# Kellogg 0

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## WHAT IS IT?

A model based on:

Kellogg, K. C. (2009). Operating Room: Relational Spaces and Microinstitutional Change in Surgery. American Journal of Sociology, 115, 657–711. doi:10.1086/603535

## HOW IT WORKS

Agents all represent surgeons in training. They are responding to a recent change in hospital regulations, mandating shorter working hours for all residents. One part of the change is easy--hospitals add a "night float" position which means that residents only need to be on call overnight once a month instead of

Each doctor has an opinion about the new rules, either as "reformer" (in favor) or a "defender" (against).

These opinions vary in strength; people start off basically sympathetic to one or another, but their opinions change over time/due to their experiences.

They also have knowlege of how to complete their role, either in the traditional or reformed framework

Finally, they also take action in the form of working either longer or shorter hours.

If a higher status person who is a defender is around, a lower status person will always work longer hours. If not they'll follow their own opinion.

Doctors can also influence one anothers opinons.

## HOW TO USE IT

Turn Privacy on and off. This changes whether rounds happen far away from other doctors or right amongst them

## THINGS TO NOTICE

In Kellogg's case, the hospital where rounds are conducted privately succeeds in implementing reform, and the hospital where rounds are conducted in a more public place doesn't.

I'm not reliably achieving that reference pattern (yet?). . .

## THINGS TO TRY

(suggested things for the user to try to do (move sliders, switches, etc.) with the model)

## EXTENDING THE MODEL

(suggested things to add or change in the Code tab to make the model more complicated, detailed, accurate, etc.)

## NETLOGO FEATURES

(interesting or unusual features of NetLogo that the model uses, particularly in the Code tab; or where workarounds were needed for missing features)

## RELATED MODELS

(models in the NetLogo Models Library and elsewhere which are of related interest)

## CREDITS AND REFERENCES

(a reference to the model's URL on the web if it has one, as well as any other necessary credits, citations, and links)

