MARIANNE: Hello, everyone, and welcome to today’s session, titled “Deploying a Block Allocation Process that. Physicians Won’t Hate.” I’m Marianne Biscup. I’m the events manager for LeanTaaS iQueue. Now before we start,. I have a couple of points I want to cover for you. First, due to a scheduling conflict this webinar is pre-recorded. We will still facilitate questions, however, so feel free to text us a question at 630-884-5493, or email us at firstname.lastname@example.org.
You’ll also notice that you’re muted. If you have any questions during the presentation, please enter them in the Q&A box, which can be found in the lower right corner of your screen. We will have a live person that hopefully can get to all your questions at the conclusion of the webinar. But again, if we can’t, then feel free to text less or email us and we will answer as many of the questions as we can. We’ll also send out a link to the webinar recording shortly after we conclude the webinar. So with all of that out of the way, I’d like to introduce our presenters, Ashley Walsh, who is the director of client services OR here at LeanTaaS, and we also have Katherine Halverson. Carpenter, who is VP of clinical operations. Take it away.
KATHERINE HALVERSON CARPENTER:. Thank you, Marianne. Welcome. Thank you for joining us today. The themes for today that we’re going to cover are, what do surgeons care about most when it comes to block time? What’s wrong with the block allocation processes today? Key elements of surgeon-centric block allocation process, and using mobile and cloud technologies to improve surgeons’ engagement with your block allocation process.
For the context of today’s presentation, I’d like to do a quick overview of UCHealth. In January of 2012,. University Hospital, located in metro Denver area, and Poudre Valley Health System, in northern. Colorado, formed UCHealth. In October of that year, the Memorial Health System in southern Colorado joined UCHealth. At that time, we comprised five hospitals. Our employees were 16,000. We did 66,000 surgeries. We had 1,600 beds. Admissions were over 104,000 admissions. Clinic business exceeded 2.6 million. Our ED visits were close to half a million, which also included three-level trauma centers. We had net revenue of $3.1 billion.
In January of 2016,. LeanTaaS and UCHealth begin the development of OR iQueue. What do surgeons care about most when it comes to block time? Access to the OR, on-time starts, expedient turnovers, accurate data, timely data, and I don’t know if your experience is mine, but sometimes when we did our block reports, it could be six to eight weeks by the time we got the reports out to the surgeons. And it lost its relevance for me, personally, as director, as well as the surgeons. And surgeons also wants fairness across all of their surgeons. What’s wrong with block allocation processes today?
It’s a long process to obtain block time, particularly if you have a high rate of block time allocation. Time needs to be earned and you need to demonstrate consistent volume over x amount of time. And to reallocate blocks, a surgeon needs to underperform consistently for his time to be reallocated and given to a higher volume surgeon. It can be a highly political process. It is not surgeon or service-centric. it is often not based around actual time used. And block utilization is a flawed metric. And included is the webinar link, “Why Block Utilization is Not the Best Metric.” And now I’m going to turn it over to Ashley to review in detail how block time is based on supply and demand.
ASHLEY WALSH: Sure. Thanks Katherine. Welcome, everyone. We’re so glad that you had the time to join us today for this webinar. So some of you might have joined our previous webinar on why block utilization is not your best metric to use when looking at how well blocks are used. I’m just going to spend three minutes today highlighting some of the key takeaways from that webinar. But if you have the time, I invite you to download that webinar, and listen to it, and talk about our thoughts on block utilization, and show you a better way to look at how block time is really used.
So let’s just spend those three minutes reviewing block utilization. So block utilization is a very common metric. We’re all using it in our ORs today. Our surgeons sometimes live and breathe by it. What is my block utilization? I need to get more block time. So how do we define that? Well, we take our total block minutes that are allocated to physicians. We look at how many minutes are they actually in the room. We often give them the benefit of adding in turnover into this calculation and divide that by those total allocated minutes. So again, we’re really just looking at when the wheels were in the room, we’re giving them some credit for turnover, and then we’re dividing that by how many minutes we allocated to them.
