Staffing: Beating the Block Time Blues

Staffing

By: Ann Geier

Published: 9/11/2019

Share:

4 tips to create a culture of efficient, lean scheduling.


Two words that strike fear in the heart of every OR manager: open time. That, of course, is when your ORs sit silent and empty while it's standing-room only in the staff lounge. More often than not, open time stems from inefficient scheduling. Here's how to correct that.

1Collect the data. You'll want to use data to schedule more effectively, but you can only do that when your staff fully uses your facility's software. Your case history modules should tell you everything you need to know about each case: from time in/out of the room to anesthesia start/stop time to time of incision. These reports should point you to the weak links in your scheduling. Train your staff to input the data.

2Set a block-time threshold. Block time is a privilege, not a right. If your physicians aren't using the blocks you've given them, you're going to have empty ORs and idle staff. A good rule of thumb: If you're turning doctors away because you can't fit them on your schedule, but you've still got holes in your schedule because of unused block time, you've got a problem. The best solution is a set-in-stone percentage of block time that physicians must fill. Let's say you set the block time utilization threshold at 70% of their scheduled time. If doctors are only filling their schedules, say, 50% of the time, you should cut the blocks accordingly.

3Create a ramp-up schedule. When bringing on new surgeons, you'll want to analyze anticipated case volume. Create a form for potential physicians that asks how many cases they typically do by day or by block, how many of those cases they'd bring to your facility and what the case mix is likely to be (for example, will an orthopod's cases include complicated shoulder surgeries or simple knee arthroscopies?). You'll also want to get the physician's payer mix. You might think twice if 17 of the 20 cases an ENT wants to bring to your facility each month are Medicaid patients.

START SMALL A ramp-up schedule like the one pictured can help new facilities build up to a full calendar.

For a new facility, once you have a reasonably accurate list of anticipated cases, you can create a ramp-up schedule (see the sample illustration) where you start small — opening partial rooms a few days per week — until you "ramp up" to a full capacity when the maximum number of rooms are opened on the maximum number of days.

4Base block times on data, not tradition. Once you've taken a closer look at your scheduling blocks, you'll likely want to rework them. This is particularly challenging for established facilities where doctors aren't going to want to hear about losing time. Look, we all know certain physicians who have delusions of grandeur, so you must use tact and diplomacy when scaling back scheduled block times. It's a tough balancing act. You want to accommodate your surgeons as much as possible while at the same time not letting them keep those giant blocks if they don't sufficiently fill them.

Surgeons who run over their block time are also a problem. It's not uncommon for surgeons' offices to book a 20-minute knee arthroscopy that actually takes 45 minutes so they can book more procedures. One caveat: Some physicians may argue they're not in the room the entire time. Be clear that it doesn't matter who's in the room; it's still the physician's patient, and as a facility, we can't generate revenue until everyone is out of the room.

Set clear expectations

If you want to run an efficient surgical facility, you need to make sure everyone understands exactly what's expected of them schedule-wise. If you schedule add-on cases before the normal starting time and an anesthesiologist gives some push back about early start times, don't be afraid to say, "Your contract clearly states you're to be 'available when cases are scheduled.'" If it's still a problem, run the numbers and get the data on the cases you've had to turn away because anesthesia refuses to start early. If you don't like what you see, maybe it's time to change anesthesia groups. OSM

See Ann Geier, MS, RN, CNOR, CASC, at OR Excellence

Interested in finding out more about what you can do to combat excessive tardiness, constant call-outs, endless turnover and personality conflicts among staff? Make plans to attend OR Excellence in New Orleans from Oct. 3-5. Ms. Geier's talk, "Yes, You Can Conquer 5 Persistent Staffing Problems," will cover everything from proven strategies to manage contrasting staff personalities (sensitive introverts clashing with passive-aggressive extroverts) to the keys to maintaining organizational transparency. Visit orexcellence.com for more information about the conference program and to register.

Related Articles