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Effectively recruit surgeons without promising block Webinar transcript


MARIANNE BISKUP:. Well, hello everybody, and welcome to today’s webinar,. Effectively Recruiting Surgeons Without Giving Them Block Time. Today’s webinar is hosted by Ashley Walsh, she’s the Director of Client. Services for OR products here at LeanTaaS. And today, she has a special guest co-presenter, that’s Michelle Ballou,. Director of Patient Services, OR Administration, at. University of Colorado Health. 


I’m Marianne Biskup, I am the. Events Manager at LeanTaaS, and before we begin today’s webinar, I’m just going to quickly go over some housekeeping items for you all and make things a lot smoother. If you want to submit a question, you can use the. Q&A widget, that’s in the console at the bottom of your console. And for some reason, you need to move any of the windows in the console, those can be moved, and they can also be resized. 


Also, if you’ve any technical problems, you can look at the LeanTaaS’ webinar tips window, and that will answer most of the common technical issues you will run into. And several of you have already submitted questions, and the answer to the first two questions is, yes, we will be sending a webinar recording via email. It will have both the audio and the slides for this webinar. It will look for it in your inbox within the next 24 hours. Also, if you want to contact us directly, a text number and an email address up here at the top of your console. And remember to post comments about the webinar using the survey widget, again, that’s at the bottom of your console. And now, here’s Ashley. 


ASHLEY WALSH: Thanks, Marianne. Good morning, or good afternoon, depending on where you are. Thank you, everyone, for joining us today. So hopefully, you are joining us because this is either a very relevant issue to your organization today, or maybe you’re expecting it to be in the near future. So what are we talking about? We’re talking about effectively recruiting surgeons without giving them block time. Yes, as Michelle said– or,. I’m sorry, as Marianne said, I’m grateful to have. Michelle with me today to share some great results that. University of Colorado Health has seen. 


Michelle is the Director of Patient Services for OR administration. And her and I were colleagues, previously, so we are excited to talk about just some lessons learned we’ve had. But let’s jump right into it. So surgeons want block time, right? Surgeons are looking for OR time, and that is very often, one of the top things that they are asking for, when considering joining an organization or in a negotiation process for joining a hospital. And looking to see if they can bring their surgical practice over. 


So let’s talk about the problems– giving permanent block time to surgeons before they have actually joined your organization, has a number of problems. But let’s talk about three big problems, and we’re going to focus on those problems in great detail today. So giving block time away is, automatically, right away, reserving your expensive capacity. And in the end, you don’t know for sure if they’ll– that maybe a promise, a gentlemen’s agreement, a word of mouth assurance that they’re going to– you don’t know. Until a provider is actually at your organization, working, and has built that practice, there is no guarantee that time will be filled, so it’s a huge problem. 


Second, a lot of our ORs across the country are fully blocked. And so, when someone comes, and this is my previous experience, the chairman of surgery would come and, say, we’re really excited to recruit five new surgeons. Find space to put the surgeons. And I look at my block schedule and, say, I have zero time, I have no time. So that’s another issue, a lot of our hours are fully block today. Now, that’s a topic we could spend a lot of time on. So we’d love to talk to you a little bit more– we’ll touch on it a little bit today. But I would certainly like to talk about that in a lot more detail on why that’s not a great process, either fully blocking your ORs today. 


Whether you’re ambulatory, community, academic, level one trauma, you name it, there are definitely problems with that. Three, the third big problem with this is once you allocate the time, it’s really hard to take it back. I have not met one or director, or manager, no matter what policy you have on the planet, taking my block time is still hard. You might have a process as you might have a policy, you might have a plan and place to do it. But to actually do it, is very hard. And why? Revenue is generated, and it’s also, of course, how our revenue in the hospital is generated. So we know surgeons want our access. We’re very confident, there is a much better way to assure them access to the OR. 


Especially when they’re new, and your recruiting surgeons. And in addition to that, there’s a better way to manage your blocks once they’re in place. A better way to alter your block policies than just using things like block utilization, especially given just the unpredictability in volumes practices and service lines. As I said, I’m grateful to have. Michelle Ballou with us today. We’re going to take a little look into some successes and wins that they have seen at the University of Colorado Health, specifically the academic location. But actually, this is now spread across that system. And similar results have been seen at the community locations, too. So depending on what type of an organization you’re from, joining us today, know that these tools and ideas, concepts, processes have been used in ambulatory surgery centers. 


They’ve been used in very large academic medical centers and medium to smaller size community hospitals as well. All right, so the first problem that I talked about was reserving expensive capacity when you’re promising block time, and not knowing if they’re going to use it very well. Let’s break that down a little further and talk about it in some more detail. So 2 problems, really, with point one alone. Reserving block time and reserving specific locations is a lot like creating carpool lanes, actually. When you think about it in that example, I think it starts to make a lot of sense for a lot of people. Imagine if you’re promising lanes on a highway to only a certain color of car or a certain make or model of a car. And only that color or make or model can go in that OR because you promised it to them. 