## Comments and Questions

turtles-own [ opinion service arrival-time leaving-time scut-work night-float? rounding? ] ;; note this doesn't give people a day off at all yet patches-own [doctors-here] breed [chiefs chief] breed [seniors senior] breed [interns intern] ;breed [dropped-balls dropped-ball] ;; Create doctors at 3 levels of hierarchy (differentiated by shape). ;; Give them opinions about whether the status quo should be defended or reformed to setup clear-all create-chiefs 5 [ ;set opinion one-of ["defender" "reformer"] set shape "star" set size 1.3 ] create-seniors 15 [ ;set opinion one-of ["defender" "reformer"] set shape "pentagon" ] create-interns 20 [ ;set opinion "reformer" set shape "x" ] ask turtles [ setxy random-xcor random-ycor set rounding? false set night-float? false set scut-work [] reset-daily-schedule ] ; ask patches ; [ set doctors-here count turtles-here + count turtles-on neighbors ] assign-chiefs&seniors assign-interns ; assign-intern-work reset-ticks tick-advance 6 end ;; monthly service assignments to assign-chiefs&seniors ask turtles [ set service 0 set night-float? false] ask n-of 4 chiefs [ rotate 1 chiefs ] ask n-of 4 seniors [ set night-float? true rotate 1 seniors ] ask n-of 4 seniors with [night-float? = false ] [ rotate 2 seniors ] ask seniors [ reset-daily-schedule ] end to assign-interns ask interns [ set service 0 ] ask n-of 4 interns [ rotate 1 interns ] end to rotate [num pos] set service ( 1 + random 4 ) if count other pos with [ service = [ service ] of myself] >= num [ rotate num pos ] end ;; daily arriving and leaving times, according to position to reset-daily-schedule if is-chief? self [ set arrival-time 6 set leaving-time 19 ] if is-senior? self [ set arrival-time 6 set leaving-time 19 ] if [ night-float? ] of self = true [ set arrival-time 18 set leaving-time 7 ] if is-intern? self [ set arrival-time 6 set leaving-time 19 ] end to go ;; long term schedules: monthly-schedule daily-schedule ;; each hour (ie tick): complete-tasks move tick end to monthly-schedule ;; every 4 weeks (counting only 6 days to a week, interns switch services if ticks mod 576 = 0 [assign-interns] ;; every 8 weeks, chiefs & seniors switch services (really some seniors should switch every 6 . . .) if ticks mod 1152 = 0 [assign-chiefs&seniors] end to daily-schedule ;; each turtle shows up and leaves according to its arrival and leaving times ;; when turtles arrive they assess whether what they did yesterday worked and decide what to do accordingly ask turtles [ if ticks mod 24 = arrival-time [ show-turtle take-over ] if ticks mod 24 = leaving-time [ hand-off hide-turtle ] ] ;; I'm not sure I want a pre-set leaving time ...I think I might want leaving to be a behavior that happens according to the model; ;; I think this can do that, since it updates every tick ;; every morning when the chiefs and seniors (and interns?) come in at 6, ;; the interns' new tasks are assigned (not really, but that's ok for now) if ticks mod 24 = 6 [ assess-strategy assign-intern-work ] ; report hours ] ;; at 5pm, chiefs gather their teams for afternoon rounds if ticks mod 24 = 17 [ ask chiefs with [service != 0 ] [pick-rounds-spot ] ] ;; afternoon rounds happen between 5 and 7pm (I don't think they really take 2 hours in the hospital, but this gives a chance to ; see it in the animation if ticks mod 24 > 16 and ticks mod 24 < 19 [ ask turtles with [service != 0 and hidden? = false and rounding? = false] [ set rounding? true ] ask turtles with [ rounding? = true ] [ afternoon-rounds ] ] ;; at 7pm rounds are over, and interns "should" be handing off routine work to night floats if ticks mod 24 = 19 [ ask turtles with [rounding? = true ] [ set rounding? false ] ] end to assess-strategy ask turtles with [ service != 0 ] [ let dropped-balls [ scut-work ] of turtles with [ service = [ service ] of myself ] set dropped-balls ( reduce sentence dropped-balls ) ;show dropped-balls if dropped-balls != [] [ ;show "problem!" assign-blame change-strategy ] ] end to assign-blame end ;; Bleggggh how to do this??? to change-strategy if is-intern? self [ select-strategy ] ; if scut-work = [] ; [ set leaving-time ticks mod 24 ] ] end to select-strategy let strategy random 2 if strategy = 0 [ set leaving-time leaving-time + 1 ] if strategy = 1 [ set arrival-time arrival-time - 1 ] end to take-over ask interns with [ service != 0 ] ;; takeover what's left from the night before [ let my-float one-of turtles with [service = [service] of myself and night-float? = true ] set scut-work sentence scut-work [scut-work] of my-float ask my-float [ set scut-work [] ] ] end to assign-intern-work ask interns with [ service != 0 ] ;; add the day's responsibilities [ set scut-work sentence scut-work [ 1 2 3 4 5 6 7 8 9 0 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ] ] end to complete-tasks ask turtles with [ scut-work != [] and hidden? = false] [ set scut-work remove first scut-work scut-work ] end to move ask turtles [ if hidden? = false and rounding? = false [ rt random 45 lt random 45 fd .5] ] end to afternoon-rounds ; if ticks mod 24 = 17 ; [ pick-spot ] ; interact ; end to pick-rounds-spot ifelse privacy = true [ move-to min-one-of patches [doctors-here] ] [ move-to max-one-of patches [doctors-here] ] ask other turtles with [service = [service] of myself ] [ move-to one-of [neighbors] of [ patch-here ] of myself] end to interact end to hand-off ask interns with [ service != 0 ] [ ask one-of turtles with [service = [service] of myself and night-float? = true ] [set scut-work sentence scut-work [scut-work] of myself] set scut-work [] ] ;] end