I spent a lot more time in our previous webinar really talking about why there are so many problems with that metric and how it is not surgeon-centric, how it can be very frustrating for surgeons because that calculation alone does not take into consideration so many of the things that happen in day-to-day surgeries. Let’s just take two examples of block utilization and the problem with this metric. So in example A, let’s just pretend that this surgeon is an orthopedic surgeon, very consistent utilization, might be a sports medicine provider, a total joint provider doing total joints mixed with some scope cases. So consistent surgical patterns we see in those types of providers. And it’s not just orthopedics, we see that in many service lines. Take example B.
Let’s pretend, for this example’s sake, this is a neurosurgeon. This also is actually a very consistent pattern you see across many service lines, where maybe they do a long case. Maybe they do a short case. They’re not perfectly always filling that block, though. Both examples– the utilization is approximately 75%. In our hospital, 75% is pretty good. But let’s talk about what you don’t identify in block utilization. In example A, this provider consistently used approximately 8 out of the 10 blocks. Really, maybe 7 and 1/2 or 8 and 1/2 for example’s sake.
On the right, they used every single block. So what block utilization did not tell me in one metric was that on the left, there were two solid days that could have potentially been reallocated to someone else, whereas on the right, most likely, we would not have fit another case on at the end of the day. I know many of you are out there saying, well, yeah, that’s why we look at release reports or we look at all these other reports. But the point of that is block utilization was not able to tell you that. You often have to look at multiple reports to get those answers. That’s not very useful because block utilization alone is not actionable.
Katherine and I had the pleasure of working together for eight years at University of Colorado Health, as she talked about earlier on slide two. You got a sense of about how big our system was and about how busy we were. So we were heavily blocked. Using block utilization was something that we did and it wasn’t actionable. So 1 minus block utilization– it really meant nothing. It didn’t mean to me in the previous slide that I could always take away 25% of both of those block owners’ times. The neurosurgeon showed up every week to use time. His cases or her cases just didn’t perfectly bin pack into those 8-hour, 9-hour, 10-hour blocks.
So block utilization was not surgeon-centric. It’s very hard to compare across service lines for exactly the examples in the previous slide. It’s not comprehensive. As block utilization alone, I still had to pull multiple other reports to try to make a recommendation to a committee. So let’s talk about a better way to do things. Let’s talk about the key elements of really making a surgeon-centric block allocation process. This was imperative to Katherine and I. Every year in our hospital, we are gaining new physicians. We were doing more procedures. We were doing more minutes. We were growing. And our process was, let’s look at block utilization, let’s figure out where we can give more time. It wasn’t a scalable process. It was heavily reliable on people.
So to make a surgeon-centric block allocation process, we knew, one, first and foremost, you need timely and accurate data. Showing data to your physicians and your administrative teams 25 days, 30 days, 15 days– even– after the end of the last month is not timely. The other problem is accurate data. Block utilization is one calculation. Oftentimes, you’re using many different reports. The cleanliness and accuracy of those reports today in our hospitals is hard to maintain. It’s hard to maintain that when it’s people-centric. So two, we need to use data to push the process and the policy, and not just the people.
Of course, we all need to still be involved in this process. We develop relationships with our physicians. We are working hard to work collaboratively across our teams– administration, nursing, physician, et cetera. So we’re all still going to be involved in this process. But rather than it being so heavily reliable on us, as people, we need to turn the needle over to rely more heavily on data and to really drive that process change. So what we are going to talk about here in the coming slides is really identifying the supply and the demand of the operating room. What is your supply and your demand? What’s your supply? How many available rooms do you have? How much time? Who maybe is not using their time very well? Who are these surgeon As, where they’re consistently leaving two of their eight blocks per month on the table not being used? And then what’s your demand? Where are your service lines going? Who’s driving that business? Who needs the time?
So we’re going to talk about how you can do that with data, how you can really allocate time truly based on supply and demand and not just on historical allocation or historical utilization, like we do today. So let’s talk about the supply. In our previous webinar, “Why Block Utilization is Not Your Best “Metric, we talk a lot about more problems with block utilization and we share with you a new concept. This is a proprietary concept to LeanTaaS, and we call this concept collectible time. So in this graphic in front of you, you’ll see days of the week. And pretend, for example, this is a surgeon’s block time over a quarter. So each line represents a different day. Dark blue indicated when that provider was in an operating room doing cases. Red diamonds represent large times that go unused. They could go unused for a variety of reasons. It could be cases were canceled. It could be cases went less than their scheduled time.
