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OR Capacity Recovery & Nimble Positioning for the Future Webinar transcript


JOSEFINE: I’m. Josefine Hederoth,, and I’d like to welcome you to today’s webinar– OR Capacity Recovery & Nimble. Positioning for the Future, presented by Justin Spector, product manager for iQueue for Operating Rooms, and Dr. James Caldwell, medical director of surgical services at Parkview Medical Center. 


JUSTIN SPECTOR: I just wanted to get started off and just talk about the format that we’re going to go through here. So this isn’t going to be a super formal presentation. We really are looking to engage with all of you and answer questions as we go. So while we do have a dedicated. Q&A section at the end, we will also be answering questions throughout. So anytime you have a question, just throw it up in the Q&A, and we’ll get to it as quickly as possible, as long as it makes sense with the flow. 


And what I’d like to get started with here, actually, is just a poll for what it is you’re most interested in hearing about today so that we can direct the conversation that way. So I’m going to launch this poll really quickly. And I’ll wait for your responses, and then we’ll get started. OK, so it looks like we’re split across things a little bit. Looks like the biggest one is prioritizing elective surgeries, which is good, because that’s the main topic of this conversation, with the next one being preparing for the second wave or potential second wave of COVID cases. 


So we will definitely talk a lot about those. And the other one reallocating block time didn’t get a ton of votes, but we will go ahead and touch on that, as well. All right. So first, I want to talk a little bit about what we’ve seen as an organization. So here at LeanTaaS, we work with a lot of hospitals across the country. We’ve also been doing webinars throughout this whole COVID 19 crisis, and so we’ve had contact with a lot of hospitals in the United States. And similar to the poll that we just sent, we’ve been doing these polls in our different presentations, as well as talking to the people that we work with. And we’ve been asking them to what extent they’ve been impacted, in their surgical volume, by the onset of COVID. 


So if you look at the chart here, basically, 90% have had somewhere between a 60% and 80% or even higher reduction in their surgical volumes. So that’s pretty huge, and that has a outsized financial impact on hospitals. So we really want to do everything that we can to get those volumes back to normal and to prevent in the future from having to take such massive cuts. So hopefully, in combination with internally getting our policies and procedures in place where we can respond quickly also working with local government to help to make the response more proportional, if that can be done in the future. So these are the non-financial impacts that we’ve seen a lot, talking to different hospitals. 


So one thing that we saw, especially in the beginning, is that hospitals would go and they would cancel a week out or reschedule cases a week out for maybe three or four weeks out. And then they would do that again and again, week by week by week. And then they got to the point where those rescheduled cases couldn’t be handled anymore. And then they would either try to reschedule those again, or then they would finally cancel them. So the process wasn’t particularly well managed in that sense. And of course, you can’t blame anybody for that, because none of us knew how long this would last. But I think it’s definitely something that we need to learn from as a system, as a country in terms of how to handle these sorts of things. And one of the things we wound up doing is trying to figure out,. 


OK, which of these cases are still in play, because some organizations thought ahead and created specific cancelation reasons within their EHRs. And that made it very easy to report on. We’d run a report on canceled due to pandemic, or canceled due to COVID 19. And we could pull those cases, send those out to the clinics, and have them keep those and hold on to them for rescheduling. But for a lot of hospitals, that wasn’t the case. They would just cancel the case and they didn’t have a specific cancellation reason. So then we had to go through and pull every canceled case, say, from March 15 through May 15. And then the clinics would have to figure out which of these were canceled for a legitimate reason or a reason other than COVID, and which of these were canceled just because the hospital couldn’t take them at that time. So that wound up causing a fair amount of additional work. 


The other really tough thing, through all of this, is that, less so on the hospital side, but definitely to some extent there, but much more so on the clinic side is that scheduling staff were either furloughed, or laid off. So that made it very difficult for the hospitals to communicate with their surgeons, especially– it’s a little bit easier at the academic hospitals, but at community hospitals where there’s very loose ties between the hospital management and the surgeons who operate there, it was very difficult for them to get that communication, figure out, hey how many cases do you have? Are you still seeing patients? How much block time are you going to need when we start starting elective surgeries again? So that part, I think, is another area where we can really look to improve in the future. 