What happens to the overall efficiency of the highway? You’re going to see a lot lower overall utilization and a lot more bottlenecks. And that actually happens in our ORs. When we promised time, and we don’t know how full will be, we also then are sometimes creating those bottlenecks, where we have overloaded capacity in some areas and underutilized capacity and others. And that exposure to that variability is not easy in the OR space at all today. So when you promise block time to someone, you’re essentially creating a carpool lane. Even when you have a good process in place, so it’s not precisely predictable. 


So what I’m showing you here is an overall distribution of individual surgeon’s volumes for a service line. So while you’re looking at overall utilization at a service level, you can see every line represents a different surgeon, and that’s high variability. And variability happens in surgical services for a number of different reasons. We have seasonal trends, we have vacations, conferences, clinic conflicts. So it’s natural and normal to have that variability and volatility in our ORs. 


But when we reserve those carpool lanes, we are restricting our overall utilization in the end, the variable, highly stochastic. I’d love to turn it over to Michelle, now. To share with us a little bit about University of Colorado Health. A little bit about what they have done, and how they have not promised block time to surgeons, and some of their successes. So, Michelle, please. 


MICHELLE BALLOU: Thanks, Ashley. Good night, everyone. You think [INAUDIBLE] ward system [INAUDIBLE] crisis in Colorado, and consistent community and academic hospitals. I work for the academic location, which has 37 ORs. And we have seen consistent growth year over year. It has been hard to keep up with the new physicians who wanted block time. So in 2016, we are almost 100% block. And had zero block time to offer to the 11 new surgeons that were coming on board. Quite challenging. Overall, and with the consistent growth, we were running fairly efficient. Room utilization was 75%. 


First case on-time starts and turnovers were decent. But there were three areas we identified major opportunities for improvement. These areas included increasing blocks utilization having better and more accessible transparent reports and a smoother way to communicate when block time was not going to be used by the original owner. When we started working with LeanTaaS, we did an analysis to see where we had opportunities to make improvements. We found that 15% of our block owners ended up not using there originally assigned block time every week. In addition, we assumed we likely needed to improve our first case on-time start, turnover, and possibly, in a hampered scheduling accuracy, to gain efficiencies in the ORs. 


But upon completing our initial analysis, we found that there was a significant amount of unused time in the OR, uses scheduling downtime. It was hard to imagine this because we were running at 75% utilization during our business hours. But the fact is the data pointed to a large number of minutes that went unused because the case was simply not being scheduled. So we thought to ourselves, how can we improve this process to better use all available business hours in a day? How could we have on block owners better communicate when they weren’t going to use their time? And more importantly, how could we advertise the available time to individuals without plot time or those that needed more block time? I’m going to turn it– Oh, sorry. In the end, we did three things that yielded a strong results. 


First, we created more open time and allowed easy exchange. Second, we move to a more scientific metric to create and enforce block policy or collectable time. And finally, we let them build a book of business before getting block time. Let me turn it back over to. Ashley to further demonstrate these tools that helped us to lead to our results. ASHLEY WALSH: Awesome, thanks, Michelle. Thanks for sharing that. So let’s talk a little bit more about those three things and what they look like. So we talked about what surgeons want, right? Surgeons want access to our time. Why else are they demanding block time in negotiating coming to your organization in the first place? So how do you give them time and promise that they’re going to get access to the OR without just giving them permanent block time? And that’s to Michelle’s point number one of what they did. 


They implemented a process by using product, it’s using a tool called. Exchange to unlock capacity and open up availability in the. OR schedule on a regular basis. So let’s show you a little bit about what exchange looks like. So exchange is a tool that is used– everything used in our products from iQueue with LeanTaaS or Cloudbase. So you can use them on your mobile device, you can use them on a computer, you just need access to a browser. And so what that access allows from, in a daily pull from your e-chart, we can see where was their block time? Where was their block time released? And where is their open time that we want to advertise to providers. 


So through very, very simple tools, providers– and let’s be honest, more frequently their schedulers or who’s using this, can go in and open up a browser, access the tool, and see when is time available that they can bookcases into. What is this do? Most importantly, it streamlines the process. So it streamlines the entire process from provider requests to our scheduling, to what’s going to end up happening on the day of surgery for the management team, service specialist, et cetera. Two, it’s providing those providers who ask for OR time, and you were unsure about giving them permanent time, it allows them access right away. So through this tool, they can see, hey, next Wednesday is available. 


Next, I was targeting Wednesdays for my permanent block time but, my Book of. Business is growing, it’s not yet fully there. So let’s use this tool. let’s go on and request when are there Wednesdays available that I can ask for time. So the results that Michelle saw. The results that many others have seen is when you need it. Whether that’s one case or an entire block. A lot of times people ask us that question, is it really only four blocks? No, if your organization wants to offer segments of time, two hours, three hours, four hours, that can be configured in here too. No one loses, we’re not leaving blocks on the table then, that go unused. So in the case that you do promise block time to new surgeons, there’s probably a lot of wasted blocks early on as they’re growing their business. 