The point is these red diamonds happen very frequently in our operating rooms and we want to help you identify them. Blue triangles– these happen every day. You’re going to have delays between cases. You’re going to have delays in first cases. You’re going to end days early. What collectible time focuses around is giving you, as a leader in the OR, a comprehensive metric to identify where was their time you could potentially reallocate, repurpose, or reuse with a different block owner, or perhaps open time, or even perhaps just closing an OR. So collectible time is a new metric. It’s proprietary, as I mentioned, to LeanTaaS.
It’s using very sophisticated math to help you identify an output. It’s an output that you can configure, as a leader, to a very easy-to-read output. Let’s talk a little bit about how you can configure that and what I mean. The red diamonds are what we want to help you configure. So how much time is acceptable to release in your organization? That will differ among every organization. Maybe it’s 100%. Maybe 100% of time that physicians release, as long as they’re releasing it, is acceptable. I can speak to my own previous experience where, unfortunately, we had providers abuse the release policy.
We did historically allow 100% of releases to not penalize providers in block utilization. I think a lot of people out there do that– a lot of hospitals. If you are in a similar situation that I was, where you had repeat offenders or individuals that maybe abused that policy, you might want to configure this a little bit differently to say, you know what? 25% of the time allocated to you is acceptable to be released. But anything above that– not acceptable. So we’re going to use that as part of the metric to, for lack of a better phrase, penalize the surgeon, or identify more collectible time, I should say.
In addition, you can tailor this to your organization so that if, for example, you’re more of an ambulatory setting, your cases are very clean, concise, typically two to three hours or less, you might want to configure your total unused time on your table to be three hours. If you’re an inpatient facility and you’re doing a lot of complex surgeries, perhaps four hours is more appropriate to identify. So again, allowing you to configure and identify what meets your organization’s needs. Here’s the important part– the output.
So again, we’re talking about supply, and we’re suggesting why collectible time is such a better metric to look at to identify that supply in your OR versus block utilization. I think we’ve exhausted sometimes why block utilization is bad, but I’m very passionate about it and it’s important for me to reiterate why it is a broken metric and how you could look at things differently in your operating rooms. So imagine that you receive a report on demand in the cloud whenever you want to, where you can identify where that potential supply was. And then you can use that table and that data to drive conversations with your providers.
One thing I’ll note on this table– if you are an iQueue customer, you will have access to many more graphics behind this table. So you’ll notice the three dots to the right. What happens when you expand on those are you get specific data related to that block owner, down to the day of the week, to show them visually how time was used well and how time was collectible, that we talk about previously. So again, this is all helping you identify the supply you have in your operating rooms.
So let’s switch gears a bit. And this is where we really get into more of the sophisticated analytics to say, OK, that’s great. Thanks. I’m happy to look at supply differently than black utilization, but what do I do? How do I truly allocate time? This was a problem. This was a challenge for me, personally, for many years. I wore many hats, and inside those hats, held a lot of information. And I knew that there could be a better way to do things. So through looking at data analytics, through using machine learning, and specifically, creating this predictive engine, you can help drive what that demand is in your operating rooms through data.
But when you talk about forecasting for block allocation, what do we mean when we say that? So one of the one things that we do is we really look by service line, how much time is actually used in an operating room by each service line? So in this example, you’re seeing, by quarter, how many cases are done in various buckets of time. Those buckets of time over there on the right being 60 to 120 minutes, 120 to 180 minutes, and so on and so forth. This is important to do because it helps identify how tightly a bin may be packed– a bin being a block– by a provider or a service line, or how many blocks may be needed to accommodate the type of volume a service line has.
When you do that, you can help understand, if a service line does 10,000 minutes per month, what’s likely to happen with the block demand for that service line? It might be three blocks or four blocks based on how long their cases typically go. So identifying that through the demand process of forecasting helps you to understand how many blocks really are needed. From there, lots of other things go into this algorithm to really produce a forecast of how many blocks and how much time is a service line, or specific provider, likely to need in the upcoming quarter. So in this example, for the service line of orthopedics, often seasonality is a factor.
