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Why Block Utilization is Still Not the Answer Webinar Transcript

My name’s Utkarsh Vaidya. I’m a product manager at LeanTaaS. I’ve been working here for about 2 and 1/2 years. I’ve worked on an open marketplace for block time, as well as some adjusting mechanisms for rightsizing blocks, which we’ll talk about today. 

JESSICA KOVASH: Hi. And I’m Jessica Kovash, a product implementation manager on the OR team, and have a background focused on perioperative consulting. Relatively new to the organization, but very excited to be here. All right. So again, this is Jessica. And I spent over 10 years working with hospital ORs, primarily focusing on access, scheduling and throughput. So as you can imagine, I spent an extensive amount of time related to block scheduling, establishing governance structures, and developing policies to make decisions, creating and modifying blocks schedules, and determining what should actually be included in block utilization calculations. And I’ve also spent countless hours in Excel trying to calculate block utilization percentages. So I can fully relate to, and empathize with the emotion, the politics, and the extensive amount of airtime that block utilization discussions require. And even after all of that, some surgeons still have way more time than they need. And some surgeons still need a lot more time than they have. So this is why I’m so excited about addressing this difficult subject and complex problem in a way that actually minimizes the politics, and gets hospitals an actionable surgeon centered and solid approach to optimizing [INAUDIBLE] utilization. 

So we see on this pie chart– and the pie chart together [INAUDIBLE]—- but the OR is the hospital’s economic engine. And correspondingly, [INAUDIBLE] time is one of the largest assets. Typically, a hospital will allocate approximately 80% of available OR time to blocks, with the remaining 20% to open time on a first come, first serve basis. It’s actually not uncommon for hospitals to allocate an even higher percentage of time to blocks– upwards of 90%. These blocks of times are painstakingly allocated, and then painstakingly scrutinized, and are boiled down to a single percentage. If it is determined that the allocated time should be recovered, it also often takes several months before the time can be repurposed, which translates into unused time, which translates into lost revenue for the economic engine. Another challenge with focusing so much attention on block utilization is that the hospitals have historically set acceptable thresholds for block utilization of around 75% or so. 

And this is essentially saying that the hospital is OK with having 80% of their economic engine’s prime time utilized, at best, at 75%. And we totally understand, it’s not realistic to say that downtime can be eliminated. But rather, what we’re saying, that focusing energy on block utilization metrics does not address what the true need is to capture usable portions of valuable underutilized time, and then repurpose it– which is now possible to do, and to do so in a very transparent, efficient and fair manner. 

UTKARSH VAIDYA: One thing I wanted to add to that, Jessica, is that 80% of block time which we’re looking at here on the pie chart– it’s usually tied into these long term allocation agreements with surgeons, or surgeon groups, or service lines. And what I mean by that is, essentially, your block schedule. So if I were to assign a Monday, a Wednesday and a Friday block to a surgeon or a surgeon group, the deal that I’m making with the surgeon– or the handshake agreement that I’m making with the surgeon– is I provide an affixed amount of access to the operating room to that surgeon. Every single time, it’s a guaranteed amount of access. And the surgeon is expected to bring a certain level of volume or business to my hospital. So what happens when the surgeon doesn’t actually hold up their end of the bargain? What happens when you do provide that access to the surgeon or the group, but they don’t properly utilize that time?

 Well, there’s no really good mechanism for you to right size or adjust that pre allocated time. The best mechanism that we currently have for that, in health care, is block utilization. The block utilization is a broken metric. And the reason for this is pretty simple. So if you look at the screen, you have a graphic I’m sharing, where you have surgeon. A and surgeon B. And there are two patterns that you can look at. [INAUDIBLE] the thing is with surgeon A, you can think of that as a sports orthopedic surgeon, for instance. So the allocation is about 10 blocks here. And you can see all of the blue bits are bits that the surgeon used, and the white bits are the bits that the surgeon did not use the OR. You can see at the end of the two weeks, there are these two red blocks. Now, you can assume those blocks were un-released, as well as unused. 