What this then allows without doing that, they can access when they need it, and how much they need. So you can absorb new surgeons without promising the block time. You’re smoothing out the communication between surgical scheduling, physicians’ offices, and then the OR. So a lot less emails, texts, and phone calls. Scheduling offices love this because if you are an OR scheduler, and are joining our webinar, if you work with our scheduling, you know, one, how hard those offices work. And two, how many phone calls come into surgical scheduling. So this is really awesome. What I’m showing you here right now as a view on the mobile device. I mentioned mobile or web, some community hospitals, physician schedule themselves. And so, it’s very nice to have this access on a mobile device. 


Let’s just look at what it looks like though on the computer. So, more often than not, I said this before, surgical offices are looking for that open time on behalf of their provider. So this is just pulling up. Google Chrome, IE, Internet Explorer, you name it. Going to the website, if you have access, you can open up when it’s time available for my provider. And so you’re maybe on the phone, might want to get into a lot more details or questions, and how do I expose only the right time to the right people. Those are constraints, that’s constraint-based optimization. So if it is a matter of a robot lives in this room, and perhaps, this new providers only looking for robot time, that’s a constraint in a configuration. That is easily accommodated in the tool. 


So hopefully, you’re gaining some insight here as to how easy it is to say, hey, you can go ahead and look for block time whenever you need it. Whenever you are wanting it, and as you’re growing your practice to those new providers who you’re talking about without promising them. Michelle made a point earlier, and I just want to reinforce it. the analysis, specifically, for her location that was done, found that 15% of blocks went unused by the original block owner on the day of surgery. So that’s a lot of time. So if 15% of our time ends up not being used by the original block owner, that means, that there was time on the table that a new provider building their book of business, right there, could have already tapped into through exchange. 


Some other really cool tools to increase that utilization, increase efficiencies are– something we do with. Michelle’s location is we mind the booking patterns. So we’re constantly mining the data to see when does surgeon x typically bookcases, and when are they likely to have their block filled. If a sports medicine provider, typically, books cases three weeks in advance, it’s just shy of three weeks in advance. And we see, there’s no cases on the schedule, the tool automatically pushes out release reminders, we call them. Or notifications to the offices to say, hey, Dr. Jones typically has cases booked by this time for his or her block a week or month or whenever from now. Would you consider releasing it? 


Because we see no cases in here. Again, this is decreasing the manual work that out OR scheduling teams are often doing today. Looking ahead, when are there slots open, who was looking for a slot, should I call them? Imagine erasing all of that manual process and streamlining on it. So again, this is kind of part of the tools I want to just empower you with that this is how you can really assure these new providers. We’re going to find you time. We’re going to find you time and give you access to a schedule so you can build your book of business. And then, on the. OR side, I’m going to have to promise you time and reserve that expensive capacity until I know you’re definitely likely to fill it. A little bit more detail on what that data analysis looks like. 


This is a nice work chart, I don’t expect you to see all the details in it, but this just speaks to the analysis of when is someone likely to have cases booked. And if they’re not booked, who can I, then, reach out? To say, would you consider releasing it? These are again, just the processes that went into the entire picture of how can we assure providers access to the OR without promising them block time upfront. That’s what this is all about. So really finding, if you’re looking to work on Wednesdays, I’m going to do everything on my behalf, on the OR side to automatically expose and unlock that time. 


So as you’re building your practice, you can look into when is there time available, and get that time if it is available. And if it’s not available,. I’m going to offer you some other suggestions. So that’s another little fun part of the tool. But let’s jump into something else. So if– again, going back to– I want block time on a Wednesday. A new provider, I want block time on a Wednesday. You told me Ashley you were going to do what you can to find it for me. But still, at the end of the day, maybe it’s just not available. So there’s this cool tool called Alerts, we call The Amazon Wish List. So rather than a surgeon’s office going in and looking every single day over and over and over again is their time available, they can set an alert, very simple. And the alert will say, Dr.. Jones, is looking for time. Let Dr. Jones and Dr. Jones, his office, now in time, becomes available. And so then we push back that information. 


This is also really good because in the case where a provider saying, I always– I want to work on. Wednesdays, you never have time available for me. This now becomes trackable information for you to then take to your leadership teams to talk about. And say, you know it is true, we recruited this new surgeon. We– the surgeon is looking to work on Wednesdays, maybe it’s a month into it, and at times just not freeing up on Wednesdays. So then sooner, you can have more meaningful conversations around. What should we do? How could we work with this provider to meet their demands and their book of business and find time? And that’s where we get into the block policy talk a little bit. 


Or on the flip side, maybe they’re just are wonderful users of the OR on that day. And so then, maybe you can go back to that provider, and say, you know this is important, us, the relationship. We want to make this work, but it just looks like you happened to pick the busiest day. How can we work with you and your practices to maybe share with you another time that frequently is open? Maybe it’s Tuesdays, and perhaps then, clinics could be switched around or something like that. And believe me, I know that’s not an easy feat, by any means, but at least you can have discussions provided with data to say, this is going to be much better than that day as that business grows. All right, so let’s talk about the scenario where– I’m sorry, there we go. 


