Silo view of scheduling in hospitals
A traditional view of scheduling in surgical services is that, its a function that helps manage operating rooms and procedures. Its viewed as a value added service that a hospital or Ambulatory center provides for surgeon offices, to help organize the date and time, and location of a surgical procedure. This is a silo view of scheduling. It’s importance is largely underplayed and often overridden by management decisions. For instance, it is common for surgeons to complain to a senior executive (often a VP or the president) that they are not getting their preferred surgery date and/or time. If this happens after the next day’s surgery schedule production, it becomes an Add on or depending on the medical need an Emergency surgery. In such situations, the executive calls the scheduling office and asks them to accomodate the request in order to provide good service. Grudgingly, the schedulers relent. But at the cost of bumping another case, which eventually means more Add ons. If this procedure requires the patient to be admitted to an inpatient bed, then it affects bed management since they had not planned for this. Eventually, everyone from the Emergency department to the Inpatient units and PACU faces long wait times for bed assignment. This can add significant time to the patient’s length of stay, affecting quality, customer services while adding significant cost to the hospital. So a seemingly noble gesture by an executive can often times have an adverse ripple effect on the overall efficiency of the hospital. Some scheduling departments even use advanced Information technology products and decision support systems to function. In which case, they become island’s of mechanization.
A new perspective for Scheduling
What we need to understand is that scheduling is a key driver of operational efficiency in the surgery department and the rest of the hospital. And therefore, we have to apply systemic thinking (you may refer to my previous post for more on this). It is very important to assess the downstream impact of all decisions while making changes to the schedule. Now, let us look at how we can solve this problem.Since, there is no one size fits all solution, I will present several strategies for problems. These strategies are drawn from best practice research, implementation done in several large surgery departments and smaller Ambulatory centers nationwide.
Block time release
Begin releasing most service line block time in advance(ideally between 4 days to week depending on your size and volume). This allows adequate lead-time for surgeons to schedule additonal cases, and will significantly reduce ‘gaps’ in your schedule.
Hold atleast one room in the OR for Emergent and Urgent cases.The idea is to clearly separate out your urgent/emergent cases from the electives. While it may seem counter intuitive, this has helped ORs significantly increase case volumes and reduce overtime.
Add On analysis and Add On Room
Just like with Emergency your Add On might be seriously impairing you ability to have a flexible yet efficient schedule. But the good news is unlike urgent cases, you will be able to predict Add ons better than you think. Review, your Add On volume for the most recent 3 months and you will see your ‘peaks and valleys’. Asses, utilization of your rooms, equipment and staff.This again helps reduce overtime significantly and increase your ability to take more cases.
Case Length Accuracy- Schedule Reliability
In a majority of ORs the schedule is not reliable due to inaccurate prediction of case time.Which means actual case length and scheduled case length do not match. Use average procedure and surgeon specific case length for scheduling. (includes typical case specific cleanup and room preparation time).
Costing out gaps in the OR schedule
Calculating what is gained or lost in terms of revenue,staff time and quality of care before implementing scheduling changes, is a good way to assess the full success of these improvements. In many cases, this has been used to get management buy-in and support from physicians