by Rosanne Zagone Nipko, RN
Senior Consulting Director
12/08/20

I have been scuba diving for more than 10 years, enjoying dives from the Florida Keys to Curacao to Hawaii to Fiji. When people hear that I scuba dive, the first question I am often asked is, “Have you ever been diving with sharks?” Well yes, I have been diving with sharks, and I love it! I am amazed by these animals in their beautiful underwater environment and forget any fears I may have. Managing, let alone changing, your organization’s block schedule might feel as intimidating as the thought of diving with sharks. But don’t let it scare you; the benefits far exceed the risks. It’s time to dive in!

About the block schedule

Most operating room (OR) scheduling is based on some type of block schedule system that was developed many years ago. Hospitals assign a surgeon (or specialty or surgeon group) blocks of time to schedule procedures for their patients. If a surgeon has any unused block time that no other surgeon can (or has) scheduled into, the OR, staff and equipment sit idle. It is like having a table reserved at a restaurant for dinner on the same day each week. No one else can sit at your table during your reserved time (even if you don’t go to the restaurant for dinner one night) unless you cancel your reservation.

During late March, when hospitals paused elective surgeries and non-essential procedures due to the initial surge of COVID-19 patients, OR revenues plummeted. Vizient’s Brian Esser, MBA, associate principal, intelligence, estimates that as of late March, OR volumes declined year over year by 40–60%; ambulatory services some 80–90%. As hospitals began to resume these procedures in late spring and into the summer, they faced a backlog of patients who required a surgical procedure. Surgeons are anxious to care for these patients; and for the hospitals, it is imperative to regain case volumes and revenue to maintain financial stability.

Your organization’s block schedule may be impeding your ability to maximize utilization of your operating room. Block schedules were often established years ago with some evolution over time based on block utilization. Instead of working in a way that maximized finite resources, the block schedule approach often leaves gaps in the OR schedule from some surgeons, while other surgeons need more time. Some organizations have adjusted their blocks to accommodate this, while others have not. Organizations would benefit from a long-term strategy to plan, assess and adjust block schedules.

How to get started

Determine what type of OR schedule your organization has. There are generally three types of OR schedules: 100% block schedule, partially blocked/partially open schedule (aka, hybrid schedule), and open schedule.

With a 100% blocked schedule, there is no time available for surgeons without blocks to get onto the schedule, unless blocks are released. A hybrid schedule allows for high-volume surgeons to have blocks, while having open scheduling time available for any surgeon. Finally, an open schedule allows for the most flexibility for any surgeon to schedule whenever they need, any day of the week.

When determining the type of schedule your organization needs, consider your organization’s needs for surgery time by current and new surgeons, surgeons’ cases lost to other facilities and the hospital’s strategic goals for service line growth.

Understand how blocks are released at your organization: voluntarily or automatically. Voluntary block release is when the surgeon lets the OR know that s/he will not be available to operate on their block day and they release their block. An automatic block release is when unused block time is automatically released for open scheduling by any surgeon based on a predetermined time defined in hospital policy, anywhere from the morning of surgery to two weeks before the surgery date. This allows other surgeons to schedule surgical cases into these dates and times.

Evaluate block schedule utilization. It’s important to note that block utilization and OR utilization are two different calculations and numbers and are not always equal. Block utilization can be measured in several ways depending on your organization’s policies. The time the patient is in the OR during a surgeon’s block time is a standard measurement. Other measures that may be included, such as turn-around time, amount of voluntary block releases, late starts and other times. OR utilization is the total time patients are in the OR during normally staffed operating hours divided by the number of staffed ORs.

My experience has shown that the most unbiased way to determine block assignments is based on OR utilization, not block utilization. Having patients in an OR is the basis for OR utilization, which, excluding turn-around time, should be close to 70–80%. If your organization does not have patients in your staffed ORs, your OR is not being utilized. A good starting point to determine who needs and will use their blocks consistently is to look at which surgeons are utilizing the OR.

Every organization is unique

Each one of my dives is different, and I plan accordingly. I might consider if I am diving from shore or a boat and how deep I will be diving. In the same way, there is no one-size-fits-all scheduling practice for every organization. Each organization need to consider its own unique needs and resources when evaluating their block schedule.

Small community hospitals, larger regional hospitals, and academic medical centers all have different scheduling needs; some organizations can tolerate a very rigid schedule, while others require more flexibility in scheduling to maximize OR utilization. There are many things to identify and consider, as I mentioned above. 

When I am planning a dive, I always have a buddy, not only for safety, but also to have another set of eyes on the big picture so that all aspects of the dive are reviewed and considered. Evaluating and implementing an OR scheduling practice that works best for your organization requires more than just one person. The development of a team of key leaders, surgeons and anesthesiologists will be required who understand and are supportive of the goal of maximizing OR utilization. This team will need to evaluate the data, consider all the options to determine the best scheduling option for your organization, as well as develop policies that are clearly understood, adhered to and enforced. Then, this team will need to meet regularly to review the data and revise schedules as necessary.

Although diving into your organization’s block schedule might feel as intimidating as the thought of diving with sharks, don’t let it scare you. It is crucial to maximize OR utilization, regain and retain case volume, and achieve the financial goals of your organization. There’s never been a better time, so take the dive!

The Vizient perioperative clinical team conducts assessments at member organizations, identifying OR scheduling improvements at most organizations. This work has opened up time on OR schedules for surgeons who had not been able to get cases on the schedule, released block time that historically had not been used and increased overall OR utilization.

About the author: Rosanne brings more than 30 years of experience as a nurse in the health care industry. Her expertise includes working with clinical teams, physicians and senior leadership to assess and maximize service offerings, improve processes and efficiencies and standardize practices within surgical services and other clinical areas. Roseanne has worked with Vizient members to identify and implement improvements to improve OR utilization, increase revenue and decreasine costs. She has demonstrated her skills utilizing Lean principles to assess and implement operating room process improvement in the areas of preoperative preparation and testing, scheduling including block scheduling and patient and supply throughput. Prior to joining Vizient, Rosanne spent more than 15 years in many clinical and leadership roles within the operating room as a scrub and circulating nurse in surgery, assisted in the setup of electronic scheduling system and electronic preference cards, budgeting and case costing and contracting for supplies, services and capital equipment. She also has more than 10 years of experience in value analysis, partnering with surgeons, staff and leadership focusing on team development and engagement in process change. Roseanne earned a Master of Science, Nursing Administration, from Marquette University and a Bachelor of Science, Nursing, from St. Catherine University.