For the schedulers, let’s show you what that looks like. So we mentioned a little bit about how do you have access to block time. And not permanently, give block time. And remember that’s a request, so these providers are going in questing time, what does that look like for the surgical scheduling team? It’s a nice easy repository. Some of you might be able to relate listening to the webinar of your surgical scheduling offices having tons of post-it and lists. If a Tuesday frees up, call the plastic surgery department, they have two providers. If a robot opens up, let’s notify OB, too in. Information is everywhere, what happens when information is everywhere, and it’s a manual process? Information gets lost. 


So in exchange, in this tool, you’re looking at here a view for OR scheduling that shows them, hey, you have two requests come in. Can you approve them? Can you do, or do you need to deny them? And when you want to look at patterns of requests, it’s also in one location. So there’s a nice History List. You can see maybe at the top,. I know it’s a little bit small, but yes, we will send out the slide deck after to show you the. History List of transactions. So you have the proof is in the data. So you can see if somebody is constantly asking for time on a Wednesday, and maybe it is being denied, or maybe it is being approved, or maybe a provider’s office might feel as though time is often denied. And you can have a transaction list to show we’ll know we’re approving you at a 70% approval rate whenever you’re asking for time on Tuesdays. So hopefully that is making sense. 


In addition, you can see there there’s this little tab that says statistics. So this is really interesting, too. This is what helps leaders, like Michelle, know are we even successful in this tool? Were we successful in recruiting surgeons and not promising them block time right away? And did we have activity in our marketplace? So the Statistics section shows that activity whether or not it exists, how much, and who it’s existing with? Maybe what service lines, et cetera. So please feel free to send in some questions. If you have any, I would love to answer any questions about those. And we can get to those at the end. 


So let’s keep moving on. So another thing Michelle said if you go back to Michelle’s points. What did they do? They implemented, they implemented exchange, they implemented this process to swap block time to get blocked time for new providers without promising block time right away. And the second point that she mentioned was they move to a better method to create more capacity, to unlock capacity. Because the historical way of doing that, was to monitor block utilization to have a policy based around block utilization. And to try to take away time-based on block utilization. 


That was challenging, hard to enforce, and a time-consuming process. So going to the second point, what do they do? They looked at a new metric. And that new metric is in a nutshell, much more comprehensive three-dimensional surgeon centric metric, which is called Collectable Time. So let’s look at the problem, and let’s break it down a little bit. Unblock utilization, and why that’s not a very effective way to monitor the usage of blocks, and to ultimately, what you’re trying to do, is take some away, right? Want to create more time to recruit more surgeons, possibly, and give them time. 


So pretend here you have two surgeons. On the left, you have. Surgeon A, pretty good user, tax cases in pretty good, pretty consistent. I’m going to guess it’s a plan predicted surgeon. Could be a sports medicine doctor, does a lot of scopes, maybe some complex cases. But for the most part, pretty predictable, pretty planned easy cases. In a quarter, maybe that doctor takes about two days off of the normal block time. And that could be because of a vacation, family vacation, conference, or other necessary reason that they couldn’t be in the OR. It’s a good Surgeon. B, on the other hand. You see a lot more holes in the practice. You see that there’s some short cases, but for the most part, there maybe a little bit bigger cases. And there is a little bit more downtime. 


Both of these surgeons, in this example, are going to give you the exact same utilization score. When you look at the patterns of use, so, how do you take time away from Surgeon B. Surgeon B’s practices such that today my case is going to be four hours, and tomorrow, it’s going to be six hours. Where you’re going to tell me, Ashley, you need to take away time from me? I’m coming every week,. I’m bringing in cases. It’s just this is the variability of my practice. And on the left, Surgeon A. This is also the standard practice, maybe for this doctor, they’re very good user. But in the end, they need every single week, every single quarter. The pattern of usage shows us, no. So 1 minus block utilization, we feel very strongly, is a very meaningless metric. 


I can say that from, personally, dealing with trying to enforce block policy and take away utilization, and how challenging it was. It was Very hard for me to go to Surgeon B, and say, you need to give me two blocks back every quarter over recruiting new doctors, and I want to try to fit them in. Surgeon A, on the other hand, I can show in the data, there’s at least two days of the quarter not filling your time consistently. When we try to work together, so that time we can be repurposable. And then, the simple answer is yes. So what is Collectable Time? How do we calculate. Collectable Time? 


Hopefully, all of you looking at this webinar right now, and looking at this slide, this sits with you. And you are definitely able to relate to that issue. So Collectable Time, remember in Surgeon A and Surgeon B, there were some days and times where there was unused time. For example, the blue triangles, the key started a little bit late. Maybe we were really efficient, and the case ended early. We don’t want to penalize those types of things. I will never disagree with the fact that improving first case on time starts. And improving turnover is important for patient throughput, staff satisfaction, and surgeon satisfaction. But the minute we stop, drop, and roll, and do everything we can to improve those metrics, that’s a lot of time, a lot of effort. And at the end of the day,. 


