Battle of the Dashboards- Dynamic Block Scheduling Virginia Chard, BSN, CNOR

Transcription

1 Battle of the Dashboards- Dynamic Block Scheduling Virginia Chard, BSN, CNOR

2 Objectives 1. Identify the necessary building blocks a hig functioning block schedule 2. Identify key points of an effective block scheduling policy and procedure 3. Review block schedule Best Practices 4. Review of the role the scheduling department plays in a successful block schedule

3 Block scheduling- key building blocks for success Comprehensive Block Utilization Policy A high functioning OR Scheduling Policy An engaged OR Operations Committee Alignment with Executive Team expectations Strong data collection tools

4 Block Schedule Best Practices Have administration on your team Manage block allocation according to service/surgeon needs Manage release times according to service/surgeon needs Strive for efficient utilization in Prime Time Build and enforce block scheduling policies Use data to drive block time allocation decisions

5 Key points of an effective Block Management Policy: Block Times defined by day of the week/hours of the day Defined process of actual scheduling into Block Time Rules around Block Time allocation Utilization targets (i.e %) Utilization review (clear definitions, reporting matrix) Clear guidelines for measurement of actual utilization Block Time release times scheduled vs voluntary Block Time allocation guidelines

6 Critical components of a Block Scheduling Policy Case classification Case scheduling process and requirement, for elective cases, urgent / emergent cases Flexibility through designated open time (first come/first serve) Scheduled auto release by service line/specialty Cancellation Performance measurement Block allocation, reallocation and release Process of new block time request

7 General Rules General Rules Block utilization is based only on cases performed in the block; cases scheduled outside of block will not be factored into block utilization. Utilization outside of block time will be considered when adjusting current blocks. Block release Voluntary release: Voluntary released block time is released block time 14 calendar days in advance for vacation, personal time, conferences, and meetings Automatic release: Unscheduled block time will automatically release per each Service Line s designated block release time. Utilization will be reviewed on a quarterly basis by the Perioperative Executive Committee (PEC). Providers, Practice Managers, and Schedulers will be sent a copy of their monthly utilization.

8 General Rules Utilization will be reviewed on a quarterly basis by the Perioperative Operations Committee. Providers, Practice Managers, and Schedulers will be sent a copy of their monthly utilization. A Block Reallocation Threshold will be clearly defined: Block falling below the 80% utilization target for the quarter will be reviewed and block time may be reallocated to meet 80% utilization. General Trauma and Ortho Trauma will have the utilization target of 70% to accommodate the need for available block time for trauma.

9 Block Scheduling Policy I. Blocks will be assigned to individual Attending Surgeons or groups of Surgeons. Groups must have an assigned Block Manager for effective block management of the block. Each surgical service s operating room time allocation will be based on: current (past three months) elective, urgent, and emergent case time (case time will include actual turnover times) surgical service Chairperson s/chief s and Attending Surgeon s next three month position plan Block time utilization will be computed by adding total surgery hours (time patient enters room to time patient exits the room) and the turnover time (actual average turnover time or the following: 20 minutes for each ambulatory case, 30 minutes for each inpatient case) 2. All blocks are to be held no later than 12:00 Noon on the day of block release. Initial block release times will be 4 business days for all blocks if not negotiated before implementation. 3. If a surgeon or block manager gives a 7-day notice of non-use or release of block, they will not have this time computed in their block time.

10 Block Scheduling Policy 4. Individual and designated elective, FC/FS, urgent, and emergent utilization reports for each surgical service will be prepared every four weeks and provided to the OR Operations Committee and respective surgical service Chairpersons/Chiefs. Individual Surgeons will have their utilization reports ed to them. A member of the OR Operation Committee will meet with each surgical service Chairperson/Chief once every 12 weeks if utilization reports indicate a need for OR time reallocation. All blocks 15% below targets for the preceding two months will be placed on probation, eliminated, or moved to a smaller block. The Chairperson/Chief of each section will be responsible for overall management of all elective, urgent, and emergent OR time allocated to their sections. Elective Blocked Time: maintaining 80 percent or higher utilization of elective blocks designated to individuals or small groups of Surgeons Block utilization above 90 percent for any Surgeon over an eight- to twelve-week period would make that Surgeon eligible for additional block time. FC/FS Time: maintaining 75 percent, or higher, utilization of service- or service group-specific allocated FC/FS times Allocated FC/FS time with utilization above 85 percent would make the service eligible for additional FC/FS block time. Urgent Time/Ortho Trauma: maintaining 70 percent, or higher, utilization of allocated Surgeon- or service groupspecific urgent times Allocated urgent time with utilization above 85 percent would make the service eligible for additional urgent block time. 5. Cases must be started in the first hour of the block with no gaps allowed within the block. 6. The OR Executive Committee will coordinate determination and allocation of all block time based

11 Challenges Complicated calculation scenarios: e.g. utilization of blocks assigned to surgery groups or service lines, and flip rooms Common issues of block utilization calculation Examples: e.g. no out-of-block surgery minutes calculated proactive tactics to avoid these issues

12 OR Scheduling

13 Optimizing Patient Scheduling Patient satisfaction Surgeon and staff engagement and satisfaction Managing available open and blocked time to maximize utilization of OR time

14 The Role of the Scheduling Office team: Schedule Planning Patient/Surgeon Access Physician Office Relations Information System Support Resource Coordination

15 The role of the OR Operations Committee Develop clear scheduling policies : 1. Availability 2. Utilization 3. Release times 4. Add-ons/emergent/urgent cases Develop guidelines for managing the policies Develop a clearly defined appeals process

16 WHOS ON FIRST!?!

17 Clearly defined data matrixes to support decision making Robust data collection tools : Evaluate total OR utilization Evaluate total Block Time utilization by provider Evaluate OR utilization by day of the week, hour of the day Evaluate emergent/urgent add on cases ( in normal scheduled hours vs afterhours and weekends)

18 Block Utilization Analysis Monthly Case Volume, including in-block case volume and out-of-block case volume Average case duration First-case On-time Start Allocated block time Block Utilization (in-block surgery minutes) Out-of-block surgery minutes Monthly trending for three months Quarterly report is for the review and consideration of OR management

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20 DETAIL

21 YTD PERFORMANCE

22 Surgeon Score Card Allocated block time Block Utilization (in-block surgery minutes) Out-of-block surgery minutes Monthly trending for three months Quarterly report is for the review and consideration of OR management

23 YTD PERFORMANCE

24 Success Factors-Tools A centralized standard report depicting a complete picture of OR operational performance A continuous measurement mechanism demonstrating performance trend An effective tool helping identify performance improvement opportunities An intuitive communication venue facilitating decision making process

25 Success Factors-Infrastructure Participation of surgeons of multiple service lines Open discussion and communication Support of senior leadership Comprehensive, fair Policy and Procedure enforcement Block utilization review, reporting, reallocation and request