And then the last bit, which especially has been impactful at places with– who are already at very high surgical volumes, so places with 70, 80, 85% prime time utilization before COVID 19, for them they canceled so many cases that it becomes really important to understand which of these cases need to be done in the next month, which of these cases need to be done in the next week or two weeks, which of these cases can wait 90 days, which of these cases can wait indefinitely. And because there was no system in place, because we just treated an elective case as an elective case, we wound up in a situation where it was hard to prioritize who to give time to first. Obviously, we want to get everyone in, but we’ve got to make sure the patient’s who are coming in for cancer are being seen before the patients who are coming in for a cosmetic procedure. 


So that’s something that we’ve worked a lot on our side to help to do research into different ways of prioritizing cases, and from a product side, giving tools to help people to do those things. So going forward, here’s how we feel like we should handle things. So we want hospitals to be able to be more nimble, agile. In the tech industry here, we always talk about agile development. And I think a lot of those same principles– I know a lot of hospitals are already working with lean ideas. So similarly, we want them to be able to respond quickly to events like this, set up the correct work groups within the hospital, make decisions quickly, and get a plan in place so that communication– everyone can be on the same page, we don’t have people panicking, we can address situations in a much more metered and calm way. So things that we want to work on there specifically is having better communication channels between the hospital and the surgeon staff. So that might be something along the lines of having a built-in email communication system where you have an email list that you can blast out emails. 


We worked with a lot of organizations where we said, hey, we need to you need to send some information out to all your clinics. We have these backlog sheets to send out to them, and they didn’t have an email system in place where they could just do that as a batch. They had to do them individually, and that can be hard when you have hundreds of surgeons that work at your hospital. Similarly, having plans in place for how you’re going to scale back block if you get your capacity reduced again. So if you get scaled down to 20% capacity again, what are you going to do with your blocks? Are you going to switch to service line? Are you going to reduce everyone at the same scale, or are you going to reduce the scale disproportionately? Just having those plans in place will really help if we wind up in a situation like this again. And then there are other things that are a little bit more on the technical side of things. 


So capturing backlogs– where we were able to get the canceled cases, that’s only part of the actual backlog. So what was very opaque during all of this was, what is the ongoing or invisible backlog? So we only saw the canceled cases that had been sent into the hospital for scheduling, but every doctor’s office also has some amount of cases in a desk drawer that are waiting to be scheduled. So you’ve seen the patient, but for whatever reason, you’re waiting on something to get them scheduled, and then you’re also continuing to see patients well, probably at a lower rate. But a lot of these clinics stayed open throughout COVID, especially the ones that were capable of doing telemedicine. So that surgical backlog was growing, but there wasn’t a way for us to see that. So that’s something that we’ve worked on here at LeanTaaS, to create tools to help to help maintain that while the capacity is restricted. 


And then, you know, the other thing is just kind of figuring out how to be more efficient. You know, making sure you’re not running rooms that are half full, trying to get those cases packed in as optimally as possible, and doing everything that you can to reduce having to run your rooms late, reduce having to open additional rooms, having to open weekends if you don’t absolutely have to. 


And, finally, which is kind of the main thing that we’re here to talk about is, you know, case prioritization, how to make that a part of the culture so that next time this comes up, you’re not left in a situation where you have to scramble and go through hundreds, if not thousands of cases, and give them a priority score so that you can be ready beforehand. Have those scores in place, have a system of bringing them back in, and being able to provide that amount of order and confidence with your staff. So I would like to ask you just one more follow up poll here. And this is, you know, depending on your organization, you may have a better idea or less of an idea of what this actual number is. 


But you know, I’d like you to just give us your best ballpark if you don’t have an exact answer. So what we want to know is, of the cases that were canceled due to. COVID, how many of those cases have now been performed? So we’re not looking at the cases that have come in since then, just the ones that were canceled due to COVID. And so I’ll just quickly launch this one. OK. So it looks like it’s been somewhere between 25% and 100% cleared for all these. So that’s, you know, that’s good. We don’t have anybody less than 25%. But it seems that the largest group was in the 25% to 49%. So it seems like we’re still in the thick of it for a lot of you. And we definitely want to talk about ways to help to reduce that more quickly. And I think Dr. Caldwell will have a lot of great advice to share on that topic. So I will hand it over to you, Dr. Caldwell. 