Now, the really critical thing about surgeon A and surgeon B is that both of them have the exact same level block utilization, which is 75%. We actually counted, and made sure that both of them had the same level of utilization– or block utilization. Now surgeon A, on one hand– because they’re a sports orthopedic surgeon, their practice is very predictable. So their case [INAUDIBLE] are predictable. Their case [INAUDIBLE] are a bit shorter. And so they’re able to pack their cases in more tightly. Whereas surgeon B, for instance, might be a neurosurgeon, where there’s a lot more variability in the amount of time that they actually need for a case, even if they do their best job at estimating how much time they need. 

And so we need to leave all of these buffer spaces when they pack their cases, because they can’t pack them too tightly. Now, what does block utilization tell you when it says that both of these surgeons are using 75% of their time? Does it mean that you can take away 100 minus 75– which is 25% of their time? Well, you might be able to do that for surgeon A, because he can just take away those two blocks that the surgeon did not use at the end of their schedule. And the surgeon would still be able to address all of their demands. And so you wouldn’t adversely affect the surgeon’s practice. 

But if you tried to take two blocks away from surgeon B, that’s a conversation that is impossible, because you are adversely affecting the surgeon’s ability to actually service their entire volume demand. And so this is the main problem with block utilization. It’s highly susceptible to service line– to the nature of a service lines practice. It’s not surgeons centric. It’s not fair. And most importantly, it’s not actionable, and that’s why it fails as a mechanism to right size your blocks. 

JESSICA KOVASH: So approaching the surgeons to right size their blocks is extremely difficult, if not impossible. It’s even more difficult to do when the center of the conversation is around a single percentage, regardless of the nature of practice. So penalizing surgeons– as we said– for being efficient, or for minor case delays, or over budget turnaround instances– doesn’t make sense. And the reality is, none of these small gaps are reusable or repurposable. There’s no chance of filling in extra cases into these gaps. So the wasted time is simply an unavoidable part of running an unpredictable business like surgery. And hospitals should just ignore some of these instances. Conversely, and not that they do– the surgeon practices can artificially [INAUDIBLE] block utilization by taking advantage of block release time. Since the release time is not counted in the denominator of block utilization, surgeons can release time at the last minute to inflate their numbers. 

And the released time is just a short window, with little mechanism– if no mechanism– to fill the time. And it becomes unusable time. So with the advances in access to data, along with some innovative thinking and engineering, there is a new and better, more surgeon-centric way to improve the utilization, and make blocks more dynamic, while minimizing the politics and the air time spent on optimizing access and utilization. 

UTKARSH VAIDYA: So at [INAUDIBLE] IQ, we’ve actually come up with a new metric– a new way to look at this problem. And we call it collectable time. And we really believe that collectable time is the answer to right sizing your blocks. We think that this is an actionable, comprehensive, fair surgeon-centric metric for you to actually act on, taking block time away from under performing block owners, and just, in general, tightening up your block schedule. So what do I mean by that? What do I mean by collectable time? Well, if you looked at this illustrative example, again, we have a 12 week schedule here. All the blue bits are bits that were used. All of the white bits are bits that were not used. And all of the things that are in gray are blocks that were released. So this block owner released four out of their twelve blocks in this 12 week– in this 12 week example. And what we’re seeing with collectable time is, ignore all the tiny delays that are an inevitable part of any surgeon’s schedule. Any just surgery itself, being unpredictable, has these delays. 

So if you focus on the 1st of February, you’ll see that that’s a pretty well utilized block. There’s all of these tiny gaps now. They might be because of staffing. They might be because of equipment delays. They might be because of patient delays. Or they might be because of surgeon delays. But in general, you can see that the surgeon is using that block somewhat well. Now if you look at the first example, which is the 3rd of January, what would actually happen if the surgeon was on late to that case– which is what it looks like– that the surgeon was late by a few minutes, and so the case ran later in the day. Now what would happen if the surgeon was actually not late? You would just move that entire blue bar to the top.

 But it’s not like you can do another case in the little bit of time that’s left at the end of the day. And so that’s the fundamental difference between block utilization and collectable time. Block utilization would actually punish the surgeon for all of those white bits that were not used. But in reality, what collectable time is saying is, when we focus on usable, repurposeable bits of time– if you can reuse or repurpose any open time into the OR, that this happens to be the result of the nature of surgery– then it’s not really time that you can punish the surgeon for. Because you couldn’t have done anything with it anyway. So what we’re seeing with collectable time is, focus on the– focus on the golden star. So if you look at the 10th of January, we have a big chunk of time that’s left unused in the middle of the day. You could definitely have used that for other surgery. If you look at the 22nd of February, the surgeon finished early and left a large amount of time on the table. And if you look at the 1st of March, the surgeon started so late that they left a significant amount of time on the table. And finally, the most egregious of any of these, on the 15th of. March, the surgeon did not release their time, but also did not use a single minute. 

