What is the difference between operational and policy decisions in the context of a medical malpractice case?

Turning to the more general issue, because the City does not deny that it owed a duty to the plaintiff, the distinction between operational and policy decisions which sometimes bedevils the law does not arise (see Just v. British Columbia, 1989 CanLII 16 (SCC), [1989] 2 S.C.R 1228 at para. 28). Given the existence of a duty of care, the issue of liability falls to be decided upon the application of traditional negligence principles. The analysis was expressed by Cory J. in Ryan v. Victoria (City), 1999 CanLII 706 (SCC), [1999] 1 S.C.R. 201, at para. 28 in the following terms: Conduct is negligent if it creates an objectively unreasonable risk of harm. To avoid liability, a person must exercise the standard of care that would be expected of an ordinary, reasonable and prudent person in the same circumstances. The measure of what is reasonable depends on the facts of each case, including the likelihood of a known or foreseeable harm, the gravity of that harm, and the burden or cost which would be incurred to prevent the injury. In addition, one may look to external indicators of reasonable conduct, such as custom, industry practice, and statutory or regulatory standards.