I’m going to promise you, you are likely not to get another case on if you shave off two minutes of all of your turnovers. I still think it’s an important thing to strive for, to improve, but you’re likely not to get another case on at the end of the day. So going back to the. Collectable Time. We want to find those red diamonds. Red diamonds are part of Collectable Time. So Collectable Time is when did we leave a lot of time on the table? On 01/10, there’s a huge amount of time in the middle of the day. And 03/01, there’s a lot of time before that case. On 02/22, a lot of time. So a large continuous amount of time that can be set by the organization. 


So if you’re an ambulatory surgery center, maybe your large contiguous amount of time might be two hours. Is two hours is what you need to get another case on. But in a very large, complex organization, may be doing a lot of oncology cases, multidisciplinary cases, cardiac, neurosurgery, spine, maybe that continuous amount of time that you need to get another case on, might be four hours. Especially, maybe when you’re trying to find time for neurosurgery or one of those complex service lines. So Collectable Time is adding up three different things. It’s adding up when it’s surgeons just completely abandoned time. They just didn’t even notify the OR, like on 03/15, there was no time released, and it went unused, that’s point one. 


Point two, when we’re there large amounts of time on the table? 01/10, 02/22, 03/01. And point three on. Collectable Time, when did somebody release more than a certain amount of time that’s acceptable? I think it’s normal that a surgeon is not going to come every single time they have block time. So accepting release is acceptable in my opinion, but there should be a threshold because if you have 10 blocks a quarter, and you’re going to release five every quarter, in the end, you’re hurting me. And you’re hurting colleagues, where we could have eventually promised time on a more permanent basis to them. So using a new metric to look at how do you gain back time in your OR, how do you repurpose time that would otherwise go unused is Collectable Time. So for Michelle, block utilization is something that is monitored much less. 


Because the metric that they are using to understand is their time available that we could permanently allocate to someone who has grown a book of business and proven it through using exchange is Collectable Time. So it’s a more conservative surgeon-centric way to evaluate that time. What’s great about this? This is a complex metric. This is a complex math problem to roll all these things together. It makes sense. You’re looking at it. Hopefully, you’re nodding your heads you agree. But then, to actually compute it and put it in a table, that’s where the product comes into play. So what the. Collectable Table looks like it’s a very simple, easy to read table that accumulates all of those things, the unused time, the large contiguous amounts of time, and time that was released above, and beyond what you consider acceptable at your organization. And here’s what you get. Again, the same web-based tools are in one location. 


So you have exchange, and you have collect where you can monitor from a leadership standpoint who is using your time well. And so now, maybe say a new provider came on that Dr. Jones. You did not promise block time to Dr. Jones. Dr. Jones used exchange for three months and gained block time here and there when it became available. After a certain period of time, the Book of Business was proven, and the. Book of Business exists. And now, as a leadership team, you need to find that permanent allocation. You can now turn to a Collectable Table, look at by day of the week when you were looking to gain that. And have a much better metric to evaluate, is it fair? Is it reasonable to reallocate time from Block Owner A to Block Owner B? 


Some more details on what that looks like. The table in the previous slide, very simple, you’re seeing your block owner, you’re seeing the day of the week, location, and what that collectable percentage looks like. If you want to know how did we get to that collectable percentage? What are the details? No problem, you can hit those dots on the far right. And dive deeper into details by day of the week. So you can see all the days where time was completely unused, the entire block unused. You can see days when release time might have been above the threshold. And you can see the specific days, so you can have more meaningful conversations on when did you leave that large amount of time on the table. So reducing that overall. Collectable Time, what’s going to happen? You’re to increase your block utilization. I can’t tell you how many hospitals I’ve been fortunate enough to visit with that have pretty good utilization. 


At University of. Colorado Health, certainly, was one of those hospitals. Overall business hour utilization in the 70s, 70 percentile regularly, month over month, quarter over quarter. Block utilization little bit lower. And when you’re recruiting surgeons, and you’re trying to reallocate time or find open time to put in a pool like exchange, at doing that through block utilization, is just a bad metric to use. And it’s very challenging to enforce. All right, so I’ll just show you some high level overview of some of our customers with LeanTaaS who are using this tool. 


Who are using it to recruit new surgeons. To open up and free up capacity through releases and requests in exchange. And through changing their block policies in something like Collectable Time. There is a list of some of the organizations that have been quite successful in using these tools alongside Michelle. We’d love to put you in contact with any of those individuals locations if you’re interested. So please feel free to reach out to us after. But you know, Michelle, just why don’t you tell us a little bit more specifically about your ORs. And actually, the return that you saw. 


MICHELLE BALLOU:. Sure, thanks, Ashley. In our first year of using exchange, we thought tremendous success. The positive benefits were surgeons without block time had access to block time when they needed it. In addition, block owners started communicating better, and tune in to the. OR when they were not going to use their block time on a given day. From August to December of 2016, we saw 496 releases through iQueue. Upon the started pushing release reminders to block owners in December of 2016, we instantly saw releases increased even further and sooner. 


