Surgeon-Driven OR Scheduling: Beyond Block Scheduling

ORs are unequivocally the most profitable area in hospitals. Despite that, most ORs are achieving just 60-65% utilization. Block scheduling is touted as one of the best ways to improve operating room scheduling, efficiency and throughput. Indeed, block scheduling is broadly more efficient than open scheduling or first-come first-served approaches.

However, even when block scheduling succeeds in improving efficiency, it often creates unintended consequences. Block scheduling often creates divisions, animosity, and the dissolution of a team mentality between surgeons and administration. Therefore, it’s worth reconsidering how blocks are being managed and implemented. A crucial aspect of this reassessment involves engaging surgeons directly in the conversation around block schedule management.

Here, we’ll explore the challenges that poorly managed block schedules create, what that looks like from the surgeon’s perspective, and what steps your organization can take to remedy those symptoms.

How surgical block scheduling works and why it’s widely used

With a traditional block schedule, the OR manager divides each day into blocks for each surgical suite. Each surgeon or surgical specialty are allocated specific blocks depending on their surgical volume and case time.  The block schedule details the day and length of time for each block holder, the department and/or surgeon, the types of surgical procedures, and required resources for each block.

Some of the main benefits of this scheduling approach include:

1. Patient convenience and throughput

Block scheduling in ORs allows surgeons to plan their schedules, provide surgical dates and times to patients, and improve patient flow by reducing waiting times and avoiding overcrowding. When similar procedures are scheduled in adjoining blocks, staff can often manage patients more smoothly and efficiently.

2. Resource optimization

Block scheduling allows organizations to optimize the way they utilize space, equipment, and staff by aligning them with the specific needs of the block’s procedures. It also facilitates better planning and inventory management for supporting departments like sterile processing and anesthesia.

3. Surgeon and Staff satisfaction

The predictability block scheduling offers is often touted as a key benefit. The belief is that consistency can improve job satisfaction among surgeons and supporting clinicians by mitigating the stress caused by last-minute changes and the general unpredictability of prior scheduling methods.

However, while many of these benefits are realized in organizations and ORs across the country, block scheduling isn’t without flaws. There are several driving forces to consider. For example, the amount of block time available is finite and creates competition among surgeons. Patient demand for surgical procedures also fluctuates throughout the year.  Finally, administration needs to achieve high utilization of OR/block time to maintain financial sustainability.

The hidden costs of block scheduling

Many surgeons have grown disillusioned by block scheduling. The main driver behind that frustration is that while block scheduling works well on paper, it doesn’t always align with reality. Moreover, it offers a prescriptive and inflexible approach to scheduling that rarely accounts for surgeons’ preferences.

Consider the differing perspectives of surgeons:

  • Surgeons feel they are under constant threat to lose block time if they do not fill their time on a consistent basis. They get notified if they’re not using their block time, and their block time is reduced, reallocated, or simply taken away if they don’t fix their utilization within a given period.
  • New surgeons on staff will immediately request block time in order to support their growing practice and often need to obtain this time from existing block holders.
  • Often a surgeon’s office or clinic practice is not well-aligned with the block time provided.
  • Often surgeons are not being incentivized to support other high-volume surgeons who could use their block time.
  • Finally, block scheduling can make surgeons reluctant to take outpatient cases to the organizations’ HOPDs or ASCs. While many organizations perceive surgeon travel between facilities to be the problem, talking to surgeons often reveals that fear of losing block time is the motivating factor. If a surgeon takes cases to the HOPD or ASC, they know it’ll ultimately reduce their block time — and it’ll be a battle for them to get it back.

Toward a new method of physician-focused block scheduling

Block scheduling is an efficiency booster, and hospitals and ORs everywhere have benefited from implementing it. However, that efficiency often comes at the cost of surgeon satisfaction which can ultimately hurt surgical volumes, patient satisfaction, the hospital’s bottom line, and the organization’s ability to recruit crucial clinical staff.

So, how can hospitals adopt a more surgeon-focused scheduling strategy that increases utilization and surgeon satisfaction? Here are some tips to start with.

1. Get your surgeons engaged in scheduling discussions

Block scheduling works well on paper, but the strategy’s fragility is quickly revealed when reality doesn’t align with the plan, when cases start later than scheduled, take longer than planned, or can’t access the proper instrumentation or equipment. This becomes a problem when scheduling and management don’t understand how surgeons and physicians practice.

The solution is to get physicians involved. At Sullivan Healthcare Consulting, our consultants have run task force meetings with physicians to address broken block scheduling policies.

