Making The Invisible Visible

By Jessica Kovash, LeanTaaS

Now, more than ever, optimizing expensive and complex hospital resources like operating rooms (ORs) is a necessity for hospitals and health systems. Maximizing use of open and block time, implementing more cases during prime/staffed hours, and creating more predictable schedules translate into increased OR profitability and more predictable use of “out of OR” resources. All of this directly impacts a hospital’s bottom line.

So why do hospitals continue to struggle with OR optimization? The short answer is “it’s complicated.”  Operating room demand is unpredictable; access to reliable utilization data has been limited, and deep-rooted cultures compounded by market pressures and undermine change.

It is complicated.

• OR demand is unpredictable: “Our OR/patient demographics, etc. are unique; therefore, our utilization is highly variable.”
• ORs have been “flying blind”: OR leadership has historically lacked ease of access to timely, reliable, and trustworthy data for decision making.
  • Surgeons, OR leadership, and even OR business managers don’t trust the data.
  • Despite access to some “very cool” data analytics tools, OR leadership does not have the time or resources to become fluent in the use of the tools.
  • Data is retrospective and, as a result, hard to act upon.
• Out-of-OR departments, services, and even beds are often not part of the big picture when looking at OR utilization, but even some administrative tasks leading up to or post-surgery can be a significant bottleneck to OR efficiencies.
• Deep-rooted cultures and lack of accountability have hampered and/or undermined much-needed changes from happening.
• Surgeons have choices. Surgeons push back, and as a result, hospital leadership is rendered powerless to make needed changes: “We can’t take away Dr. X’s block because we can’t afford to lose Dr. X.”

Given the dramatic impact that COVID-19 has had, and continues to have, on healthcare delivery, the need for timely access to key information for decision making that is easy to access and interpret has never been greater. Fortunately, we can provide hospital and perioperative leadership with actionable decision-making tools for increasingly complex challenges of enhancing the visibility, accessibility, and accountability of OR utilization. However, organizations remain challenged with efficiently and proactively filling OR time.

The ability to safely perform more cases during prime hours while sustaining (or increasing) quality of patient care can not only improve a hospital’s financial performance by doing more cases with existing/staffed resources but also can improve staff, surgeon, anesthesia and even patient satisfaction. Filling prime-time hours reduces overtime as well as the dissatisfying practice of calling off or calling back staff, increases anesthesia revenue thereby decreasing anesthesia stipends, and enables surgeons to operate more efficiently. Access to and visibility of OR open time, especially during prime-time hours, has historically been challenging and has been based on a very manual and time-consuming process of calling OR scheduling departments to see if/when time is available and proactively reaching out to surgeon offices to “advertise” open time.

Additionally, advances in data collection, analysis, interfaces, and accessibility provide surgeon offices with the ability to easily find and request open time in the OR outside of block time and enable surgeons the ability to proactively release block time that they are not going to use so that the hospital can offer the time to another surgeon. As a result, the historical practice of hoarding time “just in case I have a case” is no longer a requisite for getting a potential case on the schedule. Similarly, the ability to release time via proactive electronic reminders well in advance of a block’s auto release enables the previously unused time to be filled with a case, or cases, in advance of the day of surgery. Not only does the technology allow for these transactions but it is also showing a strong correlation to improving prime-time utilization.

Timely access to OR data is removing barriers that previously existed in making necessary changes in the OR, particularly around the allocation and utilization of block time. Data that is clean, accurate, defensible, easy to access, and supported by clear visualizations have completely changed the tone and outcome of often contentious conversations around block utilization.

For example, telling a surgeon his/her block utilization is 65 percent is ineffective in facilitating a change in allocation when the surgeon knows their practice is busy and when they are frustrated by operational inefficiencies in the OR. However, showing the surgeon their block usage patterns and calculating time utilized without penalizing the surgeon for OR inefficiencies is a game changer in right-sizing blocks (allocating the right amount of block time to a surgeon based on their practice).

Transparency is key and can be created when trends, details, decision support, and even predictive analytics are pushed to OR management, surgeons, and surgeons’ offices. This clarity will facilitate more productive conversations, huddles, and surgical executive committee meetings resulting in smoother operations.

About The Author

Jessica Kovash is the OR product lead for iQueue for Operating Rooms with over 15 years of experience in healthcare consulting and a specific emphasis on perioperative services. She has facilitated multiple complex perioperative engagements involving OR governance, access, scheduling, and patient throughput and has published articles related to this work in the American Journal of Surgery. Jessica holds a Bachelor of Science degree in business and economics from the University of New Hampshire and is currently pursuing a master’s degree from Texas A&M University. For more information on LeanTaaS, please visit https://leantaas.com/, and follow the company on Twitter @LeanTaaS, Facebook at www.facebook.com/LeanTaaS and LinkedIn at www.linkedin.com/company/leantaas.

About LeanTaaS:

LeanTaaS, an analytics software company whose products increase patient access to medical care while decreasing costs for health systems. The LeanTaaS iQueue platform applies advanced data science to match unpredictable patient demand with expensive resources. Today LeanTaaS powers 100 health systems around the country including Stanford Health Care New York-Presbyterian and Memorial Sloan Kettering. The iQueue platform has expedited 1 million infusion treatments and identified 20,000 hours of OR time that would have otherwise gone unused.