JIM CALDWELL: Thanks, Justin. Good morning, everybody. Just by way of a little bit of background really quickly, I’m the Medical Director of. Surgical Services at Parkview Medical Center in Pueblo. We are a community hospital licensed for 350 beds. And we’re one of only two of those types of hospitals left in Colorado. So like everybody,. I mean depending on whether you’re from an academic institution, whether you’re from a large health system or a smaller hospital like we are, we all took a huge financial hit when we decided to do away with our elective procedures hospital wide when this all took place. 


And to some extent, you know, it has truly impacted not just the hospital, but all the people that the hospital employs, the physicians who work at the hospitals, the patients who come to those hospitals. So working back through this is a challenge, both for communities and for the financial well-being of the hospital and all the people who depend on the hospital. And I’m not running the slide so if someone wants to advance, that would be great. What we found at Parkview, one other little bit of information, we’re about an 80% to 82% Medicare facility here and Medicaid. So our margins are very, very thin. And you know, a lot of the things that we face here, you’re going to have faced at all your institutions. 


We had physician frustration building. You know, we had physicians that, on the one hand really did not want to be operating during this time period, but we also had physicians that were really straining at the bit wanting to be operating. If you’re anything like us, we had a large portion of our workforce that we were forced to EA, or give mandatory PTO. We had, you know, many of our staff even going on unemployment, face things, you know, just the uncertainty of the staff throughout this time period, the uncertainty of the patients, the uncertainty of the community. And so it really was incumbent on us to work through this backlog as quickly as possible once we were able to start again. 


So almost from the start when we stopped doing elective procedures, we started planning for how to restart elective procedures. And we were doing that initially sort of ourselves, you know, looking up trying to find best practices on the internet. And so we’ve been a LeanTaaS customer for a long time so we were very happy when Justin and everybody at LeanTaaS reached out to us and started helping us work through the planning phase of this and really gave us some focus and some guidelines. Here in Colorado when we were allowed to restart our elective cases, we were limited for the first 10 days after we were allowed to restart to 80% of our pre-cessation volume. 


And then after that, we are still limited to 70% of our total bed capacity. We can’t allow our elective cases to infringe on that in case we would have another wave of. COVID show its ugly head. So that has been a big thing. We also have to, you know, as most of you are, carefully maintain our PPE supplies and make sure that our elective surgeries and procedures aren’t negatively impact our ability to protect our staff that’re actively taking care of our COVID patients. So working with Justin and all the team at LeanTaaS, you know, they’re able to pull a lot of this information for us right out of our EMR. So what we discovered as we started looking at what our backlog was, and they have a couple tools that he’s going to talk with you about a little bit later, one being a time predictor. 


How long is it going to take for you to work through your backlog? But then also this backlog prioritization calculator, which is so important for all this. Challenges that we’re looking at here. We’ve got about 730 cases, backlog cases that we’ve been working through. We’ve got physician concerns and patient concerns about coming back into a hospital while we’re still treating COVID patients. We really positioned ourselves well at the beginning of this. We’ve really been able to flatten the curve here in Pueblo. And we really have not seen some of the spikes that some of you all have seen in terms of our COVID patients. So we’ve been very lucky, both on I think the number of patients we’ve seen, but also our staff. And our hospital positioned it very quickly to try to minimize the amount of COVID patients here. 


But we expected sort of a tidal wave or a dam bursting effect when we were allowed to restart our elective practice. But what we saw is, it wasn’t quite that much. It was sort of just a steady influx. But we had patients that had decided that, in the meantime, they really didn’t need their procedures. We had patients that have lost jobs or lost their insurance due to their layoffs because of COVID and so they weren’t coming back. And so it has not been quite the onslaught of patients that we thought we would have. But we definitely have a large number of patients that we’re working through. So in discussing with. LeanTaaS some strategies, how to work through these challenges, the first thing we talked about is, this is not as easy as the hospital just saying, OK, we’re open for business again. 