This immediately allowed our additional increase in block requests through exchange because there are more blocks released to request. The release led time increased to 19 days across our two main OR locations. And there a lot of new surgeons who were satisfied of not getting permanent block time because they had access to get block time when they needed it, as their practices started to grow. In the end, we saw additional financial increases over our usual and customary growth. 


ASHLEY WALSH: Awesome, Michelle. 


MICHELLE BALLOU: Yeah, thanks. Due to our success, we had full support of our senior executive leadership team to publish a case study on our successes. In the study, our results indicated that there were 47% more blocks released per month, post-iQueue. Blocks release 10% earlier than they had been in the past. We experienced an additional 4% increase in OR utilization. And this was a block over and above our usual and customary growth. And then, when we are looking at the 4% additional increase in utilization, that translated into an additional $460,000 per OR in gross revenue, which is pretty significant. 


ASHLEY WALSH: Very significant, awesome. Thanks so much, Michelle, for sharing with us. 




ASHLEY WALSH: Again, we’ve seen some great results at other locations too. So you see health is not alone. They, now, stand next to all these other great users. There is actually more to add to the list, but these are some of our really big highlights that we’ve seen so far. Appreciate everyone joining our call today. Love to talk to you and a lot more details. So how do we sum this up? I hope that after hearing this presentation, looking at these slides, you can understand why giving permanent block time to new surgeons has a lot of problems. But the three big problems, it’s very expensive capacity, and you don’t know how well it’s going to be filled in the beginning. You can have some assumptions, you can do some analysis. 


But at the end of the day, until they’re there until that Book of. Business is in existence, you just don’t know. Other problems are some of your operating rooms are fully blocked or near fully blocks. You don’t even have any time to offer up in the first place. And third, policy process procedure, all of the above makes it very hard to take back blocks once you’ve allocated it. ORs are a highly political landscape, with reason. I understand that, I really do. It’s a precious commodity for providers and for us as OR operational leaders to make sure that expensive asset is cherished and used as efficiently as it can be. All right, so thank you again for joining us today. Hopefully, we have a few questions that have come through. And if not, I certainly hope that we get an opportunity to see from OR one-on-one later. 


All right, let me jump over to our questions. Oh, we do have quite a few questions coming in. Great, thank you. Question came through, what’s the standard frame for a release? Or what is the standard frame for release this is based on? I’m going to assume that you’re referring to the part in. Collectable Time of what’s considered an acceptable amount of release. At the end of the day, that’s going to be up to you at your locations. What an acceptable amount of release is. Releases in this example, and what we’re talking about. We’re really talking about releases that occur manually up until the automatic release. 


I’m sure there’s a couple of people that might be on this webinar, saying, what are automatic releases seven days, but we only credit surgeons with the release of maybe 21 days or greater in advance. And I understand that. I understand where that came from and why that came from. But at the end of the day, what’s important. What’s important is was the time used or was it not used? And did anyone notify you in advance or did they not? So what we have found is there’s so much capacity actually on the table. And a lot of times, we don’t even know it. Michelle spoke to this earlier, actually. They really didn’t understand that there was the excess amount of scheduled downtime that there was. 


So they were focusing on all these other different little things, turnovers, first case on-time start, scheduling accuracies. But at the end of the day, there was a big hole just in scheduled downtime. Because we found that so consistent, that so many organizations starting out with, were you notified of a release before an automatic release? Is if a the best place to start. You can always add more constraints from there. So this release is considering, did you release anything before automatic release? And then as an organization, you can accept. You can decide what amount of release is acceptable. Is it 20%, 10%, 50%, of your blocks, et cetera? 


Hopefully, that answer that question. Please send in another question if it didn’t? Are blocks full or blocks partial? Are they individual or group? Is another question that came up. Thanks for that question. Blocks in this tool, what is a block? Is up to what is a block to you? So in Michel’s organization, people asked for half-day block, they asked for full-day blocks. They ask for portions of blocks, all of the above. When you’re looking at. Collectable Time, and that might be specifically what this question is referring to. And you look at that. Collectable Table. And you’re looking at the number of blocks that are collectible, we’re going to identify for you, was this a full-day block or half-day block? It is, more often than not, in this case, in this example, it’s rolled out to a full-day block that are collectible. 


But you can set that for what you need. Are you looking for full-day blocks, or are you looking for half-day blocks? And where can you collect that time back? So the blocks– honestly, the length of the block doesn’t matter. That’s OK for whatever you use in your organization. It can be configured into this table appropriately, and then pushed back out to you for what you want to see if you want to see a full day or half-day. Thanks for that question. Is there a standard time for releases? 7 days, 14 days, 21 days? Another great question, thank you for that. [COUGHS] Excuse me. Let’s go back to the slide. I showed you the eye sore. We’ll find it. Here you go. What should be the acceptable amount of time for– let’s just talk about automatic releases in the first place. 


