Scheduling System Optimization
Scheduling Affects the Entire Organization
The "optimal" design of an OR scheduling process is in many instances significantly different, depending on whether you are a:
Surgeon
Anesthesiologist
Operating Room Nurse
Administrator
Ideal Scheduling Program for Surgeons
"Just have my own operating room, staff, equipment, and an anesthesiologist available 5 days a week whenever I want."
|
Ideal Scheduling Program for Anesthesiologists
Ideal Scheduling Program for Nursing
- One team per room.
- Scheduled lunch and breaks.
- Surgeon and anesthesiologist waiting in lounge for case starts.
- All cases finish in time to leave by shift’s end.
Ideal Scheduling Program for Administration
Keep all rooms utilized as long as possible.
|
|
OR Program Balance
- What is needed is an OR scheduling system that balances the diverse needs of the four groups.
- Optimizing personal time utilization can be the “fulcrum” for achieving that balance.
|
Symptoms of an "Out of Balance" Schedule
- Late surgeons.
- High rate of add-ons.
- Case juggling.
- Holes in the schedule.
- Extended preoperative length of stay
- Decreased morale; pressure for overtime
- Extraordinary demand to be "first case."
- Perceived need for more anesthesia coverage.
|
Effective Surgery Scheduling Requires Two Distinct Efforts:
Schedule Planning Process
Key Components of Schedule Planning
- Coverage Plans Balanced with Surgical Demand
- Variable OR Room Access (set aside time to accommodate historical add-ons w/o disrupting elective schedule)
- Maintenance of Correct Materials Requirements (accurate preference cards)
- Accurate Case Duration Estimates
- Knowledgeable and Accessible Scheduler(s)
- Policies and Guidelines for Assigning and Re-Allocating Block Time
- OR Committee as Governance/Oversight Body
Elements of a Block Management Policy
- Block Times (defined by hour-of-day)
- Scheduling Block Time (process for booking into one's block time)
- Block Time Allocation (how blocks are requested and assigned)
- Required Utilization Target (for block holders to retain time)
- Measurement & Reporting Frequency (of block utilization)
- Measurement Formula (how is block utilization to be computed)
- Block Release (when should unused time be made available for others' use)
- Automatic
- Voluntary
- Requesting Block (the process for new surgeons to gain guaranteed access to the schedule)
Data Needs for Initiating Blocks
Data Needs for Determining Block Release Time
Example Block Scheduling Model
Elements of a Schedule Planning Policy
- Scheduling Goals
- General Scheduling Definitions
- Schedule Start time
- Turnover time
- OR Access Plan (number of ORs available by time of day and day of week for block elective, first come-first serve elective, and urgent/emergent use)
- Scheduling practices
- First case start time
- Scheduling office hours of operation and after hours scheduling
- "Closing" the schedule
- Information requirements when booking a patient for surgery
Elements of a Schedule Administration Policy
- The responsibility for running of the daily schedule
- Order of elective cases (guidelines and who is responsible for establishing and when)
- Case "on time" definitions
- Delay classification (how will "delays" be categorized, by whom)
- Delay sanctions (surgeons, nurses, anesthesia providers)
- Flip-flopping protocols
- Staff assignments (who will make case assignments, using what criteria, when will assignments be known)
- Bumping Protocol (urgent/emergent accommodation of add-ons)
Decreasing TOTAL Turnaround Time
