Hospitals make large investments in operating rooms and surgical suites to provide physicians, staff and patients with the latest technology and optimal space for efficient and safe care. For instance, Reading (Pa.) Hospital and Medical Center is planning a surgical center with a price tag of $189 million. Even less costly projects, such as the $500,000 operating room at the Adirondack Medical Center in Saranac Lake, N.Y., require resources that the hospital hopes will be utilized fully by the OR team. However, many hospital ORs are underutilized, and one of the biggest culprits is inefficient block scheduling. Maggie Longshore, RN, MS, CNOR, CAPA, NE-BC, and senior consultant at Blue Jay, offers four strategies hospital OR leaders can use to improve block scheduling and achieve full utilization of the OR.
1. Align with administration. OR leaders need to align with the administration to ensure the success of any initiative to improve block scheduling. Without this alignment, hospital leaders may appease dissatisfied surgeons with block scheduling decisions that contradict the OR's goals. "All the key stakeholders have to be in place and on the same page," Ms. Longshore says. "It's up to the OR management and hospital administration to agree on a strategy."
2. Allocate block and release times according to needs. OR management should analyze current block time utilization to determine if certain surgeons should have less or more block and release times. While many times surgeons have too much time allotted to them, the opposite can be true as well, according to Ms. Longshore. "Managing the block is often not just taking away underutilized time, but also recognizing over-utilized time and [allocating] more time to surgeons who require it," she says. For example, she says if a surgeon is given eight hours of block time but routinely uses 10 or 12 hours, they may need more time in their block. Similarly, the most effective release times will vary depending on the hospital, the type of cases and the scheduling patterns of the surgeons. Ms. Longshore suggests analyzing scheduling practices to identify release times that would optimize OR utilization.
3. Target prime time. The OR should aim to perform as many cases as possible within the organization's defined "prime time," which represents the time period when the bulk of the cases are performed. Prime time is typically 7 a.m.-3 p.m. or 7 a.m.-5 p.m., depending on the organization's volume and blocks. "Many times, as you increase utilization during whatever you target as prime time, [you achieve] lower cost per OR minute because you're maximizing your staffing resources," Ms. Longshore says. "Alignment of resources to the schedule is key in maximizing resources and reducing overtime."
4. Enforce policies. Many hospitals have block policies that include thresholds of block utilization but often do not enforce them, according to Ms. Longshore. To effectively manage the block, she suggests forming a subcommittee of OR management, the chief of surgery, the chief of anesthesia and hospital administration representatives. While including members of the hospital administration is not critical, their inclusion would facilitate communication and alignment of goals, Ms. Longshore says. "Involving all key stakeholders and having transparent communication is key." The subcommittee would evaluate utilization on a monthly basis based on minutes allocated compared to minutes used and share the data with the surgeons. For example, OR leaders can post utilization information monthly, either with or without names attached, to make physicians aware of their utilization. The subcommittee can then make recommendations on a quarterly basis. Ms. Longshore says a combination of public posting and one-to-one conversations can be effective in changing behavior.
Learn more about Blue Jay Consulting.
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1. Align with administration. OR leaders need to align with the administration to ensure the success of any initiative to improve block scheduling. Without this alignment, hospital leaders may appease dissatisfied surgeons with block scheduling decisions that contradict the OR's goals. "All the key stakeholders have to be in place and on the same page," Ms. Longshore says. "It's up to the OR management and hospital administration to agree on a strategy."
2. Allocate block and release times according to needs. OR management should analyze current block time utilization to determine if certain surgeons should have less or more block and release times. While many times surgeons have too much time allotted to them, the opposite can be true as well, according to Ms. Longshore. "Managing the block is often not just taking away underutilized time, but also recognizing over-utilized time and [allocating] more time to surgeons who require it," she says. For example, she says if a surgeon is given eight hours of block time but routinely uses 10 or 12 hours, they may need more time in their block. Similarly, the most effective release times will vary depending on the hospital, the type of cases and the scheduling patterns of the surgeons. Ms. Longshore suggests analyzing scheduling practices to identify release times that would optimize OR utilization.
3. Target prime time. The OR should aim to perform as many cases as possible within the organization's defined "prime time," which represents the time period when the bulk of the cases are performed. Prime time is typically 7 a.m.-3 p.m. or 7 a.m.-5 p.m., depending on the organization's volume and blocks. "Many times, as you increase utilization during whatever you target as prime time, [you achieve] lower cost per OR minute because you're maximizing your staffing resources," Ms. Longshore says. "Alignment of resources to the schedule is key in maximizing resources and reducing overtime."
4. Enforce policies. Many hospitals have block policies that include thresholds of block utilization but often do not enforce them, according to Ms. Longshore. To effectively manage the block, she suggests forming a subcommittee of OR management, the chief of surgery, the chief of anesthesia and hospital administration representatives. While including members of the hospital administration is not critical, their inclusion would facilitate communication and alignment of goals, Ms. Longshore says. "Involving all key stakeholders and having transparent communication is key." The subcommittee would evaluate utilization on a monthly basis based on minutes allocated compared to minutes used and share the data with the surgeons. For example, OR leaders can post utilization information monthly, either with or without names attached, to make physicians aware of their utilization. The subcommittee can then make recommendations on a quarterly basis. Ms. Longshore says a combination of public posting and one-to-one conversations can be effective in changing behavior.
Learn more about Blue Jay Consulting.
Related Articles on OR Efficiency:
How to Determine Quality Indicators to Track: Q&A With Dr. John Di Capua of North American Partners in Anesthesia and North Shore-LIJ Health SystemThe Role of Health IT in the OR: Aligning Technology With Workflow
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