Providence, a 51-hospital health system with central offices in Renton, Wash., and Irvine, Calif., recently set out to modernize its perioperative processes and support growth across its organization, which spans seven states. As part of those efforts, the health system is scaling a new AI platform for scheduling surgeries.
Providence began rolling out iQueue for Operating Rooms by LeanTaas at its Washington and Montana hospitals in 2023 and has since expanded to other regions.
The web-based application offers surgeons and staff real-time visibility, accessibility and scheduling of open time for elective surgeries. By digitizing workflows and streamlining the scheduling process, the system has experienced fewer delays, higher levels of patient, surgeon, clinics and staff satisfaction, and improved scheduling accuracy, according to health system leaders.
Specifically, Providence has achieved a 30% reduction in unused and unreleased block time after the implementation of the AI scheduling tool.
Susan Stacey, BSN, chief executive for the Providence Inland Northwest Washington service area, and Hoda Asmar, MD, executive vice president and system chief clinical officer for Providence, recently spoke with Becker's about this technology and this achievement.
Ms. Stacey described block time as being like a standing reservation for a hotel room. Physicians and their clinic staff who need to schedule surgeries and procedures reserve the operating room for a set amount of time. If they don't use all the reserved time and they don’t release it, it ends up sitting idle.
"The ability to release it early so that someone else in there is crucial. Think of it like that hotel reservation; if you can put somebody else in that room who needs that access, it's better. It's all about serving more patients in the allotted time that we have during regular business hours," said Ms. Stacey.
Two connected metrics to unused and unreleased block time are how early block time is released and the percentage of backfill for that time. Providence has increased the early release time frame from within a few days (less than seven days) to up to 28 days, said Dr. Asmar. The current rate of backfill for those released slots is 34%, and it continues to improve month over month.
The launch
Providence launched its perioperative initiative at the end of the pandemic, around the second half of 2022.
Dr. Asmar said the goal was to address pent-up demand for elective surgeries, which had been delayed or canceled during the public health crisis. There were also workforce shortages, particularly of surgical technicians and caregivers who staff the operating rooms.
"We brought to the table operational leaders, chief executives like Susan, clinical leaders, anesthesiologists, surgeons," said Dr. Asmar. "And we agreed to a longer-term vision, 'We don't want to just address the current problem. We want to build something to last. We want to achieve modernization and growth in the space, so we can serve our communities better and more timely.'"
The group organized around all aspects of the surgical process: preoperative, intraoperative, and postoperative. Then they set foundational work around best practices, key metrics to follow, and benchmarks to follow.
During that process, Providence leaders realized the organization was still using traditional scheduling methods, such as phone calls and faxes, for its high-demand operating rooms, Dr. Asmar said. This meant no real-time visibility for stakeholders — the surgeons, operating room teams and leaders — as far as available schedule slots, and limited ability to make just-in-time changes without delays.
They could not easily see available schedule slots or access timely data to make necessary adjustments. However, the application provided an automated and transparent system to do so.
Dr. Asmar likened this to a favorite reservation app, such as an airline or OpenTable, where the user can immediately see availability and adjust to it.
The effects
Once this new system was in place, Providence was able to identify metrics such as the percentage change in unused and unreleased block time.
"The new system we're using has created transparency, and I'm a huge believer that if people can see the information, they respond differently than if it's living in a hidden environment where only one person knows what's really going on. That's never good in any setting," Ms. Stacey said.
"The level of transparency where everyone's looking at the same information at the same time really lends itself to better utilization just because of that."
Still, she acknowledged there were challenges along the way, including the initial difficulty of ensuring that all physicians, especially those practicing at multiple hospitals and managing various block processes, understood how to leverage the system to their benefit.
"It wasn't as much a barrier as it was a process that required intentionality and hand-holding early on," Ms. Stacey said. "So that they actually saw it as a good thing. Because, like anything else, you have to use it to understand it."
She said there were also some initial challenges early on with the integration of iQueue for Operating Rooms by LeanTaas with the health system's EHR which was resolved timely and effectively.
She credited project managers as well as local teams, "because you can't just put something in place and hope it works. It really does take everyone's intentional effort to implement, monitor, and sustain the change."
Additionally, she noted the project had an inclusive approach of all stakeholders and involved strong executive leadership in Dr. Asmar.
"I was the executive sponsor. And, more importantly, I had full support from the entire senior executive team, [including] our CEO," Dr. Asmar said.
Dr. Asmar said she also had a nursing leader subject matter expert, with a background in the surgical space assigned to the initiative full time. And "our physicians, surgeons and anesthesiologists were on board. They were at the table before we even started the conversations with the vendors. This technology is what they wanted to ease their way and serve our patients."
The goal was to implement the system in nine months across seven states in more than 420 operating rooms. Dr. Asmar said the vendor had not implemented the technology with that condensed timeline at another large health system, but they were willing to listen, understand the Providence culture, and provide on-site support that would make the project successful.
"Everyone knew what's happening, when it's happening, and what we are trying to achieve. It's very rare to implement anything and have no one complain…There were no complaints, just teamwork leading to success," said Dr. Asmar.
She described the process overall as a structured change management approach in focusing on a longer-term vision, building the foundational work before implementing a new technology and providing transparency on all aspects of the project.
"The technology was a complement and accelerator to operational and clinical excellence versus the driver," she said.
Washington and Montana hospitals have been live for more than eight months. Phase two included sites in California, which went live three months ago. The rest of the system went live about two months ago.
Meanwhile, Providence tracks data from the project on a weekly and monthly basis, specifically block utilization, released block timing, and backfill percentage and timing. So far, the health system continues to see data track in an ascending trajectory as far as early release and backfill.
However, a less obvious effect of the project is how it has shaped surgeons' approach, according to Ms. Stacey.
"The perception that I frequently heard [from surgeons] was, 'I can never get OR time.' That was the most common thing I heard routinely," she said.
"Now, with data, I can say, 'Here are days when you had the opportunity but didn't fill it. Is there something else we can do?' And that level of transparency has kind of stopped the hyperbole around the perception that [the individual] can never get the time [they] want. This really puts it back in the hands of surgeons and of teams to say, 'Oh, no, wait a minute, there actually is time. I need to work with my team to better utilize the time I have.'
"And so that level of transparency has really changed the conversations. It's changed the conversations in our block committees, because we have one source of truth. And we didn't always have one source of truth. It depended what data you looked at as to what the story was. And now we don't argue about that anymore. Now we go, 'OK, this is our source of truth. Now we can make better decisions about block allocation. We can make better decisions about where we put our cases, mornings or nights, Tuesdays or Fridays.' Really looking at it much more strategically."