The other thing that. Jessica mentioned earlier, is that when you calculate block utilization, you actually subtract the released minutes from the denominator. So the way you calculate block utilization is used minutes divided by allocated minutes, minus released minutes. But does it really make sense for me to have 12 blocks if I’m releasing four of them regularly? That probably just means that I’m over allocated in the first place. And we understand that surgeons are people too. Life gets in the way sometimes. And sometimes you do need to release time. And sometimes you do need flexibility, without losing any of the access. So what we’re recommending is, allow releases up to a certain threshold of the surgeon’s total allocation. And as the surgeon crosses that threshold, start counting it as collectable time. And so the three categories of collectable time that add up to give you an actionable number– the first one is large, contiguous portions of unused time that are scattered across a surgeon’s schedule. And we’ll get to the product demo in just a bit, where I’ll show you how you can configure what that word means– what large means in this context. The second category is abandoned time. Now this is very obvious. It’s time that was not released and not used at all. That’s the lowest hanging fruit. And then the third category, of course, is for reasons beyond a certain threshold– which I just mentioned– they can set that, for instance, to be 25% or 30%, which would mean that I can release up to 30% of my total allocation with no penalty. And only beyond that threshold do we start counting that as collectable time. So let’s actually go into a demo. 

So what we’re actually looking at here is our real product. So this is currently live at 13 hospital systems in total. And many hospital systems are actually using this to make their decisions. So I’m going to show you how we’ve actually put this collectable time concept into practice. Now what I have here is our module called collect. And that’s where we show you, with surgeons you can take block time away from, or with services you can take block time away from. So let me kick off this entire process by clicking this new table button here. So the first thing we’re going to ask anybody to do is to define their policy– define the collectable policy that we apply to every single block owner to understand how much time they have collectable. Now, the first threshold that you need to set is, what percentage of your total block allocation is it acceptable to manually release? Now, when you set it to be 0%, that essentially is the most aggressive setting from a hospital perspective, which is no releases are considered to be acceptable. 

So every single release that a block owner makes will be counted against them. If you set it to be 100%– that’s the most conservative setting, it’s the most surgeon centric setting, because you’re essentially saying, hey, you can release your entire allocation with no penalty. Normally, we recommend something around 20% or 25%. Let me set it to be 25%, just so we can get something that seems a bit more even keeled. The next number that you need to set is what you actually consider to be a large, contiguous chunk of unused time. 

Now the way to think about this really is, remember, I mentioned that collectable time is focused on creating repurposeable, reusable bits of time. So the way to think about this is, what is the smallest length of case that you can do at your hospital? Anything under that, you should ignore. And any gaps over that, you should consider, because you could have actually scheduled a case in there. Now, the smallest length of case is a pretty aggressive way to look at the problem, because you’re really trying to squeeze out every little bit of time that’s scattered across your block owners’ schedules. What I would actually suggest– and what we do suggest as a best practice to most of our customers– is to select the average length of case. So you’re not really being that strict with large gaps that are left in surgeons’ schedules. You’re focusing mostly on repurposing and reclaiming large gaps that can serve as at least your average case length. So I’m going to set out to be three hours, which I think is a good length for a community hospital, or for even some academic hospitals. The last thing you need to do is, if you have specific goals in mind– for instance, if I have a new practice that started at my location, and they would like blog time on Mondays, Wednesdays, and Fridays, I would only really like to claw back time on Mondays,. Wednesdays, and Fridays. It doesn’t matter if there’s a lot of time that’s unused on Tuesdays and Thursdays, because what I’m really concerned with is creating capacity on a specific day of the week. 

