Many hospital operating rooms don’t run at optimal efficiency, because OR leadership is often flying blind. Their analytics and reporting tools don’t provide the data needed to set policy and ensure optimal block utilization.
A new generation of web-based post-EHR software directly addresses the issue, giving leadership and service management a “single version of the truth.” This software aligns the strategic goals of executive management with the tactical requirements of individual services and practice groups to create a better use of limited OR resources.
While every OR is managed differently, each has some form of block utilization reporting, which drives decisions about how to allocate fixed OR resources to services, practices, and individual surgeons. However, lack of trust in these block reports can cause OR management to revert to decisions based on politics, seniority and hunches.
The latest software on the market empowers managers with unprecedented flexibility to run their ORs in a way that reflects each institution’s unique mix of patients, staff and payers. With these improvements in reporting and analytics, we see hospitals generally converge on one of two management models, which we call the “department store” model and the “mall” model.
In the department store model, a centralized OR committee manages the OR down to the individual surgeon level and monitors all block metrics. The OR committee works with services, practices, and individual surgeons to increase block utilization, but maintains final responsibility and decision making over all block allocations. The committee meets monthly or quarterly to make decisions about individual blocks by reviewing historical data, demand forecasts and staffing changes.
The mall model is decentralized. The OR committee allocates blocks to services and leaves the actual assignment to the service practice managers. This gives services much greater flexibility to manage blocks that fit their individual case mix and management style.
A neurosurgery practice where a typical case is four to five hours may want to manage blocks differently than an otolaryngology service, where a typical case is 45 minutes. A common practice for the former is for all blocks to be available to everyone in the service, but surgeons have to alternate between scheduled first starts and non-first starts. Otolaryngology, on the other hand, is more commonly managed with traditional half and full-day surgeon block assignments that would not make sense for longer cases.
The mall model has historically been attractive in theory, but difficult to implement in practice because services lack the tools and staff to ensure accountability between blocks and surgeons. Poorly performing services are often unable to identify underperforming actors and take corrective action. Corresponding changes to the service block allocations from the OR committee often feel like clumsily applied collective punishment.
The development of web-based OR management software enables the centralized OR committee to give busy non-technical practice managers modern tools to actively manage their blocks in the mall model. Practice managers can re-allocate blocks to surgeons or change local policy as necessary to maintain utilization targets. The centralized OR committee only needs to monitor overall service performance and leave the details to the practices.
This class of software also helps overcome the lack of trust that can stem from bad data (garbage in, garbage out) and unclear or unaligned block accounting policy. Hospitals with transparent and verifiable data are much more proactive about reassigning blocks to surgeons who need them most. Hospitals with opaque data operations simply lack the tools to make any meaningful changes to block allocation and will often suffer from poor utilization.
This trust is built by use of interactive online data workbenches that enable OR managers and relevant staff to directly validate the accuracy of the raw data. Surgeons and practice managers can verify surgeries, start times, end times, and quickly reconcile discrepancies in records and recall. Additionally, a configurable block accounting policy enables all parties to converge on a set of policies applied transparently to everyone. More specifically, OR managers can set policies such as block release, turnover times, late start grace periods, and in/out of block accounting, and apply these policies uniformly across all services.
For a typical hospital with an 8-hour surgical day, each 1 percent improvement in OR efficiency is a savings of more than $50,000 per year per OR; for mid-sized to larger hospitals, that is $1 million if they have 20 ORs. Alternatively, the increased revenue from fitting in one or two more cases per week per OR can be even greater.
Modern software enables these efficiency improvements because of transparency, accountability and validation. All blocks have ownership, all parties have access to the same information, and all parties have the tools to authenticate the data used to power the analysis. Merit comparisons between services are based on open and agreed upon protocols that both improve OR efficiency and reduce the executive burden of managing the OR.
Rather than software that imposes a uniform policy on hospitals, the right software frees managers to implement a style that best fits each hospital’s culture and community. This helps both the bottom line and more efficient delivery of care.
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