Block Scheduling in the Perioperative Environment
Surgeons, who are the hospital’s biggest revenue generators, are also on a list of the least happy physicians, according to a report by Press Ganey. Of the 5 least satisfied physician specialties, 4 were in surgery. Also dissatisfied were anesthesiologists.
What are surgeons least happy about? Surgeons are the least satisfied with the operating room; particularly surgery’s inability to schedule surgery, tests and therapy in concert with each other. As a subset of this dissatisfaction, the primary issue for surgeons is being able to coordinate their practice hours with the OR schedule.
Surgeon under-utilization within the OR can be particularly costly to a hospital. How quickly surgeons can get patients on the schedule is important for patient care as well as practice revenue. Difficult access to available operating time and inaccurate or delayed schedules often lead surgeons to reduce the number of cases performed at the hospital. This subsequently means lost revenue not only in the OR but patient units and ancillary departments.
Scheduling Dynamics in the OR Space
Scheduling in the OR affects the entire organization in the following ways:
- Productivity: surgeons, anesthesiologists, pre and post op units.
- Utilization: OR rooms, anesthesia, equipment, nursing personnel
- Utilization: Hospital beds and ancillary services
- Direct costs
- Marketability of the hospital’s surgical services program to physicians and patients alike.
Four groups of people are actually impacted by the OR schedule. Besides surgeons, they are anesthesiologists, nurses, and hospital administration. OR Scheduling systems need to balance the diverse needs of the four groups. The key to maximizing the operational effectiveness of all surgical programs is the patient scheduling system.
Key components of schedule planning include coverage plans balanced with surgical demand, variable OR room access (times to accommodate add-ons without disrupting the elective schedule), maintenance of correct materials requirements, and accurate case duration estimates. One way to facilitate these key components is to offer block time scheduling.
Why Block Time Scheduling?
Planning OR time in blocks designated for individual surgeons has several advantages:
- The surgeon knows months in advance which
day(s) of the week he will operate, and thus can avoid scheduling clinic appointments on those days.
- The surgeon knows how many ORs have been planned for him, and can schedule patients and surgical assistants accordingly.
- For the hospital, block time for different surgeons
can be planned to spread the workload evenly
among days of the week.
- Block time can also be planned to distribute admission to the ICU more uniformly on different days of the week. Planning additional block time beyond that needed to meet current needs is a tactical decision made for the purposes of capacity planning.
Each surgeon or subspecialty’s contribution margin per OR hour, in combination with it’s potential for growth and need of limited resources such as ICU beds, provides a rational basis for deciding which surgeons or subspecialties should receive additional block time to promote expansion of their practices.
A critical first step in discussion of block time scheduling, has to be an honest appraisal of the OR’s profitability margins. Implementing block schedules may have a heavy impact on payment schedules. Changes in the payment schedule or payers and the impact of those changes needs to be evaluated with finance management as block scheduling decisions can proactively impact financial performance and the overall income statement.
Block Reporting and Surgeon Satisfaction
An automated surgery management system can assist hospitals in capturing and evaluating appropriate data to allocate block time. Important data elements include:
- Annual elective cases
- Average cases/wk (48 wks/yr)
- Turnover minutes per case
- Hrs/wk plus turnover
- Cost per case
While many hospitals have fully automated surgery management systems, not all provide the full range of data needed to analyze performance at the level that takes major considerations of profitability and performance impact.
For daily operational needs The ForSite2020® block utilization reporting tools can optimize forecasting of elective OR Suite occupation by procedure, surgeon, specialty, or patient type. The detailed daily block utilization report examines each day’s activity, both block and non-block days. Frequently a low utilization block owner will show signs of a consistently unused day of the week. This analysis can be used to reassign time to higher valued users.
A block summary report is instrumental in evaluating if the block owners are using the time allocated to them. The typical target for block utilization is between 75-80%. These reporting tools also factor in any time the block owners release to others and does not penalize them.
Business Drivers for Block Reporting in Business Analytics Tools
Since maintaining positive profit margins is important while achieving organizational mission goals with block time scheduling, robust analytics tools are crucial. The ForSite Analytics tool can provide a full range of data needed to analyze not only performance in allocated block time, but surgeon rankings according to the largest contribution margin by payer mix. This data allows an OR governance team to look at each situation and back up its decisions with facts. For example: the surgeons might be given additional block time, provided their contribution margin per OR hour is above average and they have the potential for growth and other constraints are not limiting. If the hospital places some intangible value on certain types of surgery and wishes to encourage growth, then that intangible value should be added to the contribution margin for these cases, and more OR block time may be planned.
The key to success in block scheduling is an approach that readily taps into the operational, financial, and outcome information. The ForSite2020 suite of products can help automate and collect empirical data for analysis of the workflow processes that drive collection of that information and can be the different between a positive and marginal block scheduling experience.
