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Bringing Factory Thinking to Healthcare

   March 29, 2016

Optimizing block scheduling for hospital operating rooms is a potential cost savings for health systems. Having the right tools and the right data is imperative.

While it’s possible to bemoan the industrialization of healthcare, when large amounts of resources— represented by operating rooms, hospital beds, and staff—it is essential that healthcare systems look for inefficiencies and squeeze them out.

Toward that end, Mercy Medical Center, an 875-bed operating unit of Catholic Health Initiatives in Des Moines, Iowa, recently turned to cloud-based analytics software from Hospital IQ (formerly PatientRoute) to improve patient flow, reducing backups in the emergency room, and to better meet surgeon demand for operating rooms.

Mercy’s path to Hospital IQ began several years ago, when Kathy Goetz, vice president of perioperative and specialty services, attended a meeting convened by the Institute of Healthcare Optimization about how to do more to optimize scheduling people, rooms, and equipment.

“I was introduced to some statistical theories about how to help manage the flow of patients with a concept called the queuing theory,“ Goetz says. “That’s the concept of how do you help get things through a system. Queuing theory basically talks about when you have people standing in lines, how do you get them through? If you think about having four tellers at a bank, and you’ve got five people in one line and seven in another line and three in another line and eight in another line, how do you decide at what point you’re going to open up a fifth line? Or are you better to shut down one of the lines and consolidate your resources and have everybody go through three lines?“

Queuing theory is a fairly simple concept, but not so simple to implement without algorithmic help. Still, many industries, such as banking and grocery retailing, have applied the theory to good effect, as witnessed every time a supermarket opens a new checkout line when demand for clerks soars.

“I became very intrigued by the idea and came back and tried to implement some of the concepts, but found that what we lacked was the statistical software to help us be able to analyze our current flow data, and also to enable us to do some simulation modeling,“ Goetz says.

Through the Institute of Healthcare Optimization, Goetz found Hospital IQ. “We spent some time looking at what we thought the return on investment would be for our organization if we were able to utilize those tools,“ she says. In fall 2015, Mercy began its formal partnership with Hospital IQ, which began to send staff to Des Moines monthly to identify the data needed from Mercy to input into its analytics software.

‘A Big Surgical Factory’

One of the most challenging resources to optimize is block scheduling, which is the way surgeons use specific blocks of time, a resource most electronic health records do an inadequate job of optimizing. Block scheduling is made complex by the fact that different surgeries and surgeons require different lengths of time.

Since operating rooms can cost $60 per minute to run, making sure those ORs are not prepped-but-idle is a real area of potential cost savings for health systems.

“You want to get the most out of that time and understand who’s using it well and who’s not using it well,“ says Rich Krueger, CEO of Hospital IQ. Kruger comes from outside of healthcare, from virtualization software vendor VMware, and has a background rich in the theories of W. Edwards Deming, who championed quality control and management theory in the post-World War II era.

“The way you run the operating room, it’s a big surgical factory,“ Krueger says. “Most of your procedures are elective. Some percent are urgent or emergent, trauma cases or work-ins or whatever, but a lot are scheduled, and surgeons need to know when they can schedule patients.“

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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