“When I’m working with an organization to update their scheduling policies, I do it with a group of physicians and often their practice administrators in the room every time,” Gerry Biala, RN, MS, CNOR, CSSM, Senior Vice President of Sullivan Healthcare Consulting explained. “For each of those policies, our team identifies where things currently stand and what the main pain points preventing them from improving their utilization rates are.” Starting with full transparency is key.

Then, Sullivan’s consultants work through each of those elements with physicians to find a better way to schedule blocks, increase flexibility, and protect or restructure surgeons’ block time so it works better for everyone. Industry best practices are reviewed and discussion is focused on how to apply these to surgeon practices.

2. Identify surgeon pain points in scheduling

Revoking block time when it goes unused does little more than frustrate surgeons. Instead of relying on that standard practice, start by having a conversation with the physician to understand what they need.

A physician’s block could be underutilized for countless reasons. In many cases, it’s not as simple as a surgeon failing to utilize all of their allocated time. Often problems with the day of week, and more often the length of block time that is out of alignment with the surgeon’s procedures.

For example, if a surgeon has a ten-hour block with average procedure lengths of 4 hours then it is impossible to schedule more than 2 procedures, consistently leaving unused block time. Alternatively, surgeons could have the need to perform an eight-hour procedure while only having a six-hour block available. Likewise, if a surgeon can’t access the staff, equipment, or other resources for their procedures, they may not schedule those procedures in the first place.

Add-on cases also pose a challenge if block time is not provided to accommodate these procedures during normal operating hours.  Obstacles often are created because the surgeon has office or clinic hours preventing them from performing the procedure. Flexibility and the ability to provide guaranteed start times often resolve this conflict.

To move past these issues, it’s essential for OR management and surgery schedulers work directly with surgeons and their practice administrators to truly understand what surgeons need. Whether that is more flexibility in blocks, greater support from clinical staff, or access to equipment, increased understanding offers a path forward that increases utilization without punishing surgeons who haven’t filled their time.

When a hospital ignores these challenges or responds with the same auto-releases it has always used, it only hurts itself. The truth is that even high-volume surgeons with ideal utilization rates are facing similar challenges or impacted by the fallout of such an approach. However, when the root of the problem is addressed, organizations can improve every surgeon’s utilization, not just those who are struggling to schedule their block time.

3. Offer partial block release

Most hospitals offer two common types of release:

  • Auto release: If a surgeon hasn’t scheduled their allocated blocks by a certain time (be it days or a week before the date), their block time is automatically forfeited to the hospital’s time pool to be used by other surgeons and trauma or emergent cases.
  • Voluntary release: If a surgeon hasn’t scheduled their block or knows they won’t, they can voluntarily release it to the hospital for other surgeons to use, and their utilization will be adjusted for it.

However, physicians don’t always want to release their block hours voluntarily because they lose the flexibility to schedule procedures as they need. At the same time, they don’t want to hold onto their blocks needlessly, ultimately hurting patient throughput and their colleague’s ability to schedule procedures.

So what’s the solution? Sullivan Healthcare Consulting’s team of surgical consultants has found success implementing what we call partial release.

Partial release allows a physician to look at the average length of the procedures they have and voluntarily release the difference. This way, they’re giving the rest of the hospital’s surgical staff more time and more flexibility, yet they also retain the time needed to schedule procedures.

For example, if the same surgeon doing TJAs doesn’t anticipate using their full time, they could release most of their time, while retaining the enough time to do a case for a patient seen later in the office. This approach encourages surgeons to proactively assess their scheduling needs. Doing so enables surgeons to release the time they don’t need earlier, maximizing the time that block has to be scheduled.

Ultimately, partial release meets surgeons where they are. It gives them the ability to increase their utilization, preserve their long-term access to block time, support other surgeons’ needs, and maintain their flexibility when it comes to scheduling procedures.

The bottom line: Surgeon-focused blocks can drive utilization rates

For some OR managers, reshaping their OR’s block schedules around surgeon needs is unfamiliar and therefore a source of anxiety. It feels as though they’re giving the keys to the surgeons and relinquishing control.

However, “the truth is that the control has always been with surgeons,” Biala said. Utilization ultimately comes down to how effectively surgeons schedule and execute procedures. What’s changing is the level of flexibility surgeons have in scheduling and releasing time.

If your OR’s utilization rates aren’t meeting your expectations, consider starting a conversation with your surgeons. When a process isn’t bringing the ideal results, it’s often wise to bring in key stakeholders to learn more. Recently, a Sullivan consultant used this focused approach to revitalize a major university’s sterile processing department.

If you don’t know where to start, Sullivan Healthcare consulting’s team of surgical consultants can help. Our team has decades of experience in the field and have guided organizations just like yours through similar challenges.

To learn more about optimizing your OR utilization rates, get in touch with our team of consultants today.

Let’s Connect Today

10 + 11 =

Complete equation to submit