MedCity Influencers

Four reasons why OR block scheduling is finally getting overhauled

The process most health systems rely on for managing the complexity of operating room utilization — block scheduling — needs an overhaul.

NHS Healthcare Organisation Looks To The Future

Roughly 51 million surgeries are done in more than 10,000 hospitals and surgery centers in the U.S. each year. Yet the corresponding utilization of operating rooms across these centers is, at best, 55 percent to 60 percent, based on estimates from the Medical Group Management Association. Given that a minute of utilized OR time is easily worth more than $70 in revenue and a minute of staffed OR time can cost $50 or more, having underutilized OR time is a huge problem.

The process most health systems rely on for managing the complexity of operating room utilization — block scheduling — needs an overhaul.

Blocks are assigned to surgeons and service lines. The OR committee reviews trends in utilization performance by surgeon and service line in order to make informed decisions on the potential reallocation of blocks on a monthly (sometimes quarterly) basis. The scheduling of the slate of surgeries is then left to the surgeons themselves.

Since the OR committee does not have a sufficiently robust, transparent and defensible fact base for allocating OR blocks to different surgeons, there is an inherent subjectivity to the “algorithm” used, which reduces the perception of fairness in the minds of many surgeons. This, in turn, makes surgeons naturally more resistant to releasing their allocated blocks, even if releasing their blocks would aid overall productivity.

Consideration of any overhaul of OR block scheduling also has to be done with real-world constraints in mind. These constraints could include equipment in a specific OR (such as robotics) or scheduling challenges (such as a surgeon who can only operate on Tuesdays, and the candidate blocks that could be released are only on Thursdays and Fridays).

The benefits of such an overhaul can be considerable.

For each percentage point of increased utilization, a single OR can deliver $100,000+ in revenue to a hospital or surgery center. Even for a small hospital or ambulatory surgical center with 8-10 ORs, the value of increasing utilization by 5 percent can easily be in excess of $5 million annually. For large systems, the value of a single OR can run into the tens of millions. If average OR utilization increased by 5 percentage points, more than 2.5 million patients could undergo procedures within the same OR infrastructure.

Forward thinking hospitals like UCHealth are leading the charge in giving block scheduling the overhaul it needs. Here are four reasons why this is possible and starting to happen.

The technology exists and is starting to be used
Imagine a series of timely, accurate charts that are automatically — on a daily or weekly basis — “pushed” to the smartphones of every surgeon, their schedulers and the administrative personnel responsible for managing OR utilization. In addition to providing key statistics on utilization such as first case on-time starts, cancellations, cases running long, it creates a high level of awareness in the minds of each surgeon about their utilization performance both in absolute terms as well as relative to their peers. Surgeons are data-driven, fact-based and competitive; accurate, transparent, automated feedback will go a long way toward improving the utilization even if nothing else was to change.

Better forecasting
Several factors need to go into determining a fair and equitable allocation of blocks on a periodic basis. Instead of using historical rules for how blocks have been allocated and redistributed, hospitals can now methodically match supply (e.g., regularly underutilized blocks) to demand based on sophisticated forecasting and predictions for blocks, staff and rooms. This is possible because the necessary data exists within the EHR/scheduling system —historical scheduling data by surgery (the date, time, type, surgeon, room, duration) and the corresponding surgeon-specific performance metrics.

Forward thinking governance/leadership
Hospital leadership is not just more tech-savvy today than it was 10 years ago; an increasing number of CEOs, CIOs, COOs and CMIOs are now not just open to looking at new technologies but are requiring their teams to go through process transformation through data, lean methodologies and sophisticated analytics.

There isn’t much choice. The demand for medical services has never been stronger, and it’s only going to increase. ORs will have to do more surgeries and get reimbursed less per unit for them.

The aging population will greatly increase the demand for chronic clinical therapies and surgical procedures. By 2050, the American population will be over 438 million, up from 320 million in 2015. More than 20 percent of the country is expected to be over 65 years old by 2030, compared with 15 percent in 2015. In raw numbers, the Census Bureau estimates that by 2030, when the last proportion of Baby Boomers will hit retirement age, the number of Americans above 65 years of age will hit 71 million — in fact, one in five Americans will be older than 65. Not surprisingly, 49 percent of Americans will be affected by a chronic disease and need corresponding therapies by 2025.

The Affordable Care Act will add another 30 million Americans to the healthcare system by 2025, which means an increase in the demand for operating rooms. Reimbursements will increasingly depend on outcomes and efficacy, quality of care, and patient access. Unless providers increase efficiency in how they process and treat patients, they will need to spend billions in capital spending on new operating room infrastructure.

More and more healthcare providers are waking up to the fact that their operations need a data-driven, scientific overhaul to accomplish efficient and effective OR scheduling. The appropriate tools, software and resources are finally available to help achieve such a transformation.

Photo: Christopher Furlong, Getty Images


Avatar photo
Avatar photo

Sanjeev Agrawal

Sanjeev Agrawal is president and chief marketing officer of LeanTaaS. Sanjeev was Google’s first head of product marketing. Since then, he has had leadership roles at three successful startups: CEO of Aloqa, a mobile push platform (acquired by Motorola); VP Product and Marketing at Tellme Networks (acquired by Microsoft); and as the founding CEO of Collegefeed (acquired by AfterCollege). Sanjeev graduated Phi Beta Kappa with an EECS degree from MIT and along the way spent time at McKinsey & Co. and Cisco Systems. He is an avid squash player and has been named by Becker's Hospital Review as one of the top entrepreneurs innovating in Healthcare.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

Shares1
Shares1