So that’s something that is taken into consideration into this demand forecasting. At the end of the day, it needs to be easily interpreted. So what this process then does for block committees, leadership groups, et cetera– whoever your decision-makers are in your perioperative environment around blocks– we produce a very easy-to-read table to highlight how many blocks were you allocating to various service lines or physicians? This can go to the next level of physician-specific forecasting, as well. And based on that algorithm, based on that predictive engine and demand forecasting, how many blocks are recommended?
Now, operating rooms are not airlines. We can’t say that on any given day, it’s likely two providers are not going to come. So therefore, let’s allow overbooking, or let’s tightly bin pack, and let’s assume that three cases can always be done in a block. We know that that’s not the case. So one very important element to this entire process is that it’s surgeon-centric, that it’s forgiving, and that it’s conservative. We know that we need to overforecast and overpredict in order to accommodate all the variances that happen in surgeries.
But what we don’t want to do is what I think most of us have done in the past, overpredict too much because of the what ifs in surgery. When you overpredict and you overallocate, it makes it much tighter on your schedules to accommodate the day-to-day variability and variances that happen in surgery. So you’ll notice here at the bottom of this grid, this is a real hospital’s data. This is data from a large hospital that does transplants. They do traumas. Obviously, you can see neurosurgery, vascular, urology, et cetera– all the major service lines. But it’s a very large and busy OR.
What we really are helping this facility, in specific, to do is accommodate more open time, which will allow for surgical smoothing on a day-to-day basis to happen more easily. So this is a hospital that previously blocked out almost 95% of the time. And what we’re suggesting is, let’s block out to the plan predicted and forecasted surgeons and service lines. And for the ones that it’s not consistent, there isn’t that math in that predictive engine to backup giving block time, let’s create more open time so that those surgeons and those service lines who may not be forecasted for blocks are likely to get access to the OR. Because as Katherine mentioned in slide three, access is so important.
That’s what our surgeons want. They want to know they can have access, and they want to know that they can get access when they need it. So creating more open time is very important. So let’s move on. We talked about identifying the supply. We talked about identifying the demand to help build the schedule. But how do we help get the surgeons involved in this whole process? I think that’s very important. Whether or not a surgeon sits on a block committee process, every surgeon should understand the process, and that should be fair, transparent, and communicated well across all of your surgeons.
In doing so, I think it helps create a much happier environment, a more fair and transparent environment in our operating rooms, which then ultimately will help us reduce that political cloud that often hangs over a lot of our operating rooms. So communication is important. We talked about timely and accurate data. What about getting it out to them? In my experience, surgeons are much less likely to pull up an email, open up a PDF or a PowerPoint, weed through that to find their information than they are to respond to a simple text message.
So one thing that we really focused was introducing mobile technology. The power of mobile is incredible. Getting a text message that’s relevant to a surgeon, that’s personal to them with their data, will make them much more likely to know where they stand, what their utilization is, what their volume is. Rather than ask them to do more work, weed through more emails, and open up more PDFs, or stop by communication boards. I think communication boards are excellent. But I want a surgeon to know what their data is so that when we have a conversation, it does not come as a surprise. So distributing through mobile, we found to be very effective in our facility. And many facilities, also, are rolling this out and using these tools today.
Again, being relevant, and current, and personalized is important. So if text message isn’t the way to go to your facility, send out personalized scorecards and send them out in a timely manner. That’s very important to getting them involved in this process. So the suite of iQueue. Tools for operating rooms not only allows you to communicate via mobile, but it also allows you to send out these scorecards if that’s something that is important to your organization. So these can be sent out among service lines or per provider so that they have this information that is relevant just to them.
Making the transaction process easy is extremely important, as well. So one way to increase the release of blocks is to allow surgeons to have faster access to it. The historical process was typically someone had to call someone or send an email, surgical scheduling would have to keep track of it, maybe create a database to remind themselves that not only did someone phone in or email to release a block, but then also to remind them to actually go into your EHR and release it. In the world of mobile and cloud-based technologies, you can do that through two clicks on your phone or on your computer, either way. So allowing physicians access in their offices to see what blocks are allocated to them and access to release or request additional blocks right then and there on their mobile or the cloud makes them more likely to be good stewards of our OR and follow the process and policy we work hard to implement.