So I’m going to do that. I’m going to remove. Tuesday and Thursday. I’m only going to leave it to. Monday, Wednesday, and Friday. Now as we all know, being part of the hospital ecosystem, there’s certain block owners who just have to remain under utilized– block owners like the trauma block, for instance, or the transplant block. Because it’s really about access, not utilization, for those blocks. You have to have capacity open in case those cases come on, because of regulation or because of the way your hospital’s run. And so you don’t actually take block time away from every single block owner. There are always block owners that you exclude from any sort of analysis where you’re making decisions. So we actually allow you to do that. For instance, I’m going to exclude the transplant block here, because I don’t plan on taking that away. Now, we also have a service line filter here. For instance, if you know that your cardiothoracic practice is something that you are strategically trying to grow– maybe it’s a recently growing practice, or you recently hired some surgeons whose business you want to build. So you might want to exclude that from the scope of this analysis. And we allow you to do that, just by simply unchecking this box and excluding cardiothoracic. And we also exclude dental. And that’s it. So that’s the entire setup for running this analysis. And once you create a table, what we’re actually showing you here is every single block owner, day of week, location combination. And by location, we have a– this is our dental tenant. So it’s not real data. It’s anonymized data. But if you have a main center, a [INAUDIBLE] center, GI– each of those, we consider to be a separate location. And so, every single row on here is a unique block owner, day of week, location combination. Because that is the most atomic unit of decision making that any hospital administration has. 

When you actually go and try to take block time away, they’re always taking it away on a specific day of week. And this is why collectable time is so actionable as opposed to block utilization, because if I had a Monday, Wednesday, Friday block and I’m using the Monday block at 100%, the Wednesday block at 100%, and the Friday block at 0%– my block utilization would be 66% overall, which might cause some alarms. But it’s not really the worst that you might have at your hospital. But in reality, you just need to take away on my Friday block, because I’m actually using my. Monday block and my Wednesday block pretty well. And so the action really comes from a unique block owner, day of week, location combination. So what are we seeing on this table here? Well, for each of these block owners, we’re first seeing the number of blocks that are allocated to them per quarter. Now the reason we are showing this per quarter and not per month is, it’s a lot easier to make decisions on a quarterly time frame. And the goal of this product, and [? IQ ?] as a whole, is to help you reach decisions. So it’s a decision support tool, not really a decision making tool. And so we want to give you a time frame where it’s easy enough to say, take away three blocks per quarter, which just means, take away a block a month. 

The second column we’re showing here is, what is the total collectable time for this block owner? And you can also think about that as excess blocks or excess allocation per quarter. So for [INAUDIBLE]—- which is a group block– you can see that they were allocated 33 blocks a quarter, which is just under three blocks a week for a 13 week quarter. And about 11 of them were collectable, or 33% of their total allocation was collectable. You can see the same thing for these other block owners as well. Now say I look at this block owner, White, Cynthia– who works on Mondays admission and she’s an EMT doctor. We have 11 blocks allocated to Dr. White. And we’re saying that five of those are collectable blocks. Now you want to take some of this time away from Dr. White. How would you actually have that conversation? How does collectable time help you take that time away in a actionable way, in a data driven way? Well, what you can do is you can actually click on any of these block owners– and what we’re showing you here is a pattern for how well the surgeon has been using her time. And so what you can see here is 12 data points going all the way back to January 31st 2012. And what we’re running here is an analysis for every single one of those data points. What we’re showing you here is, there’s 11 blocks currently allocated. Six of them were used well, and five of them need to be released, on average. And that’s the data point right here, at the end of this analysis. But you can also see how, historically, this block owner has been using her time in general. So you can see that the allocation has been fluctuating because of seasonality. And the excess time, obviously, is also fluctuating. But what’s really indicative of the performance here, is that the user release average time– which is actually a rolling average that we look at for the past year of performance– is pretty steady. In general, this block owner is showing a pattern for using– or acceptably releasing about six of her blocks. 

So whatever you allocate to this block owner above that six block threshold is always collectable. Now what if I actually want to go have a conversation with Dr. White, and talk about maybe taking away three out of those five blocks? What do I do then? Well, Dr. White is, of course, going to ask me for specific instances where she had transgressions, or she used her time poorly. And so I can go to this toggle, and I can actually show her a day by day, block by block view of every single transgression or every single instance of collectable time. And remember, we talked about three categories of collectable time. We talked about entire blocks unused, which it any time that was unreleased as well as unused. And you can filter every single instance of when the surgeon had that sort of behavior. So you can see that there were four instances where the surgeon did not release any time and did not use it. The second category we talked about was any release time over the threshold. So let me go to another example– or let me actually tighten that up a bit to illustrate this. And look for White, Cynthia. Great. So the second category– I just tightened it up to illustrate a bit better what I meant by release over threshold. So as you can see, this block owner released a lot of her time. But it only started becoming above that 15% threshold that I just set on the 9th of November. So all of these releases that are highlighted in red are the only releases that we’re actually counting toward collectable time. So all these releases, which we don’t highlight, we are not punishing Dr.. White for those at all. 