We really truly had to get collaboration from the surgeons. We had to talk to the anesthesiology team. We had to get buy in from the nurses. And then of course the hospital leadership. You know there are multiple aspects, like if we were going to extend hours in the evening to try to work through some backlogged cases, if we were going to open up on the weekends. There’s a lot of ancillary staff and support staff that have to be pulled in. So we really had to have some good discussions on those fronts. We were watching to see what was happening locally and nationally, and, again, trying to follow best practices from some big institutions. And then one of the things is we just looked at the cases themselves. We really tried to look at what the clinical urgency was for those cases. 


We tried to look at what the risk to the patients coming into the hospital was going to be. And so those are some things that we really took into account early on. Some of the things that we worried about, you know, again we’re a small community hospital. And we do have some relatively close neighbors that could obviously up their capacity much more quickly than we could. So one of the things is, we really didn’t want to see that we were losing in our community patients to other cities due to our inability to quickly take care of their needs. They’d already been waiting a couple months, in some cases, for procedures. And what we really didn’t want to have was a bunch of patients that were being told, thank you for waiting two months, but now we need you to wait another couple months while we get to your case. 


So that’s really where the prioritization portion of this comes in. And we already, like I said, we’ve been working with LeanTaaS for quite some time. And so some of their tools that we have in place really helped us to work through some of this. So they have a module called Exchange, if you’re not familiar with the LeanTaaS. And one of the things we really wanted to try to do is maximize our primetime block utilization. And what Exchange allows you to do, and again not to step on Justin and the LeanTaaS folks, but just by way of history for those of you that are familiar, it sort of works like OpenTable but for OR block time. So the surgeons that might have had a long list of outpatient procedures that they were trying to get onto the schedule outside of what their assigned block time was, can use this module. 


Much like OpenTable, they just type in when they’re available, the amount of time they need, and then the Exchange module will tell them when they have some openings in the block schedule. And they’re able to just grab them right there from their phone, or their computer, or their schedule can do it. So it makes it very, very easy for surgeons to find holes in the block schedule where they can plug-in cases without having to contact schedulers and that sort of thing. So it makes it very easy for them to work through this. And because of that, without changing one thing, our outpatient backlog has already been taken care of. We were getting ready to open up our out outpatient center to some weekend days. But that backlog has already been worked through. And in large part, that’s due to the ability of the surgeons to work through Exchange and very quickly plug-in those cases. 


Inpatient is a little bit more challenging. When I say inpatient, I mean things like, you know, invasive gynecologic procedures, joint replacements. We do not do those outpatient here. And so, again,. Exchange has allowed us to work through some of that. But that’s really where we have to start looking at prioritization. And that’s where we start looking at models that work for various institutions. So a lot of these case prioritization methodologies that LeanTaaS is looking at, these have come from countries where they have socialized medicine. And so they’re trying to figure out how to schedule their procedures efficiently. You know, so we’ve heard about countries where you’ve got a six month wait to get your joint replaced. And so that’s where a lot of this data comes from. 


Without getting too far into the weeds, I was just going to really briefly describe four of these models. One comes from Italy. And this is the Surgical Waiting. List Info System, or SWALIS. Italy developed this in 2001. And this is software driven and it utilizes urgency related groups and then maximum time before treatment. And this is a very subjective model where physicians place their patients into these different urgency related groups, but it’s a subjective criteria. And then they look at the maximum time before treatment. And then this software generates real time prioritization according to where those patients were placed in the URGs, or the maximum time before treatment buckets. 


Then the second one that they looked at comes from British Columbia. Ministry of Health. And this is the Surgical. Patient Registry. And it’s similar to the Italian model, but it actually uses procedure. IDs to prioritize these cases. But then it breaks them down into five different time periods. So a priority one would be a procedure IDs that needed to be done within two weeks. Prioritization level two, they needed to be done within four weeks. Prioritization level three needs to be done within six weeks. And then 12 weeks, 26 weeks. And so rather than using subjective data, they simply use case diagnoses to place the different patients into these different prioritization categories. 


