In a recent interview, Megan Eubanks, Senior Director of Business Operations of Perioperative and Procedural Services at The University of Kansas Health System (TUKHS), discussed her team’s success in creating a better system for managing OR block time in a unique organization, starting with delivering accurate and reliable performance data.
Question: Can you start by talking about TUKHS’ perioperative footprint, and the unique way your system allocates block time?
Megan Eubanks: Our health system comprises over 100 hospital and clinic locations, with over 1,000 physicians and 14,000 employees. We perform 34,000 surgeries annually in our 52 ORs, cases which are fed by three million outpatient visits and 63,000 emergency visits, as well as urgent add-ons. TUKHS supports our sister hospitals by providing OR space to them, and has additional ambulatory ORs as well.
Because we’re a Level One trauma center, it’s critical we’re ready to accommodate urgent and emergent add-on cases. Each of our service lines have time allocated within their service block for trauma. Block allocation is managed by individual service chairs, rather than a single block committee, so a priority for us is keeping universal visibility into block management data.
With an already large footprint prone to emergency add-ons, we’re experiencing volume growth in our surgical department, which we need to accommodate without further expanding site or staff. Instead, the system must deploy better operating room utilization management and tactics to extend the capacity it already has.
Q: What’s your perspective on block utilization and management, and how does that tie into the challenges you’ve had at TUKHS?
ME: Block utilization is often thought of as the time we grant a service group or surgeon to the OR, compared to how well they use that time. This means in-room time – actual wheels in to wheels out, plus patient prep, clean up, and turnover – compared to how much time was allocated and manually released prior to the date of scheduled release.
But this number is only one piece of the picture. Block utilization doesn't tell us exactly how that service or that surgeon is performing, and it doesn’t necessarily amount to additional capacity. One surgeon’s block utilization could show consistently at 100%, while that individual's releasing a lot of their time. Another could be at 60% utilization, but as a neurosurgeon with long case times, they simply don’t have flexibility to add more. We need to know these details to make informed decisions and improve our block management, or else we risk making arbitrary choices that aren’t based on the full story.
What makes us unique at TUKHS is how our locations are almost fully allocated to services, who each manage their own block assignments. We know there's untapped opportunity in those existing service allocations, including through higher releases of surgeons’ unused time, but there's no visibility into them. We have a significant number of add-ons outside of existing block allocations, and all those can only be accommodated if time is released. Underutilized blocks does not necessarily mean additional capacity.
Overall the biggest barrier we’ve had to efficiently using the OR, especially block time, is lack of visibility – and the data that has been visible has not been highly trusted. We needed a platform to not only make the data visible to support decisions, but also reliably show available time in the OR and better support surgeons and service lines releasing that time. To start supporting block management this way, we adopted the analytics platform iQueue for Operating Rooms.
Q: How has the TUKHS surgical department started to address those block management challenges to use more capacity, and how did data visibility support that process?
ME: Our goal is to create a foundation of block management through our relationships with our service chairs and provide trusted analysis of the data for decision support. TUKHS is a lean organization, and always looking for opportunities to improve performance, and the iQueue platform has created all kinds of opportunities for us to optimize OR access, utilization, and block management as a team. We can now truly give our service chairs their time and empower them to manage it with the surgeons and staff in their group.
We don’t have a block committee, but we do have a strong partnership with our chairs, so having iQueue as a source of truth to share data with them has been a huge value add. The at-a-glance operational data from iQueue’s analytics helps us all drill down to figure out the “why,” as well as “how” to improve, for each service line.
iQueue let us very quickly and easily update how our surgeons were mapped, so that it credited utilization appropriately. We also highlighted how our blocks had been consistently released 48 hours prior to the date of procedure for all services and surgeons, allowing no time to add cases on, and encouraged longer lead times. We could customize service and surgeon level releases based on those on practice as represented in the data and use the data as needed to optimize our standards.
Q: How has accessible data changed surgeon and leadership behaviors around utilization?
ME: Having all this visible and accessible data – at the location and service line levels and updated in real time – fostered an environment of strong communication and processes with our department chairs, who have also found much value in having that data at their fingertips. Our surgeons and their leadership are extremely busy and need to see their true performance at a glance. For instance, if I'm a surgeon and want to learn how to improve my OR performance, I can look on my mobile device and identify the reasons for late starts or long turnover or case length accuracy and check how I’m performing as I’m running down the hall to see patients.
The addition of release reminders for surgeons has been a major support for better use of OR time. iQueue sends out real time alerts our surgeons can react to and act on, which helps more time be released and become available immediately. Our clinics, surgeons, and their schedulers then can look ahead into the OR calendar, see that released time has become available and reserve it. They can also place themselves on a waiting list for a time slot they want, and then be instantly notified if another surgeon releases it.
Q: What are the results you’ve seen from taking these steps for a better overall block management system, and how do you plan to build on these in the future?
ME: We previously saw quite a bit of a misalignment between our block utilization and prime time utilization numbers. Now, within a year of our new approach supported by visible data, we’re seeing those numbers line up more, meaning the time we're granting to surgeons is being well used. There’s room to grow but overall, this is very promising.
We’ve increased overall block utilization by 11%, prime time by 3%, overall volume by 8% – all with a 7% reduction in available rooms, as one of our sites is under construction. This indicates we're using our space much more efficiently, which is very important. Then we have a staggering 98% of proactive releases or transfers of time, which is vital to creating OR access. Pre-iQueue, we didn’t see many releases. Now it’s exciting to see people a lot more active in the system. Our chairs manage their blocks well and are very engaged in the process. To be able to be a hundred percent allocated and still maintain space for add-ons and trauma is pretty significant.
That said, we aren’t done. Our leadership always says that we're proud, but never satisfied, here at The University of Kansas Health System. So, while I'm excited for these results so far, to me it's only the beginning. We've barely scratched the surface on what we can do with our partnerships, with block management, and with the functionality of iQueue.
Working with the team at iQueue has really been a valuable partnership. We look at opportunities we can develop together. There's more functionality in iQueue we could use, like identifying how much unutilized block time is truly “collectable” and reusable for other cases, that would continue to enhance the way that we use and manage our blocks here. I'm excited to get started on this in the next few months.
For more from Megan Eubanks on TUKHS’ block management success, including a deep dive into the adoption and use of analytics, watch her full interview at the Transform Virtual Hospital Operations Summit on demand.