So if the total number of releases were under that threshold, we would not count any of those against her. And then the final category which I mentioned was any large, contiguous chunks of unused time that were left in the surgeon’s schedule that were larger than three hours. And so you can see here, we’re actually ignoring all of the highlights– or sorry– all of the tiny chunks of time that are left unused, like this one, this one, this one, or this one, as we mentioned earlier. But we’re actually including any of the unused chunks of time that are highlighted in red as over policy, because they are larger than three hours. So you can see that this is a pretty conservative way to actually look at this schedule. This block owner is performing,. I would say, fairly poorly against this allocation. And we’re actually [INAUDIBLE] a lot of time that is used poorly, because we want to take a conservative approach. And so what would end up happening is, you can definitely make a case, using this information, to take away maybe two or even three or even four blocks per quarter from this doctor, based on our information and on our data. So going back to our larger presentation, how do you actually make this work at your hospital? How do you actually put this methodology and this philosophy into place, like many of our customers have, and make it work for your unique hospital ecosystem? 

JESSICA KOVASH: So as we just illustrated, collect is really designed to be the decision support foundation that helps you organize your block committee meetings. And we encourage you to shift your focus towards collectable time versus block utilization. And using the collect to interactively illustrate why there is extra time, or where this extra time is that can be recaptured and reallocated based on your organization’s strategic goals. And whether your goals lead to open access for new surgeons or provide existing surgeons with new time, create more open time that can be used for other surgeons to access. And again, just really focusing on getting away from that emphasis on that utilization number, and looking at, actually, how to make decisions, setting up the right committees, to have the committee focused on taking action– making a commitment to take action based on the results of what they’re seeing. So again, we talked about once you are able to use the system, to identify blocks of time that you can recover, you will want to look at ways to strategically distribute, or what areas you’re recruiting in. But this gives you a good visualization of what you actually might have available as well– something that you probably don’t have great visibility into currently. 

UTKARSH VAIDYA: Yeah. So these items [INAUDIBLE] what Jessica mentioned– there’s three things to do with the capacity that you unlock. The first one, as. Jessica mentioned, is to strategically distribute this to grow your business. The second one actually links to another bit of functionality, or another part of the product that we have, which we call exchange. And this is simply a way to request open time. So all we’re saying is, if you unlock capacity from poorly performing block owners, put it up for grabs with open time. If you remember that pie chart we showed earlier, which was an 80-20 split between block time and open time– you can take some of that 80% and you can add it into the open time. 

And what you can then do, is you can look at who is showing a consistent pattern of picking up more and more open time– which surgeons are productively using open time a lot more than the time that they’ve been allocated. And you can then consider giving permanent allocation to those surgeons or those surgeon groups. So really what we’re suggesting is, let the market decide who is actually able to bring more capacity, if you don’t already have a strategic thing in mind, or a strategic goal in mind, as to where this capacity needs to go. 

JESSICA KOVASH: The third option is actually to consider closing some of the ORs, or possibly if you have discussions going on now about the need to expand for additional capacity– using this tool to assess what you truly might be able to recapture and repurpose before going forward with an expensive expansion. And so again, you can close your ORs. It does account for seasonality. You can [INAUDIBLE] size them and staff accordingly. 

UTKARSH VAIDYA: So let’s actually look at some of the numbers that we get from the 13 hospital systems that we’re actually using this product at. So last night before this webinar, I went into the product. I went into each of these 13 hospital systems. And I did the same thing that I showed you earlier. I set very conservative thresholds for both of those categories of collectable time. So I said only include releases that are over 25%. And I said don’t count any gaps of time in a certain schedule that are under three hours and 30 minutes, which is extremely conservative. And I excluded any practices that usually people do not take block time away from, like transplant, trauma, pediatrics, emergent, urgent– all of those block owners. And then I counted every single collectable block that we identified. So what did I get? Across these 13 institutions, the aggregate total was 3,701 blocks per quarter.

