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How to Conduct an Effective Block Committee Meeting Transcript

PRESENTER 1: iQueue for Operating Rooms is the predictive data analytics platform with the mission to help hospitals unlock unused capacity, and maximize the utilization of operating rooms. It has been deployed across more than 90 locations that are various EHRs. So, there are three pieces of the tool. But today, we’re going to focus on the strategic piece of the product that helps OR managers and periop directors identify your biggest opportunities with your current volatile location, and effectively repurpose block time with a concept called collectible time. Today, we’ll do a skit where we’re going to play out the before and the after of leading a Block Committee meeting. We’ll show you how to make surgeon-centric, yet powerfully defensible block decisions. Welcome to Q1 Block Committee Meeting. Thanks to all the division chairs who joined today. 

PRESENTER 2: No problem. So to get started, Dr. Williams is joining us in August, and we’d like to have him build up the Urology Practice. He’s looking for block time on Tuesday, but it looks like the entire grid is currently blocked. Can you help me see where we can carve out some block time for him? 

PRESENTER 1: Sure, so let’s take a look at the block utilization report. Looking at this list, starting from the lowest utilizers, Dr. Bowman has a 30% block utilisation. What do you think about taking some time away from him? 

PRESENTER 2: Well, Dr Bowman is one of our highest volume surgeons. He brings quite a lot of business to the practice. We can’t take away time from him. Dr. Bowman also complains a lot about anesthesia being late to his cases. So that actually might be a contributing factor to his low block utilization, and that’s not really his fault. 

PRESENTER 1: Then what about Dr. Flores? She’s only got a 40% utilization. 

PRESENTER 2: Well, Dr. Flores is just finishing early because she’s pretty fast at getting her cases done. Does it really make sense to punish someone who is very efficient in getting their cases done? 

PRESENTER 1: No, you’re right. We definitely don’t want to do that. Then how about Dr. Howard? His utilization is only at 67%, and he has never complained about first-case delays or long turnovers, and usually does not finish early. 

PRESENTER 2: Yeah, Dr. Howard seems like a good candidate to repurpose block time from. Since his utilization is at 67%, we can safely take away 33% of his current allocation. Please set up a meeting with him to inform him of our decision. 

PRESENTER 1: Will do. 

PRESENTER 2: Hello, Dr. Howard. Thank you for meeting with me today. I had a chance to review your block usage with the perioperative director, and we noticed that, based on your current utilization numbers, we can repurpose 33% of your current allocation. Now this will still leave you with enough block time to meet your existing practice volume.

HOWARD: There is no way I can meet my existing volume if you repurpose a third of my allocation. I’m using all of the time allocated to me, and I might actually need more time because my practice is now starting to ramp up.

PRESENTER 2: OK, well let’s first just take a look at your practice pattern then.

HOWARD: As you are already aware, our service line is quite prone to unpredictability. The cases are long, and complications may or may not arise. It’s hard to know how much time I’ll need on a particular day. You can see, even on your reports, that I’ve used every single day almost completely. On March 13 and March 27, there were no complications that came up, so there was some unused time. But I’ve used almost every other block completely. I’ve also made it a point to release my block when I know I won’t need it, as you can see on March 22 and May 15. The only exception is on March 18, where I released only one room because I had a case scheduled in the other, that eventually canceled.

PRESENTER 2: OK, I see your point. Let me talk to the perioperative director again and re-evaluate with this in mind. Thank you for your time. 

PRESENTER 1: So, that’s how pretty much every single block review ends. The division chair was not able to find a spot to give to the new surgeon. And by ignoring practice patterns in its simplistic calculations, block utilizations steered the OR leadership team to try repurposing blocks from a surgeon who was actually using it quite well. As you can imagine, it’s a frustrating process for everyone, as the OR leadership has to go back to the drawing board, and the surgeon feels like there is a target on her back for no good reason. So, since February, the Block Committee has switched over to this new concept, called collectible time, for evaluating block usage and repurposing blocks. We’ve heard this worked great at other hospitals, so we wanted to give it a shot. Welcome to our very first meeting using collectible time. Let’s first review what this really means. Collectible time is designed to provide actionable insight on where your biggest block opportunities are, in a surgeon-centric way that takes into account variability amongst different practices. Remember the time when you were reviewing surgeons that had low block utilizations because their cases were longer, and thus, more unpredictable. Or because of operational delays such as late starts, early finishes, or small gaps in between cases where you couldn’t have used the time otherwise anyway. Collectible time does not punish surgeons for those. Instead, we only focus on these three– entire block unused minutes, large contiguous unused time that is not enough to fit in another case, or releases above a certain threshold, which basically means that, for a surgeon with a decent block utilization because he is releasing a ton of time, there may be a need to revisit his block allocation because he’s been over allocated to start off with. 

PRESENTER 2: This methodology sounds great. Let’s try it out. 

