Three Strategies to Optimize Your OR: Part 1

In the optimization of the operating room (OR), just as in a lifesaving surgical procedure, every minute counts. Small improvements in OR efficiency over the course of a year add up to a substantial time and cost savings for a health care organization.
Approximately 80 percent of surgical cases are completed between 7:00 a.m. and 3:00 p.m., Monday through Friday. In a blended OR, surgical case predictability ranges from high to low, as follows: outpatient, inpatient and ED/trauma. Typically, 60 to 80 percent of surgical cases are outpatient cases, and the remaining 20 to 40 percent are inpatient cases — either from the inpatient floors or ED/trauma — requiring immediate surgery.
OR space and operational efficiency is determined by time metrics. Because of their high predictability, surgical managers are best able to quantify and schedule outpatient cases on a daily basis, even when they are same-day admits.
Efficient staffing and block scheduling, the standardization of OR equipment, supplies and technology, and optimization of the department’s layout are three strategies that help to make every minute count. This article will focus on staffing and scheduling improvements, while part two will highlight standardization and optimization strategies.
Efficient Staffing & Block Scheduling: Solutions to Add-ons
Add-ons are the most challenging efficiency issue for hospital surgery departments. Say that Physician A’s scheduled block runs from 7:00 a.m. to 10:00 a.m. He or she may schedule as many cases in that block as can be accommodated because the surgeon “owns” the OR during that block. If the OR is efficiently scheduled and fully used during the block, then Physician A and the hospital are optimizing operational and space efficiency; however, in most organizations, there is idle OR time. This results in add-on cases. If Physician B has a case and can’t find time in the block or persuade another surgeon to yield time, then that case becomes an add-on. Pushing add-on cases increases staffing and labor costs.
On the other hand, if every block in the OR is efficiently filled and there are still add-ons due to high volume, then the hospital has a capacity issue. Physician B will most likely need to push a case back to 3:00 p.m., 4:00 p.m. or 5:00 p.m., after block scheduling ends. Whether the reason for lack of OR availability is inefficient block scheduling or high volume, the result is the same. Physician B will keep an OR team on the roster longer in the day, driving up labor costs.
In short, time (a.k.a. throughput) is money in the OR. The more efficient a hospital is with OR time, the less costly are labor and facilities, and the less revenue is lost. The most cost-effective staffing solutions are based on predictive analytics, which, by necessity, are typically employed to analyze throughput data in the high-throughput departments such as imaging, ED and surgery. When combined with daily bed-census data, surgery-scheduling managers can use predictive analytics to quantify subsequent case volume and structure staffing to match volume and manage labor costs. The most experienced schedulers can predict volume over the course of several weeks.
Computer simulation is an effective tool to analyze procedure time for each type of case. For example, if a hip replacement procedure averages several hours in a particular OR but can be performed in less time using minimally invasive techniques, this indicates inefficiency. The process must be analyzed to identify the cause of the longer-than-average procedure time and associated issues. The component of the process that is causing the delay must be standardized to avoid schedule back-ups and overtime costs.
An audit may also reveal that a surgeon is not performing at capacity. The obvious solution is to increase the surgeon’s case volume or decrease block time accordingly; however, it is more effective to analyze the trends, share the data and ask, “Using predictive analytics and simulations, how can we help you to address capacity challenges?”
If these efforts fail to resolve the problem, additional solutions are possible. For example, in return for block time reduction, one might suggest offering time each day when the OR staff is available for add-ons to accommodate urgent cases.
Ultimately, a partnership is fundamental to improving efficiency. This requires both the hospital and surgeons to find solutions for staffing efficiency and block scheduling options in order to share the benefits, including convenience, assigned staff, amenities (lunch, lounge) and new technology. Physicians are more likely to support these solutions.
Read more about OR optimization strategies in part two of this article in the HC+O News November Newswire, available Nov. 11.
As director of strategy at FreemanWhite, a health care consulting and design firm based in Charlotte, N.C., Michelle Mader collaborates with health care leaders to achieve high-level performance and identify profitable market opportunities.