This is a hot topic in hospitals because providers, of course, want every ounce of time they can possibly get, to add on a case. I get it, they want they want every opportunity to bring in more revenue for themselves. The hospital, of course, meet their patient needs in the first place. Data tells us a lot of great things. And this is not a very easy calculation, necessarily, in our EHR’s today. Requires a little bit of understanding on where does the data live in the first place? And second, how do we pull it out of the e-chart? And that’s a booking analysis, a lead time analysis. So this is something that we’ve provided for all the customers that use iQueue for OR to show them by service line and by surgeon, when are they likely to have cases booked? 


If a providers practice is such that 75% of cases, and actually, the example that’s highlighted right there. Orthopedics, over 50% of cases are booked at a minimum 14 to 21 days. 70% of cases are booked seven days or greater in advance, in this case. So when I look at this service line, and I look at that data, why should we let that service line have a release time of 24 hours holding onto their case? I would disagree with that. I would say, that, so when you get to what are appropriate release guidelines, it varies by practice, and it varies– but so by service line and by provider. So it’s important to look at the data and use the data in your process policy procedure to say, when are we going to allow the block owner to hold on to the time, and when are we going to implement an automatic release? 


So far, in all hospitals that. I’ve been able to work with, most hospitals have data to at minimum, a seven day automatic release with the majority of their service lines and providers. So we’d love to talk to you about that further and share some interesting statistics on that. But I know, a lot of us have dealt with providers saying, oh, please let me hold onto my block time till the morning of, I get a lot of blocks added on. OK. 


MICHELLE BALLOU: Hey, Ashley, can I can I jump in there. 


ASHLEY WALSH: Oh, wait. 


MICHELLE BALLOU: That is one– 




MICHELLE BALLOU: That is one of the pieces of data that we used. Because our block time for everybody was at 48 hours. And through this data, we were able to at least, maybe not move to the seven days, but we were able to move to a four-day block release, which has really helped us as well. 


ASHLEY WALSH: Awesome, thanks so much, Michelle. OK, another question, how you interface with EHR’s? And what are IT challenges? I’m sure that’s in the back of everyone’s mind. It always was mine, how am I actually going to even publish anything? Statistical or reporting-related, how am I going to work for IT in the EHR? What you’re looking at today, the tools that you’ve looked at, Exchange, Collect, these are very, very simple. And I truly do mean that, very simple tools to implement with EHR’s. 


The EHR and the IT requirement is simply a daily feed to a secure server where we handle that data. No PHI information. The IT departments love us because we’re not looking for specific patient demographics, et cetera. Now, as customers, some of our customers are interested in starting to look at some quality information, things like that. The company lead test is actually going through a SOC-2 compliance review right now. So we would be accredited to handle PHI information. But today, for these types of tools, when is time open in the blocks schedule or in the schedule? 


When can I, as a provider or service line, request it? And how can, I as an Operative Leader, better analyze how my. ORs are performing? From an efficiency standpoint, it’s a very simple daily feed. So far, we’ve worked with. Meditech, Cerner, Epic, Paragon. So a number in more EHR’s, and. I’ve referenced right there. A number of different EHR’s and are familiar with where data is stored in those tables. What kind of extracts are needed, so that we can work very, very easily with your IT team? Actually, providing the scripts to extract the data. So it’s a very lightweight touch for your IT counterparts, and for your hospital. OK, let’s look at some other questions. 


Thanks for that questions. Can surgeons have a designee to use exchange? Yeah, I think I’ve mentioned this, but I might not have. If I did, I might have mentioned it briefly. 90% of exchange transactions come in through a provider’s office. So their office manager, their surgical scheduler, you name it, is doing it. Because they actually know the provider’s availability better than the provider, sometimes. So, yeah, provider does not have to do it him or herself or provider’s office can. Again, this is just sharing some great tools on why you don’t need to promise block time to recruit new surgeons. And how you can assure them a seamless process to get off time and access to your ORs. 


OK, I’m sorry, I just read another comment that we did have an echo earlier. So I apologize if some of the audio did not come through very well. We’re happy to again send the slides or do any one-on-one conversations. Question, where is the case time pulled from? Is this reliant on surgeon estimation or does this program integrate with the OR logs, scheduling program to pull usage for past case information? Very good question. It’s actually multifactorial, so let’s start with the first one. Where is the case time pulled from? For evaluating, whether or not, blocks were used very well, and was time filled? That case time is pulled from the nursing documentation. 


So the patient, in room and out, are in timestamps. Now, on the other hand, if you’re referring to– when you’re looking for open time, and how much time are you looking for? We are asking for providers offices to implement and/or input an estimate. So some of the OR managers that might be watching this, so like, oh, no way, my doctors are all going to say that they can do the case in an hour. But I know, it really takes two hours. So what we do in the background is we can actually mine and analyze that data to see is this provider– how much time are they likely to need? And we can actually work with you to roll up on an estimate. So for example, if you have individuals looking for two hours. 