Another important part is guiding them in the right direction. So remember way back in the example of surgeon A not using two blocks, that may have been a consistent behavior or that may have been an irregular behavior. If it’s irregular, we should be guiding our physicians to make it easier to release. So sending them reminders of, we notice you have block time and you don’t have any cases scheduled. Would you like to release? Makes them more likely to release. So being able to do that through a simple proactive push to the physician or their office, rather than a cumbersome process, will make everyone more likely to respond and be those good stewards that we want them to.
The other part is feedback. Not only just sending them text messages about, hey, here’s the volume we see that you’ve produced for the OR recently to get them involved, but give them additional feedback and make it very non confrontational, easy to understand and interpret. Hey, we noticed that you requested this many blocks in the recent quarter. This many had great utilization. Thanks for using them very well. These blocks, on the other hand, might not have been utilized. Perhaps they yielded collectible time. So really communicating and being consistent in that communication is extremely important.
Mobile and cloud technologies allow you to do it very seamlessly. They allow you to do it very fast without a lot of added personnel or human intervention in that process. Also, allowing it to be a two-way conversation. Again, I think that emails can be clunky. They can be effective, but they also can be clunky. So when I’m sending an email to 50 providers and I’m asking them to open up monthly reports, the chance of them even doing so, let alone responding, is less than if I send them a text message and I ask them, was this relevant, current, was this informative to you, et cetera, and then allowing them to text me back.
So the suite of tools that we’re talking about here and we’re showing you some examples of, it’s a two-way communication street. So providers, administrators, et cetera can comment right back. Rather than waiting to go to a person that sent that information out to ask them about more detailed information on what was sent, it can be a two-way text. I’d love to share this video with you. This is a provider from. UCHealth, Dr. Evalina Burger. She’s an orthopedic spine surgeon, and she talks about the power of data and some of these tools that we’ve shared with you today. So I’m going to go ahead and play this for you.
It’s valuable in terms that you know how much block time you are using, what are the actual minutes that you’re spending in the OR. It helps from a vice chair perspective that I now can see everybody’s blocks and so I can help grow a service line. If they have 96% block utilization and they’re spending x amount of time outside of the block, then you know that they are at capacity and they need help. And on a personal level, being able to move my schedule if I save my guaranteed room for a block has been very helpful.
ASHLEY WALSH: Awesome. So Dr. Burger is actually the vice chair of orthopedics at the University of Colorado. And she not only receives messages on her personal performance, but she receives messages on her entire department. She’s on the block allocation committee and is very involved in the process. So she’s been a great steward. She’s been a great advocate for using data to push decisions and looking at things differently. So we’ve been flipping through slides. We’ve talked about a lot of information here. We’d love to hear from you. So I’ll just highlight one more time what Marianne mentioned, but you can text us directly at 630-884-5493, or you can email us at email@example.com.
So we’d love to hear your feedback. So just in review of today’s webinar, we really feel that the current process of allocating block time in hospitals is a broken process. It’s very lengthy. It’s often weighted with a lot of politics. So really, allocating blocks based on supply and demand truly can be a more fair and transparent process for all of your providers, all of your departments. And then through using mobile and cloud technologies to really maximize that data leveraging helps minimize the person-dependent process that exists today.
So again, I really thank you for your time. I’m so happy you joined us. I hope if you didn’t join us for the other webinar, this has encouraged you to take a listen on our previous webinar on block utilization not being the best metric. And we look forward to hearing your feedback.
Thanks so much. Well, huge thanks– excuse me– to Ashley and Katherine, and to all of you for participating today. I want to remind you, keep an eye on your inbox. You should be receiving a copy of a recording of this webinar shortly, and also, hopefully, announcements for future webinars. Take a moment at the conclusion of this webinar to complete a survey that will pop up. It should only take you a few seconds. And remember, if you haven’t already heard, you can text us, 630-884-5493, or you can send us an email for a demo request, firstname.lastname@example.org. Thanks again.