 Now if you normalize that for the year, you get 14,804 blocks a year. So what does that really mean in terms of revenue? Or what does that really mean in a dollar value? So if you multiply this blocks per year a number by 0.25– which, what I’m doing here is, I’m assuming that you only claim 25% of this identified time as the hospital’s. So you ignore 75% of this, and you’re only able to make decisions on and take back 25% of this fully utilized time, which is again extremely conservative, considering I’ve already excluded transplant, trauma, and other blocks that you can never take action on. So out of all of the block owners that you can take action on, let’s only consider 25%. Now after you take these blocks back, say you give it to somebody strategically, or you put it into your open time, and people pick it up, and they use that time at 50% utilization– which again, is extremely conservative. So I’m saying of all the time that was reclaimed, you’re only using 50% of it. If you consider each block to be 480 minutes– which is 8 hours– again, something that’s on the smaller end of the spectrum, because blocks can go up to 10, 12 hours, also.

 And you use $125 per OR minute number, which we see is, again, on the lower end of the spectrum. We see anywhere between $75 to $210, $215 per OR minute in the customers that we encounter. Well, the number that we end up getting is $111 million of collectable opportunity per year. And that’s the average for a customer. Now, what does that mean? If you normalize that by OR– which is the more important number. So if I divide that opportunity by the number of ORs that comprise– that that opportunity comprises of, you actually get $216,000 of collectable opportunity per year, per OR. So if your hospital is smaller, larger– we have a good mix of these under our portfolio. We’re actually averaging it out across all of those. And so you can think of this number as a very conservative average, given that we’ve put all this– we’ve baked in all this conservativeness– for how much you can expect to see as an opportunity per OR, per year. So you can multiply that by the number of ORs at your institution to get a ballpark of the opportunity that you’re looking at. And again, it really depends on how strict you want to be with this new methodology, how aggressive you want to be in right sizing your blocks, and how easy it is to have new methodologies implemented in your ecosystem. For some systems, it takes a bit longer to move from block utilization to a newer metric like this. For some, it’s a lot easier. It can be done within a quarter. And so, if we think about the total capacity that’s addressed for the entire hospital, on average this new methodology is addressing about 10% of total capacity that’s usable. 

So if you think back to that pie chart again, if you add up the 80 and the 20, and you look at the whole pie chart holistically, we’re addressing a slice of that pie that is about 10% of the entire pie. And that’s, again, a very conservative number. So that’s the conservative end of– for our analysis. 

JESSICA KOVASH: So as. Utkarsh illustrated, we have provided a solution that will give you timely access, be able to make decisions more quickly, and really, during your meetings– make your meetings much more actionable, that are around block utilization. At this point, I think we’ll go ahead and open it to questions. 

MODERATOR: It looks like we had a couple questions come in already. As a reminder, we’ve allowed plenty of time for Q&;A. So feel free to take advantage of the Q&;A widget that’s at the bottom of your screen. And we’d love to answer all your questions. We’ve got one that’s come in already. So the underlying assumption here is that the block utilization should be at 100% or close to it, correct? 

UTKARSH VAIDYA: Right. So I would say that there is no assumption on the level of block utilization at all. Block utilization definitely does not want to be at 100% or close to it. In fact, what I would say is block utilization is not the right metric to look at the overall health of your system at all, because of the reasons that I mentioned earlier, which are block utilization is so susceptible to the nature of the surgeons’ practice, that you can’t actually have the same yardstick to measure a neurosurgeon and a sports orthopedic surgeon. So we’re not saying that block utilization needs to be 60 or 70 or 80 or 100%. What we’re actually saying is, don’t use block utilization to make allocation right sizing decisions at all. Look at it in a different way. Instead of counting up– which is counting from zero to whatever the surgeon’s using– count down, which is count from what the surgeon is not using that you actually think is repurposable. 

And that, I think, is the fundamental difference between the collectable time metric and block utilization, which is collectable time is counting all of the repurposable, reusable, actionable time, which could be anything, really. We’re not really having a benchmark for that, because it’s so configurable that you can decide what level you like to set that at. You can make it aggressive, conservative based on the needs of your institution. And so I think that’s a good question. But I would mention that block utilization is just a square peg round hole sort of situation when you try to use it to make rightsizing decisions. 