But we see, based on scheduling accuracy at your location, we should give it an hour buffer. We’re only going to show that providers practice when there’s at least three hours of open time that they could then request. Again, think of exchange a little bit like OpenTable. When you want to have access to a restaurant, and you really want to go and have dinner. There’s part of that buffer in there, too, as well. If you’re looking for a reservation at a certain time or you’re looking for OR time at a certain time, and you’re telling me you want at least two hours. But I know, that it’s likely to need a little bit more, we can add in that buffer factor. 


So that then we only report back when we’re there three hours or greater available. Hopefully, that answer that question. But if you have some more questions on that specific– oh, is this relying on surgeon estimation or the program? So again, hopefully. I answer that. Little bit of both, and when it comes to case length the accuracy, that’s a really interesting topic. Because you can do a lot of things on case link accuracy. At the end of the day, our EHR’s don’t provide a very good turnaround of what is the average case length we should be expecting, and how much time should we be reserving. 


Data science allows us to get even more accurate. So we actually do, do case length estimations, and we are working on that as a part of some of these tools. But let’s be frank, at the end of the day, surgery is highly variable. It is a stochastic environment where case lengths vary every single day by every single provider because of many, many, many different factors. So you’re never going to– you’re highly, unlikely to have your cases estimated in a very precise to the minute level. But you certainly, if your distribution is far, you can certainly likely make it more tighter. When we’ve looked at that though, we found that while maybe certain service lines or practices have higher variability in that accuracy. 


As an overall trend, a lot of ours don’t have a very wide distribution on that. So we are able to provide some guidance and where they can improve case length accuracy, and scheduling in certain service lines or for certain surgeons. Is this product standalone? Does it work with epic? I am just going to jump to this slide right here. So this is a cloud-based software product. You log onto a website and can see the tools. It can work with any. EHR, so this is not fat cliented to your computer, it’s not downloaded. 


You don’t need special software, or you don’t need an app downloaded on your phone. You need a mobile browser, and you need an internet browser. The EHR does not matter. On this page right here, three out of the four listed are actually. Epic customers. One is a Cerner customer. I mentioned this earlier, that we have worked with a number of different EHR’s as well. All right, let me just look through here really quick. I know we’re pushing our hour limit. But I believe, I’ve answered most of the questions. How do you get surgeons block owners to increase their releases? Michelle, that was a question for you. How do you have surgeons and block owners, how did you increase them to encourage them to release? 


MICHELLE BALLOU:. Sure, [INAUDIBLE]—- sounds like I have an echo again. Once all the surgeon officers were onboard into the product. It really made it so easy for them to release a block time, that they weren’t going to use. That at least for block releases increased. And then, also part of the onboarding process, we stressed how releasing blocks would not negatively impact the block owner. Meaning, releasing blocks that would otherwise go unused, would not put them at risk for having permanent block time removed, unless too many blocks for a release. So that’s how we roll that out to the surgeon. 


ASHLEY WALSH: Awesome. Part of the onboarding process, too, is to re-emphasize over and over again that releasing time does not inhibit the ability, necessarily, to keep block time, unless, you’re releasing an excess. So releasing time is helping the greater good. Every practice has seasonality. Every practice has variability. So that is part of the education rollout process to really reinforce that by doing that, or you’re others access to the OR schedule when maybe they are in high seasonality. And if everyone else is playing well in the sandbox, and you make the process really easy to do, then chances are you’re going to be able to have access to more block time when you need it as well. Great, thanks, Michelle. 


So I believe, that we have answered is there a lot of maintenance to do last question I see, is there a lot of maintenances to do in the application if certain schedulers change position, et cetera? Michelle, that was for you, or. I’ll take a first pass at it. We regularly work with our leadership teams to review their user list. Just to show them who’s using. Because what ends up happening is the tools so easy to use, anyone can invite anyone. So if there is turnover in your provider practices or offices, peer-to-peer invitation is very easy in the tool and the application. And then, to make sure that it doesn’t get overloaded with users, we also work with leadership teams to make sure that they are reviewing who had access. And if individuals are no longer with the organization, or have a need to access this preoperative information, we can simply remove them. OK. 


MICHELLE BALLOU: Yeah, and I just want to emphasize this. It’s really easy to invite any user, internally. And the tool itself, I use almost every single day, and there’s little education needed. And we can– we usually provide that just from user-to-user, so it’s really easy to use.


ASHLEY WALSH: Awesome, cool, thanks, Michel. So thanks everyone for joining. Marianne, I believe that I have answered our questions. 


MARIANNE BISKUP: I believe you have, Ashley. I really want to thank everyone for submitting so many questions. It’s great to see this level of engagement in a webinar, especially, viewing it live. So again, everybody, thanks for joining us today. Special thanks to. Ashley and Michele for presenting today’s webinar. Friendly reminder, keep an eye on your inbox, you should receive a link that will have the audio recording and the slides for this webinar in about 24 hours. So keep an eye out for that. And again, thanks for joining us all. Thanks a lot.

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