New Zealand uses a general surgery prioritization tool called the Clinical. Priority Assessment, or CPAC. And these patients are placed into different, or they’re prioriti– prioritie– prioritized, excuse me, I’m stumbling over my tongue this morning, based on aspects of impact to the patient’s quality of life and health. And that’s a zero to 100 scale. And so that is a fairly easy model to use. And then the American. College of Surgeons is getting ready to publish their medically– it’s a multi-factor prioritization model, but it’s called a Medically. Necessary Time Sensitive Procedures, or MeNTS Process. And that uses both subjective and objective scoring in multiple categories to produce a cumulative score that ranges from 200 to one– sorry from 21 to 105. And higher scores mean a greater risk to reward for those scheduled procedures. 


The problem with this model is that it requires scoring each case for 21 different factors on a scale of one to five. So LeanTaaS really recommends the SWALIS modeling because it’s very easy, and it’s consistent, and it’s much easier for, say, community hospitals or private hospitals to get their surgeons to buy into that modeling. Because they have to provide the least information, realistically. The American College of Surgeons is an excellent tool but you really need a fairly robust administrative staff to get all those categories filled out for each patient. So that might be a much better, you know, a model for, like, an academic institution where you have interns because it could be used not only for scheduling, but for learning for the interns so you learn how to prioritize cases as well. 


So each of these models has merits, has pros and cons. And I’m sure that. Justin, if you have further questions about those, would be happy to go through those either offline or later. But those are the four real models that LeanTaaS is looking at right now. And here at Parkview we really use SWALIS. Just after multiple discussions with LeanTaaS that is sort of what we finally settled on here. And that is what I have on case prioritization. And I think we’re going back to Justin at this point. 


JUSTIN SPECTOR: Yeah. So we want to start talking a little bit about tools. Although, before I take over, one thing I would like to hear a little bit from you, Dr. Caldwell, is how you kind of set up the internal committees and working groups within your hospital to make these decisions. Because, you know, of the people we’ve worked with, you guys have really been kind of a northstar example of how to go about that. And I think that would be really helpful for a lot of our attendees. 


JIM CALDWELL: Oh, absolutely. So we sort of got where we are, we’ve been chasing utilization for many, many, many years– in block utilization. I’m referring to. And so we had formed an OR committee several years ago with the entire purpose just to try to help manage our block schedule. That is a very limited resource for us. Again, we’re a very small hospital, but we have a large number of physicians wanting to operate here. And so trying to fairly fit them in and not, you know, allow surgeons to have more block than they need. It’s not a challenge unique to us. 


Multiple institutions face that same problem. What we found was, though, we were chasing spreadsheets. And we would look at data from 100 different directions and really in the initial seven years of that OR committee, we never made one meaningful change to our block time. Surgeons, you know, we have to be very cognizant that they are very, very– what do I want to say there? They are not really wanting to believe the data that the hospital provides to them if that means that they have to give up some of their block time. So getting them to trust the data is a really key portion of that. And we were never able to provide data that we could really back up well enough that we could really take block time away from a surgeon. 


So that’s how we came to be involved with LeanTaaS. As we implemented LeanTaaS here, in discussing that whole process, we developed an OR block committee. And we used another module from LeanTaaS called Collectable. Time, which is well beyond the scope of this conversation. But based on the data that we received from Lean TaaS in that Collectable Time module, our block utilization committee then sits down once a month and we review all that data. And we, in some cases, do remove some block time from surgeons now, or we’ve even added block time to surgeons based on those discussions. And the surgeons trust the data. We’re able to show them in graphic form really what they’re collectable time is. It’s a little different than utilization. 


But surgeons have really come to trust the recommendations that come out of that committee. And a key portion of that, it’s fair and it’s consistent. And it does not penalize. It is set up to be as big a benefit to the surgeons as possible. So once we moved into this issue where we weren’t doing elective cases anymore, during that time period an extension of that block utilization committee became our surgical triage committee. And we had a portion of surgeons that sat on that committee, we had OR leadership, and then we had administration on that committee as well. And while our surgeons were very, very good at not posting cases which were truly non-emergent, every so often we would have a case that popped up that we really did need to review. 