to-report current-time let hours ticks mod 12 if hours = 0 [ set hours 12 ] let am-pm "am" if 1 + ticks mod 24 > 12 [ set am-pm "pm" ] report word hours am-pm end ;to-report hours ; ask interns ; [ if hidden? = false ] ; [ set daily-hours daily-hours + 1 ] ; ; ;end ;; how 'bout this: ;; every time there's a handoff, there's also a % chance of a dropped ball; ;; someone ; set service number-groups ; set number-groups number-groups - 1 ; if number-groups < 0 ; [ set number-groups count chiefs ] ;end ;to go ; wiggle ; call-team ; pick-spot ; assess-expectations ; find-influencers ; be-influenced ; adjust-appearance ; tick ;end ; ;;; When they are not doing rounds, let doctors walk around the hospital randomly ; ; ;;; Show doctors' opinions and actions in their color and size ; ;to adjust-appearance ; ask turtles ; [ if opinion = "defender" ; [ set color blue - 2] ; if opinion = "reformer" ; [ set color blue + 2 ] ; if action = "shorter hours" ; [ set size 1.5 ] ; if action = "long hours" ; [ set size 2 ] ; ] ; ;end ; ; ; ;; [ ask n-of group-size turtles with [ current-group = 0 ] ;; [ set current-group number-groups ] ;; set leaders (turtle-set leaders (one-of turtles with [current-group = number-groups ]) ) ;; set number-groups number-groups - 1 ] ;; ask turtles with [ current-group = 0 ] ;; [ die ] ;; ;; layout-circle chiefs 13 ;; ask chiefs ;; [ ask patch-here ;; [ set group-center [ current-group ] of myself ] ] ;; ask turtles ;; [ join ] ; ;;end ; ;;to join ;; move-to one-of patches with [group-center = [ current-group ] of myself ] ;; bk 2 ;;end ; ; ; ; ;;; Put together a team of 1 chief, 3 seniors and 4 interns who will work together ; ;;to call-team ;; ask turtles [ set rounding? false ] ;; ask one-of chiefs [set rounding? true] ;; ask n-of 3 seniors [set rounding? true] ;; ask n-of 4 interns [set rounding? true] ;;end ; ;;; As the chief to pick a spot for them to conduct rounds ;;; If privacy is true they try to pick a spot without other people around ;;; If privacy is false they pick a spot with lots of other doctors around ; ; ;;; Ask interns and seniors to assess the expectations of their superiors, and set their actions accordingly ;;; If anyone of higher status expects them to work long hours, they will do so ;;; Otherwise they'll follow their own opinion ; ;to assess-expectations ; ask interns with [ rounding? = true ] ; [ ifelse any? chiefs in-radius 3 with [ opinion = "defender" ] ; [ set action "long hours"] ; [ ifelse any? seniors in-radius 3 with [ opinion = "defender" ] ; [ set action "long hours"] ; [ enact-own-opinion ] ] ] ; ask seniors with [ rounding? = true ] ; [ ifelse any? chiefs in-radius 3 with [ opinion = "defender" ] ; [ set action "long hours"] ; [ enact-own-opinion ] ] ;end ; ;to enact-own-opinion ; if opinion = "defender" ; [ set action "long hours"] ; if opinion = "reformer" ; [ set action "shorter hours"] ;end ; ;;; Let doctors have their minds changed by those they interact with on rounds ;;; Doctors are influenced by those of the same or higher status ;;; Chiefs are only influenced if everyone they're working with on a shift came in ;; already working in the reform way (ie with shorter hours) ; ;to be-influenced ; ask turtles with [ rounding? = true and influencers != 0 ] ; [ if count influencers with [ opinion = "reformer" ] > count influencers with [ opinion = "defender" ] ; [ set opinion "reformer" ] ; if count influencers with [ opinion = "reformer" ] < count influencers with [ opinion = "defender" ] ; [ set opinion "defender" ] ] ; ask chiefs with [ rounding? = true ] ; [ if count turtles with [ rounding? = true and action = "shorter hours"] = count turtles with [rounding? = true ] ; [ set opinion "reformer" ] ] ; ;end ; ; ;to find-influencers ; ask turtles ; [ if is-intern? self ; [ set influencers (turtle-set chiefs with [ rounding? = true ] seniors with [ rounding? = true ] interns with [rounding? = true]) ] ; if is-senior? self ; [ set influencers (turtle-set chiefs with [ rounding? = true ] seniors with [ rounding? = true ] ) ] ] ;end ;to service-setup ; let number-groups count chiefs ; ask chiefs ; [ set service number-groups ; ask n-of 2 seniors ; [ set service number-groups ] ; ; join ] ; ask one-of interns ; [ set service number-groups ] ; ; join ] ; set number-groups number-groups - 1 ] ; ; ;end ; ;to network-setup ; build-formal-ties ; build-informal-ties ;end ; ; ;to build-formal-ties ; ;; create formal, directed ties between people on the same service ; ;; the higher status people give orders, the lower people follow them ; ; ;end ; ; ;to build-informal-ties ; ;; create informal positive ties among people at similar status levels who have similar opinions about the reform ; ;; create informal positive directed links bewteen high status people and underlings who do what they want them to ; ;; create informal negative directed inks between high status people and underlings who implement the reform?? ; ; ; ;end ;to go ; switch-services ; act ; interact ; ; tick ;end ; ; ; ;to act ; ; ;end ; ; ;to interact ; ; ;end ;to arrive ; ask turtles ; [ if current-time = arrival-time ; [ show-turtle ] ] ;end ;to leave ; ask turtles ; [ if current-time = leaving-time ; [ hide-turtle ] ] ;end

There are 3 versions of this model.

## Attached files

File | Type | Description | Last updated | |
---|---|---|---|---|

EleanorAnderson_ 6 03 13.docx | word | project update 6 3 13 | over 5 years ago, by Eleanor Anderson | Download |

project update 5 18 13.docx | word | Update 5 18 13 | over 5 years ago, by Eleanor Anderson | Download |

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