Surgeon Capacity ~$27M potential loss

$2000/hr x 55 hours = $110,000 opportunity cost in one day …  Who’s in charge here?.

click here:  3 Graphs of Actual and Optimized Surgical Schedule « ORTimes – Healthcare Systems Engineering Analysis

The above chart surgeons’  idle turnover time was derived from data during one day’s schedule at the primary hospital that an anesthesia group covered. Another blog displays additional charts derived from the same collected data which show the poor utilization of the CRNAs and seems to indicate that they have an excess of five CRNAs at the hospital.
For the graph above, I used $2,000/ hr for the calculation of  opportunity cost. This amount is quite variable depending of the situation. For a DOD military hospital, the lack of surgeons’ availability causes the patient to be outsourced to a private facility. A one hour knee operation that adds a minimal additional cost over the fixed costs of personnel salaries within the DOD hospital would end up costing at least $10K (could be $30k or more) to outsource to a private hospital.  For a private, non-military surgeon, the opportunity cost would be however much (s)he could bill for an additional procedure within that extra hour ($5K would not be unusual). If the surgeon had a limited surgical practice, then the opportunity cost might be the net amount from seeing patients in a clinic. There are lots of variables that influence the choice of hourly opportunity cost.

Beside each surgeon’s name is a red bar and a green bar. These bars represent the total time the surgeon had to be in the OR to finish his cases. The red bar is from ‘actual’ time recorded on the anesthesia records. The green ‘ideal’ bar is from a simulation using the actual durations, but scheduled differently. The black bar measures ‘actual’ – ‘real’.

You’ll notice that for two cases the green bars are longer than the red bars, but for all the rest the red bars are as long or longer than the green. In some cases they are over twice as long. This means most surgeons spent much longer than they needed to finish their case schedules. In fact, the total number of surgeons’ wasted hours is about 55.

In this case the OR was very busy, with most rooms being used. In the ‘ideal’ simulation, the OR did not use any extra rooms and did not stay open as long. I like analogies, and this scenario reminds me of packing a suitcase or the trunk of a car. The amount of space doesn’t change, but given the know how (and the right tools for scheduling) you can make a big difference.

The significance? If you were a surgeon, would you move your patients to a hospital where you could finish your cases in half the time? Would you do more surgery?

Below is the same chart but with only the ‘actual – ideal’ times showing. The black bars to the right of 0.00 indicated potential saved time. Those to the left of 0.00 indicate the surgeons’ whose time actually increased with the new schedule. Ways to avoid that can be discussed at another time.

update: Graphs of actual and optimized surgical schedule are on blog post dated January 20, 2010.

Time potentially saved by individual surgeons (actual – ideal)