So that committee would get together. We would review the cases. We would discuss them with the surgeon, if necessary. In most cases we did proceed with the surgeries. But that triage committee, then as we moved into doing elective procedures again, then that morphed into the prioritization committee. Justin will talk about this a little bit, but when we talk about primetime block utilization, that is really where the meat of this comes from. Yes, we can always add hours at the end of the day. Yes, we can add weekend hours. But really maximizing that primetime block time is the biggest key to this. And sometimes that means we may have to ask a surgeon, hey, we have this other surgeon that’s higher on the priority list than you. We would like you to temporarily release your block for one week in order for that surgeon to work through some of his backlog. So what we’ve really done and what has been key to this is really the surgeon buy in and having them participate on these committees. 


It’s important to have surgeons that the other surgeons respect, no matter what the specialty might be, so that– No matter what, if you have surgeons telling surgeons things, it always comes across better than having leadership tell surgeons things. So having surgeons be a huge part of the participation in those committees has been crucial and has really allowed for us to move through this fairly quickly, efficiently, and painlessly actually. But, yeah, those committees and really following– that’s the other thing is the empowering of those committees by the administration to say, we are not going to circumvent what those committees decide. 


So if we have surgeon X that comes to our COO or CEO and says, I don’t agree with what those committees say, our COO and CEO, they always back those committees up. And that’s really instrumental. Because without, you know, putting some teeth into those committees, they really are powerless. And so that is very, very important that, you know, that really there’s backing of those committees. And that can be challenging when you have a very high producing surgeon come to the hospital and say, you know, I’ve got these cases to do and your committee’s not letting me do them. Well, it’s not that we’re not letting them, but they may be a little bit farther down the priority list than other surgeons so. Did that answer your question, Justin? 


JUSTIN SPECTOR:. Yeah, absolutely. Thank you very much for going into that, Dr. Caldwell. So before I start talking about the tools, are there any questions from audience numbers that you’d like us to address? And if you have any, there’s a. Q&A button in the Zoom meeting. So just click on that and type in the answers, sorry, type in the questions. We will answer them here in the presentation. 


ANNOUNCER: Justin, we do have one for Dr. Caldwell. It says, do you historically have a heavily blocked schedule? And if so, do the surgeons give up their blocks so that you could do the cases? I think they mean to catch up with your backlogged cases. 


JIM CALDWELL: Sure. Yes. Our schedule is incredibly heavily blocked here. And so, yes. We have had to have that exact conversation already a couple times. And again, you know, we stress to the surgeon that we’re making the request of, this is simply a temporary thing. You know, we ask them to just understand that we need them to be a team player at this point and that it’s maybe a one or two time thing where we’re asking them to give up their block. For instance, if we had a orthopedic surgeon that had the ability to flip rooms on a day, he has enough backlog that we could justify giving him two rooms, but he only has one room on that day, we have asked some other surgeons if they would mind giving up their block time for that day so that surgeon could bounce back and forth and do five or six joints in one day. So, yes. Very heavily blocked and we have had to have that conversation a couple of times. And our surgeons have been very, very flexible throughout this. And that’s one thing. I would have to say, we’ve been very, very lucky in that we have had tremendous surgeon support for this. 


JUSTIN SPECTOR: I think that’s it for questions for right now. I’ll start talking about some of the tools we have here. So at LeanTaaS we have tools that we built specifically for COVID, as well as some of our core functionalities. You heard Dr. Caldwell talking about the Exchange module. You know, that’s part of our core offering. But we also have built some tools, and some free tools, that all of you can get access to help deal with COVID. So this first one, a backlog calculator tool. 


And again, this is a free tool so any of you can get to this. So all you need to do is email us at and we can get you set up with this and help you to put in the correct values here to get the calculation. And you can also go to our website to find this, as well. So what this tool does is it helps to kind of help you figure out when you will be finished clearing your backlog. And so it takes into account, you know, quite a few different inputs. So what your pre-COVID volume was and how much you reduced that volume as a result of COVID. And then we look into, at what pace are you going to start recovering that volume? So most places didn’t go from 20% back to 100%. You know, for most places it was 20% up to 50%, up to 75%, and a lot of hospitals still haven’t gotten to full capacity yet. 


