Why OR staffing and scheduling is different than ER staffing and scheduling…

The OR case load has a very high daily variability of patient arrivals similar to an ER.

However, unlike an ER patient’s arrival that normally may monopolize a single (or shared) ER nurse and room until the next caretaker (physician, etc) arrives, each OR case requires the simultaneous availability of multiple skilled people (circulator, scrub, anesthesia, surgeon, etc) who must be there at a specific time or else they will interfere with the on-sight and off-sight schedules of the following case’s personnel (usually surgeon and anesthesiologist with their clinics, office hours, or other ORs).

note: An active trauma based ER will require a different scheduling system than the typical ER in order to coordinate the multiple people involved with a single patient (or patients) which makes it a hybrid of OR and typical ER.

Since there is such an economic hit to so many people (surgeons, anesthesiologists, and hospital indirectly through physician clinic staffing) if there is a delay in the cases, there needs to be a surplus of those people who are assigned only to the OR (nurses, scrubs techs, etc). These people assigned only to the OR are not the constraint, therefore they need to be buffered — which means extra people.

There are three ways to tactically minimize the cost of that OR buffer and have as little effect as possible on other areas outside the OR:

1) Have those surplus ‘inside OR’ people perform other chores when they are not busy
2) Optimize the throughput of those ‘visiting OR people’ when they arrive so they spend the least amount of total time in the OR
3) Decrease the total startup and cleanup times of specific OR cases.

Number ‘1’ will be determined by the unique nature of the particular OR.

Number ‘2’ will require an OR scheduling program that adapts and optimizes changing constraints.

Number ‘3’ will require decreasing non-contiguous case loads (ex: decrease ’emergency’ cases which require people not at the hospital to come in) by changing staffing times or making it possible and preferable to do those ’emergency’ cases at a different time.

There can be a calculated balance for the ‘buffers’ after stating the objectives and tradeoffs with regard to financial preferences and legal requirements so that they are transparent and understood by all parties. The finance, risk management, and legal departments should be involved as well as the OR managers.

Your regular staff scheduling program should be able to handle scheduling the ‘buffered’ personnel. How you optimize the use of those ‘buffered’ personnel cannot be handled by your regular staff scheduling program.

To clarify:

Most facilities are trying to solve two different types of problems with one type of software.

Stabilize the system through information and policy so that you can take as much variability as possible out of the workflow. You made need some more conceptual background that helps you do this. Some software will help with those concepts and implementation.

After that, other software needs to be based on throughput concepts that permit you to adapt to the variability that arises minute by minute in order to optimize what’s left over. This, too, requires a bit of background and specialized software.

Your practical, effective result is the combination of the two. With a simpler OR you can take out a larger percentage of the variability (stabilize the system). That’s why free standing surgicenters can cost much less to operate than the surgery center within a larger facility. However, with the right throughput scheduling concepts (along with throughput accounting concepts) a major facility should be capable of adapting to, and taking advantage of, the remaining variability in order to compete successfully with a free standing surgicenter.

I once presented to an OR team tasked with finding new scheduling software–they had seriously considered using meeting room software. There are scheduling professionals who save multi-national corporations billions of dollars every year. They achieve that by using software that aids in optimizing the use of certain concepts. Professional schedulers will tweak the software instead of being tweaked by the software.

About Brian D Gregory

Board Certified Anesthesiologist for 20 years. MBA from U of Georgia '90: Finance, Data Management, Risk Management. Practiced in multiple US states and Saudi Arabia at KFSH&RC and KFMC Taught residents in two locations. Worked with CRNAs for 20 years.
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