PRESENTER 1: So, we’re going to go into demo mode right now. Could you please click on the red widget at the bottom of your screen to see the screen share. Thank you. OK, so once you get into iQueue, click on collectible. You’ll first see a wizard that guides you through how to set the filters, depending on how tolerant or strict you wish to be. So, we can start off with setting a 20% for acceptable amount of manual releases, and 3 and 1/2 hours as a threshold for continuous unused time. This threshold should be determined by the minimum amount of time where you can squeeze in another case. And you also have the option to filter to just see specific days of the week, or within certain service lines. And now we’re going to go ahead and create a table. So now you can see your lowest hanging fruit in order of most number of collectibles lost. 

PRESENTER 2: That’s very interesting, and it looks like the most atomic unit on the table is by block owner, day of week, and by location. 

PRESENTER 1: Exactly, that means if a surgeon has blocks allocated on Tuesday and Thursday, we’ll treat it separately as practice patterns are different. And as you can see on the right, the counting is on a quarterly basis. So anywhere around 12 or 13 blocks per quarter, pretty much means one block per week on that day of the week. 

PRESENTER 2: And so what does it show when you click into a particular block owner? 

PRESENTER 1: Yeah, so let’s give it a shot. I just clicked into Dr. Paul’s block. And once you click into the block owner view, the very first thing you will see is a visualization of the surgeon’s allocation, indicated by the blue line on the top. And usage, indicated by the area in the green. 

PRESENTER 2: So then the difference would be the overallocation, correct? 

PRESENTER 1: Exactly, and that is shown in red. So iQueue learns the algorithm on data over a year and, as of right now, you can see that the time frame being used is May 30t, 2018, to May 31, 2019. 

PRESENTER 2: Well, what if the usage is impacted by seasonality? So, for example, my pediatric surgeons might experience a surge in volume over the summer, but then some downtime when the school year begins. 

PRESENTER 1: iQueue is actually doing the optimization on the back end for you. For any block owner, it looks at the usage over the past quarter and past year, and pick the better one out of the two, so that it is in favor of the surgeons. So once I click into the, [INAUDIBLE] chart drill down view, it will switch over to this specific instance of the block allocation and its corresponding usage. You can see that, for example, on May 24, Dr. Paul started late and finished early. But those were not held against him because those were small operational gaps that weren’t large enough to fit another case. So now let’s look at another example. This surgeon shows up high on the collectible table as well.

 PRESENTER 2: Well, that’s pretty interesting because Dr. Simmons actually has a pretty decent block utilization. 

PRESENTER 1: Exactly, and that is because he has been releasing a ton of time, indicated by this striped gray bar. So you can see that he released both of his rooms on May 15, and then on March 13, as well as the two days in January. So even though that is the behavior to encourage, he probably doesn’t need so much time to begin with. Let’s also take a look at how early he releases. So if we pull up iQueue exchange statistics and go to see release productivity leaderboard, you can see that this surgeon is actually releasing at just six days before the date of surgery, right before the auto-release deadline. 

PRESENTER 2: OK, interesting. So the chair of orthopedics will probably need to have a conversation with him. 

PRESENTER 1: Yes, totally agree. Let me add a note in here so we remember that piece of information. So now I’m going to switch back to the demo. OK. 

PRESENTER 2: And with that in mind, I’ll also talk to the other general surgeon that we were looking at earlier.

PRESENTER 1: Let’s go back to Dr. Paul. 

PRESENTER 2: So how many blocks do you think we should take away from Dr. Paul’s Friday allocation at the Killarney location, in particular? 

PRESENTER 1: Well, it’s says seven collectible per quarter. We could select six to take away roughly Friday block every other week to start off with. 

PRESENTER 2: Yeah, that sounds good. We can start from there. 

PRESENTER 1: I’m going to go ahead and download a report. This is essentially a block letter. 

PRESENTER 2: That’s a really cool feature. Can you also customize the language in that block letter as well? 

PRESENTER 1: Yeah, for sure. So, if you see this box at the bottom, this actually makes it much more standardized and smoother. So I did send one earlier as just a warning letter by changing the language at the bottom to say, this is not to take your blocks away yet. We just wanted to let you know that we’re detecting a pattern of under usage, and we will like to see your utilization go up in the next few months. 

PRESENTER 2: Great, so I will take this letter and have a meeting with Dr. Paul then. Dr. Paul, thanks for meeting with us today. We wanted to talk to you about the decisions we’ve made about your block allocation. Now you’re up to speed with the changes we’re considering making to our block policies regarding collectible time, right? DR. PAUL: Yes, I am. 

PRESENTER 2: Great. 

PRESENTER 1: So reminder to click on the red widget again to see the screen share. 

PRESENTER 2: So as we take a look at the data we’re getting from iQueue according to our standard collectible time thresholds, we’re showing that half of your block allocation on Fridays is currently collectible time.