So we’re able to kind of take in that side of things and we’re able to kind of predict to what’s the extent that backlog is growing through that time. And then once you get to 100%, you know, at what rate will you clear that? So because you will have backlog cases on top of incoming new cases, we expect that that’s going to be a little bit slower than just the amount of time it would be to run the backlog cases. Another thing we do here is allow you to predict a second wave if your organization or your municipality thinks that that is a likely situation. And then the ultimate output of this is, you know, an approximate date of when you will have fully cleared the backlog. So that’s a really nice tool, very easy to use. It can just help you get an idea of where you stand. 


JIM CALDWELL: And,. Justin, if I could jump in real quick on that. That is a really powerful image to show your surgeons. When you’re having those discussions about things like block time and working through the backlog, showing them in your example there, sometime past July 2021. You know, I mean that really can demonstrate to them the impact of them being flexible and helping the hospital to work through the backlog. Because no one wants to take eight to nine months to get through this backlog of cases. You’ll lose patients due to attrition during that time. So that’s a really powerful communication tool with the surgeons to just show them what this looks like. And then it really shows them sort of the reality of the situation for your institution. And so they’re not expecting that they’re going to get through their backlog in the next three to four weeks. You can show them what this really looks like graphically. 


JUSTIN SPECTOR: Thank you, Dr. Caldwell. Yeah. And again that is available to all of you. So you know, please reach out to us if that’s something that you are interested in. So the second tool, this is not a free tool. This is part of our core offering, but it was developed in response to COVID. And this is a automated way of tracking the backlog. So what this tool does is it connects to your EHR. So you know, whether you’re on. Epic, or Cerner, or MEDITECH, or anything, really, we will pull in either– you know, if you’re on a non-Epic EHR– we would pull in the canceled cases. 


And then the individual surgeons would go in, or their staff would go in, and prioritize those and determine whether or not they need to be rescheduled, or whether they are truly canceled. Or if you’re on Epic, you have the option of having us connect this to your case depot. And then you can pick a date in the future. A lot of hospitals have gone with July 4, 2021. And just tell every clinic out there that, hey, all of the cases that you need to get scheduled, just put them on that date in the depot, and we will pull those in. And we will know that those are your backlog cases and those are the cases that need to be rescheduled. Similarly, those will get pulled here into the system. 


The hospital will be able to see which surgeons have how many cases and at what priority levels those cases are. And then we also have a system that uses AI and machine learning to give a recommenda– sorry to give a recommended block schedule out of that. And then we do have a free version of this that’s an Excel spreadsheet template. Obviously it’s a bit more manual. But it is another thing that’s available to you. Another thing here, and sorry that image came out a little bit blurry for some reason, is just our ability to track how you’re doing. So we have our analyze module. And it can tell you how you’re doing compared to previous months, how you’re doing compared to previous years, all very easily. 


You just set a few parameters here and you get these really nice graphical outputs. You can export these to CSV, you can export the images to share in a presentation. Just a really handy tool for your organization. And actually, let me go to another poll before we get to that one. So I would like to ask you all, you know, what is your organization planning to do about its block time? Let me just– oh, sorry. Sorry that’s the wrong poll again. Give me one second. 


JIM CALDWELL: While you’re doing that, I’ll throw in there that one of the things we did do here was increase our auto release time. And that really freed up a lot of the primetime block schedule that the patient, or sorry, that the physicians were then able to access through Exchange. So that was key. 


JUSTIN SPECTOR: And for this question, if you’ve gotten back to normal now, if your organization is now operating at 100% capacity and your backlog is cleared, what I’d like to know here is what you did during the time where you were recovering. So how did you handle block when you were at 75% capacity or 50% capacity? All right. So yeah. So it looks like most of you all have decided to either keep it the same and not change anything with your auto release or keep the block the same and increase your auto release deadlines. So we have seen that a lot. Extending those auto releases definitely helps, especially if you have a strong system in place for notifying surgeons when those blocks are dropping off and you have time available. 


