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What’s The Best Way To Allocate Or Block Time? A Data Driven Approach To Departmental “Operations”.
Jugpal Arneja, MD, MBA1, Jason Goto2, Geoff Blair, MD1, Larry Gold1, Barb Fitzsimmons1, John Masterson, MD1, Erik Skarsgard, MD1.
1British Columbia Children's Hospital, Vancouver, BC, Canada, 2Analysis Works, Vancouver, BC, Canada.
In health care systems, although operating rooms (ORs) often function at high capacity, there often is a significant supply-demand mismatch resulting in waitlists for non-urgent surgery. Additionally, financial/Relative Value Unit (RVU) optimization is rarely considered when OR time is allocated. Within surgical departments, OR block allocations were traditionally based on historic apportioning and perceived priority amongst surgeons, rather than on scientific data. Since historical allocations of OR block time were simply based on conjecture, the introduction of Operating Room Allocation Methodology ‘ORAM’ creates an environment of transparency whereupon surgeons with the most need are recipients of the hospital’s most expensive and most revenue generating fixed commodity, OR block time. Furthermore, in an effort to create value for an organization, or to incentivize departments, this methodology can be incorporated to optimize revenue in the form of allocating more OR time to services based on RVU generation. There have been no previous published reports of a similar methodology.
A gap persists between our surgical resources and demand. ORAM reallocates the fixed pool of OR time amongst surgical divisions based on benchmarks. Over 6 months, the differences in waitlists (net arrivals) as well as completed cases were analyzed. Quantitatively, ORAM is predicated on 50% of the total calculation assigned to net arrivals and 50% given to operating on patients who were the most out-of-benchmarked-window. Reallocations occur semi-annually and a maximum 20% reallocation is possible to an individual surgeon. Qualitatively, a survey was sent to all surgical division chiefs to determine their subjective impressions of the ORAM process. An analysis was also performed to determine financial metrics associated with reallocation of block time.
Quantitatively, surgical waitlists reflected significant difference based on reallocations. No significant differences were found in OR costs associated with reallocation. Qualitatively, a data-driven methodology was accepted and favorably received by department members.
Although it is always a great challenge to deviate from historical comfort zones since no surgeon welcomes any loss of OR block time, feedback regarding ORAM has been positive. The method of putting science and data behind the decision making has been embraced by all services. With future iterations of ORAM we should arrive at a steady state of limited reallocations between services. ORAM provides the data needed to argue scientifically for more resources when and where needed. We are proud practitioners and teachers of evidence-based surgery, yet in the “operations” of our organizations little scientific data is employed to drive decision making. Optimization of either waitlists or RVUs can be more easily attained with the utilization of ORAM to allocate OR block time.
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