As a perioperative business manager for over a decade, I’ve seen dozens of approaches and projects to improve operating room efficiency. No matter how you calculate your operating room utilization, if it’s less than 80% there’s room for improvement. Even if you’re happy with your utilization as a metric, you know you have several problems: New surgeons can’t get block time, block owners resist changes, nurses and anesthesiologists want more predictable schedules, and your management wants more efficiency. So even if your numbers look good, they can always get better.
OR efficiency improvement projects typically focus on reducing first case delays and turnover times. In our experience, first case delays and turnovers are a very small piece of the pie. Every OR is different and improving its efficiency requires a unique approach. However, there are a few simple things you can implement right now to improve efficiency continuously.
1. Remind surgeons to request and release blocks in advance
One of the easiest things you can do is to remind surgeons (and their schedulers) to release blocks they don’t plan on using. More often than not, abandoned blocks (blocks that are not released that end up in RFT, for example) are not utilized efficiently. Proactively reallocating released blocks to needy surgeons increases utilization. So if a surgeon does not have cases scheduled for the upcoming week, remind them to release the block and assign it to a surgeon that could use it, rather than letting the block go abandoned (and unutilized).
Similarly when a block becomes available, send a note to all surgeons looking for block time saying a block just became available and allocate it on a first-come, first-served basis. Such just-in-time notifications enable block reallocation before blocks go abandoned, and that increases overall utilization. At UCHealth, we’ve seen a 16% increase in block utilization with this process.
2. Increase transparency across the board
There are two issues with metrics today.
First, not all of them are meaningful. For example, telling a surgeon that their utilization is 57% and they need to improve it is not effective. Surgeons are intrinsically motivated to use their time efficiently. It so happens that many times things outside their control affect their metrics. For example, a surgeon who plans six hours for a knee replacement can sometimes finish in four hours and that affects their utilization on that block. Sometimes delays just happen.
In many cases, simply asking surgeons to improve their utilization does not help. What we need to do is delve deep into their utilization patterns and provide more practical recommendations. For example, if a surgeon consistently finishes their cases 3-4 hours early, that’s an opportunity to recover some time from them and make it available to someone else. If a surgeon is consistently releasing too many blocks, that’s worth having a discussion to see if those blocks can be reallocated. Surgeons welcome such practical discussions much more than policing utilization.
Second, not everyone is aware of the high-level metrics. Even the CEO sometimes has visibility into revenue targets but not into OR utilization and how it affects revenue. When everyone is informed about the high-level performance targets, they do their part to meet them. Having a consistent set of top-level performance goals and metrics and keeping everyone informed goes a long way toward inspiring people to do the right thing.
3. Inspire staff to keep things moving
I’ve seen this over and over again: A case is completed ahead of time, and no one knows about it. The room sits idle until the turnover team arrives at their scheduled time. Sometimes they arrive early and prep the room, but the stakeholders for the next case don’t always know about it. This unnecessary waste can be avoided through simple communication.
We’ve overcome this waste by having a nurse take responsibility for communicating to the next case’s stakeholders that the previous case was completed early. The nurse coordinates with the turnover team and everyone else involved in the next case. That way, a room is cleaned immediately upon completion of the case. While it’s being cleaned the anesthesiologist can begin preparations simultaneously, so the surgeon can start as soon as possible.
This is a continuous hustle that must be done to keep things moving and reduce the turnover time between cases. This is more about culture than process. When everyone is aware of the high level goals and the value of avoiding idle time then they automatically take the responsibility to keep things moving.