PAUL: That seems higher than I’d expect. What time is being identified as collectible?

PRESENTER 2: Well, it looks like all of the collectible time is a result of continuous unused time. Either entirely unused blocks, or segments larger than 3 and 1/2 hours. Over the last few months, in particular, it looks like you left your first Friday block completely unused each month. Now that’s definitely some time that you could have released proactively.

PAUL: Yeah, I can see that. And I’m starting to have my schedulers do that more, since I now know I can go into iQueue to find open time when I need it.

PRESENTER 2: Perfect. Now moving on, the rest of your collectible time comes from unused segments greater than 3 and 1/2 hours. 

PAUL: Hang on, now that example on May 24 seems somewhat unfair. I remember that day, and I had to start a couple of hours late due to an issue with a patient which was out of my control. I shouldn’t be getting penalized for that. 

PRESENTER 2: Right, and with collectible time you’re actually not getting penalized for that. Remember, we’re only looking for segments larger than 3 and 1/2 hours. Just the ones with that red border on the chart there. Those late starts or early finishes aren’t going to hurt you. But, here’s some more of those examples of large unused segments.

PAUL: Well, in my defense, that was a pretty big problem for me in February. But I’ve been much better about it over the last three months. That’s why I’m a little surprised to see my collectible time is so high.

PRESENTER 2: But the thing is, iQueue is actually removing that uncertainty. It calculates collectible time based on both your past quarter’s performance, and your past year’s performance. So it’s actually already choosing the one that’s better for you.

PAUL: I see. So I’m just going to have a lot of collectible time, regardless. But you can see from the data that I’m still improving, right?

PRESENTER 2: Oh yes, you definitely are. I’m going back to this graph for a minute. It looks like the amount of non-collectible time that you’ve had, which is shown in this green color, has actually grown over the last couple of months. So the truth is, that even with that slight improvement, there is a lot of block time we could take away from you without cutting into any of your existing volume.

PAUL: OK. I guess I can’t really argue with that. But can you revisit this if I continue to grow my practice?

PRESENTER 2: Absolutely. So with that in mind, I’m going to record that the decision we’re making here, is to take away six of your Friday blocks, as that neatly translates to once every other week over the quarter. I’m also going to add a note saying that we’re going to revisit this decision after two months to see if your practice has continued to grow. If so, we can discuss giving some of your block time back to you. DR. PAUL: Sure, that’s fine. 

PRESENTER 2: So it seems like this method of collectible time is working really well. Should we go ahead and build it into our block policy? 

PRESENTER 1: That is exactly what I was thinking, and here’s a draft version that I have prepared. Basically outlines how we will use the three buckets of collectible time to right-size blocks. 

PRESENTER 2: Wow, this looks great to me. Let’s do it.

 PRESENTER 1: Since the switch to collectible time, we’ve been able to have a couple of conversations with surgeons where we were able to make reasonable decisions to take blocks away. The Block Committee has been posting the block review policy in the surgeons lounges to increase awareness, create a culture of accountability with increased transparency, and operationalize it on a quarterly basis. 

PRESENTER 3: And now we can go into Q & A. Here’s our first question. How successful have the other hospitals been? 

PRESENTER 2: Great question, and I can speak a little bit to that. So a lot of our customers have actually been very successful at implementing collect. We’ve noticed that most institutions in the past have tended to rely on block utilization as the default metric for rightsizing blogs. And, as you saw from the webinar, usually it’s very hard to make decisions using that data. What we’ve found with collectible time, is that the decisions are a lot easier to be made because the methodology is so much more friendly to surgeons, and it’s a lot more actionable for you as the administrations of the OR. So, what we really try and do on the lean-cost side, to help facilitate this process, is bake it into your block policy, attend your SSEC meetings. And what we’ve seen is now a lot of our customers actually review collectible time data in their SSEC meetings every month. And then as a group, they collectively go over the opportunities, take notes, make decisions, and then communicate that to different block owners. So that way, you’re able to have an audit trail of all the decisions that you’re making in the collectible table as well. So, all of our customers are able to look back on every single decision that they’ve made using collectible time, as well as the context behind each of those decisions. So they can actually see what data was being used to make that decision, and what was the actual decision that was made. 

PRESENTER 3: OK, looks like we have a couple more questions here. And again, if you have a question, feel free to submit one. Use the Q&;A widget. How often does the data refresh? 

PRESENTER 1: Great question. I’ll take this one. So the data for collectible time refreshes every day. But the time frame upon which the analysis is done, refreshes every month. So it makes sense to go back to this table every month to review any improvement or progress on each of these block owners. 

PRESENTER 3: OK, it looks like this is the last question. Who will be able to access this? 

PRESENTER 1: So, any of the admins, including surgeon’s admins who administer other surgeons, will be able to access this. But this is all configurable for your organization. 

PRESENTER 3: Thanks again for joining us.

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