MIRROR IMAGE? How does the time surgeons requested compare with the time they've historically used?

Block time. Most of your surgeons want it, but you might not be so sure how to dole it out equitably and efficiently. Done correctly, block time can bring order to the chaos of the typical OR, drive revenue and satisfy your surgeons. Done poorly, block time can create scheduling nightmares, reduce your case volume and rankle surgeons. From someone who has experienced the good, the bad and the ugly of block scheduling, here are 6 tips for doing it tight.

1Take requests. Not all surgeons will want or need block time at your facility. Ask your docs what days and times they'd prefer block scheduling. 0730 start times are, of course, going to be the most popular and everybody will want to operate on Tuesdays. Then take it one step further and run those days and times by each surgeon's scheduler, who'll likely have a better sense of how reasonable the doc's request is.

2Crunch the numbers. Assess each surgeon's current utilization over a 6- to 12-month period, a timeframe wide enough to account for vacations and fluctuations in the schedule. Remember that doctors love numbers and will challenge any data you give them. You can run a monthly utilization report from your scheduling system or manually count the hours a physician spent in the OR.

3Compare requested time with time actually used. Compare the actual time a surgeon used to his requested block time. For a visual comparison, make a block template that lists each day and time that the surgeon requested and what he has actually used. Not surprisingly, you'll probably find that the surgeon has requested more time than he has used, or historically can use. Use this data to illustrate to the surgeons the difference in the time a surgeon has requested and the time he's likely to actually use. The goal is to mirror block time with time used (see "Drawing Up a Winning Schedule").

4Prepare to negotiate. With your data in hand, show each surgeon what he has used and what he has requested. Negotiate with the doctors, with input from their schedulers, what days and times will work for them and for you. Not everybody can have OR2 at 0730 every Tuesday. Assure them their times are not set in stone and their block may increase as they need more time and decrease if they don't use their time. Emphasize that you'll adjust block times based solely on their actual data, as reported in the monthly utilization report.

5Draft your block scheduling policy and procedure. To keep your block program running efficiently, you'll need to set rules and boundaries for your surgeons covering such areas as block release and minimum utilization rates.

• If a surgeon won't be using some or all of his block, he must notify you 72 hours in advance so that you can release the block and offer the slot to another physician. It'd be best if your scheduling software can automate the 72-hour block release.
• Surgeons risk losing their block time if their utilization rate falls below a certain threshold. I'd suggest 60-70% at the outset, with an ultimate utilization goal of 80% or higher. For the first year, assess utilization of block time every 3 months.
• Surgeons must notify you they will be on vacation or out of town for an extended period so that you can fill their time.

6Keep 1 OR open. Keep at least 1 room open for add-on cases and for cases you want to flip out to a second room. Open blocks will let you continue to accommodate new surgeons. OSM

REASONABLE REQUESTS?
Drawing Up a Winning Schedule

A surgeon's historical utilization rate should closely mirror his requested block time. Compare requested block times with the time your surgeons actually used in the last 6 to 12 months. If there's a discrepancy, adjust the blocks as necessary. As you can see in the example below, you also want to leave open blocks on the schedule to accommodate add-on and concurrent cases, as well as new surgeons.

Room

M

T

W

Th

F

1

OPEN

Smith
0730-1130
(Uses 3.66 hrs)

Jones
0730-1000
(Uses 1.35 hrs)

Williams
0730-1100
(Uses 2.93 hrs)

OPEN

2

OPEN

Miller
0700-1430
(Uses 7.03 hrs)

Goodman
0730-1400
(Uses 5.96 hrs)

OPEN

Hardy
1100-1330
(Uses 1.94 hrs)

3

Crone
0700-0930
(Uses 2.05 hrs)

OPEN

Chriswell
0700-0930
2nd & 4th
(Uses 1.54 hrs)
OPEN
1st & 3rd
0700-1000

Loura
0730-1100
(Uses 3.10 hrs)

Chriswell
0700-1130
(Uses 4.02 hrs)

4

James
0730-1030
(Uses 2.38 hrs)

Beale
0700-1030
(Uses 2.49 hrs)

OPEN

Crone
0700-0930
(Uses 2 hrs)

Presley
0700-0900
(Uses 1.19 hrs)

KEY: • adjusted requested time • historical time used • open blocks