That’s one thing that our Exchange product really– that’s kind of its main function is to help surgeons to release that block sooner and to pick it up when it does get released. So that’s encouraging to see. OK. And then, yeah. I’d like to open things back up for Q&A if you have any other questions. If not, I do have one other poll to share. 


ANNOUNCER: Hey, Justin. We’ve got one more question for Dr. Caldwell. Given the predictions of the possible future waves, what are you planning to do differently for future as it relates particularly to the scheduling or access to the ORs? 


JIM CALDWELL: So it’s interesting that you ask that. We were talking the other day about the crystal ball function. And we’re still waiting for someone to generate one of those for us. But one of the things that we would really like to do going forward is to maintain a prioritization list instead of having to regenerate it if something like this were to happen again. Because obviously if we do get a second wave, we might have to shut down our elective cases again, or at least minimize them. And so one of the things that we’ve discussed is how nice it would be going forward, and if we did have a tool available that would allow us to do this, that it just keeps generating a prioritization list as cases are scheduled. 


And so that’s one of the things that we’re really hopeful about. And we’re looking forward to working with you guys on is that that’s something that we can come up with in the future. The other thing that we like to do and that we’re probably going to start talking a little more about in our OR committee meetings, is this thought of, you know, as we look at the prioritization, rather than asking the surgeons sort of reactively to be able to manipulate their block schedule temporarily, asking if they would be able to– this is a big ask for surgeons and everyone on the phone will probably realize this– but if they would be willing to let the hospitals sort of proactively manipulate this with proper notification, of course, proactively manipulate the block schedule rather than having to simply you know go to each and every surgeon and ask if it would be OK to take some of their time. 


Again that is a lot of trust on the part of the surgeon. That would require a huge amount of trust. There are going to be surgeons that are going to be completely against that. But there are a lot of surgeons that already let us manipulate their schedule in order to more efficiently work through their cases. So it’s something that’s really going to be on our future to do list and to talk about and really look at it a meaningful way at our committee meetings. But realistically, the biggest thing, if we can get just a real time prioritization list, that makes a lot of this sort of academic because we have it immediately. 


As soon as we would, you know, we look more into the future, and we have that available at our fingertips rather than having to generate it retroactively.


 ANNOUNCER: Thank you. 


JUSTIN SPECTOR: Do we have any other questions? 


ANNOUNCER: I think he’s pretty much covered the other questions that have come in. 


JUSTIN SPECTOR: Great. So if you have time everyone, I would like to just ask one more question just to see if this was helpful for all of you. So I want to just kind of see if you’re planning on doing anything different as a result of hearing this or even if what we’ve spoken about today has maybe reinforced some ideas you already had. 


And thank you, everyone, for hanging in to the very end of the call with us. I know it’s been a lot of content. But I really do hope that it’s been helpful for all of you. And of course, please feel free to reach out to us either at or my personal email I will be happy to answer any of your questions if you email us. I’ll bring that side up again so you can have those email addresses handy. LeanTaaS is not the most obviously spelled word. So, yeah. Looks like we’ve got some people who are looking to get some tools. So again please email us and we can help to point you in the right direction on those things. And I’m really glad to see that, you know, we have people who are looking to take in some of this advice. 


So again, on those subjects, as well, we’re happy to help. So just email the And we will be happy to discuss any kind of first steps that you or your organization can take to implement those. So really, thank you, everyone. Thank you, Dr. Caldwell. You know we really appreciate all the time you’ve spent with us working on this presentation. 


JIM CALDWELL: Of course. 


JUSTIN SPECTOR: And of course, Jessica and Josephine, thank you for putting together all of this content and getting this organized. We really, really appreciate you. 


ANNOUNCER: Thank you so much everyone for joining. Thank you, Dr.. Caldwell and Justin. I hope you all have a great day. And don’t forget that you can email or for any questions. And look out for an email with the recording later today. Thank you




ANNOUNCER: Bye, everyone. 


JIM CALDWELL: Thank you.

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