chair the Advi- care facilities in the aftermath of the war and the years of sory Committee on Hospital Facilities and Services of the economic depression that preceded it. In both countries the U.S. Public Health Service. need for support of research and education was recognized At the time all this was taking place, I was a gradu- and implemented, opening the door to forms of inquiry not ate student in Dean Roy\'s department, and was one of his widely accessible to the health services in the past. advisees. I was in the throes of doctoral research and some Subject classification: Professional: comments on. Area of review: Anniversary Issue (Special). Operations Research Â© 2002 INFORMS 0030-364X/02/5001-0052 $05.00 Vol. 50, No. 1, January-February 2002, pp. -60 52 1526-5463 electronic ISSN