MODERATOR: It looks like we have a number of questions coming in. Will this solution assist with reducing add-ons? 

UTKARSH VAIDYA: So I think this question is a– it’s a bit layered. What I would say is, it’s a bit difficult to say if it will reduce the number of add-ons, because add-ons, I think, are more of a tactical way of scheduling, which is– people are picking this up from open times. What collectable time is really talking about is addressing all of the timing that is blocked that you have assigned to surgeons as a part of the block schedule. So it’s difficult to say whether it would reduce add-ons or not. One way that I can think of it reducing add-ons– it’s a bit of a– it’s not a direct correlation. It’s, I guess, like a causality source, which is, if you actually have a more right sized allocation, what you can do is, you have more of a lead time in knowing which of your time is actually going to be open. And so cases don’t necessarily need to be add-ons, because people, in general, will be releasing less of their time because the allocation is a lot tighter. And so you just won’t have as much time available for add-ons. You would have more elective cases, because more of your time is better allocated, better right sized in your block schedule. And so if they’re healthy block owners– people that are using their time well– you just won’t have as much liquid time that opens up so late into your schedule that it gets take up by add-ons. And that’s how I think it would actually end up reducing add-ons. But it doesn’t directly address that issue. 

JESSICA KOVASH: Sorry. And I think it definitely depends on why you’re having those add-ons. If people are adding on cases because they can’t get on during the day, this– as we said, this will allow for greater access to open time. And then if the add-ons are just a function of the practice, you’ll be able to better plan for that accordingly. 

UTKARSH VAIDYA: Yeah. And in my experience, most add-ons actually happened because the time opens up too late, which is time is locked into all these block schedule agreements. People don’t release it until after the auto release dead– or the auto release deadline, or just before the auto release deadline. And no one really thinks about the opportunity cost with me holding that time from the time that the block schedule opened up– six months prior to the day of surgery all the way until two weeks prior, or a week prior to surgery, which is when the auto release deadline is. And so people are holding onto time for all that duration. And they release it so late that people with elective cases– maybe they went to a different institution. Maybe they found another block to do that case then. Or maybe they just told the patient to come back to reschedule. And so that’s how you end up with a lot of add-ons, which is you don’t have true visibility into the reality of open time, and to the reality of access at your institution. So the sooner you can understand how much open time you have, and how much allocation you nationally have available, the better you can address institutional, operational challenges, such as reducing the number of add-ons. 

MODERATOR: How does turnover time play a role in the collect block utilization product? 

UTKARSH VAIDYA: That’s a great question and I’m glad you asked this question, because turnover time is an extremely important metric when you think about the operational health of your hospital. Of course, you need to know if turnover time is setting targets, because it tells you how efficient your staffing teams are. It tells you how well your. OR is running in general. Collectable time is a lot better at buffering for turnover time than block utilization. So think about what turnover time is. Turnover time is time between surgeries that’s not used. Now, you might have a budget for turnover time or something of the sort. But when you look at block utilization, anything that goes over budget is automatically counted in your block utilization. So let me go back to this slide, if you can see the screen. So what I want you to focus on is, again, this example on the 1st of February. So all of those white bits that were not used– let’s assume for a second that they were all instances of turnover. So the first white bit, and the second and the third white bit– I think those are acceptable amounts of turnover. They’re probably between 30 minutes and an hour, which is not great. But it’s near your budget. That middle instance of turnover– that actually might be operationally problematic, which is, you definitely need to have a faster turnover than that. But it’s not really something that you can punish the surgeon for. And that’s precisely the problem with block utilization, which is, surgeons always have a defense when you try and take block time away from them, because they’ll blame operational reasons for why their block utilization is low. And that’s a valid reason also, because there are instances where the turnover is outside of their control, and you’re still punishing them for it. 

And what happens with collectable time is, because we’re allowing you to set the minimum threshold of continuous, unused time that you consider to be reusable, you can actually set it to be two hours or more, which all instances of turnover will fall under. So no instance of turnover is going to be larger than two hours. No instance of turnover is going to be larger than three hours. And for the outliers that are larger, I think you should [? calm ?] them. And you should actually think about why that situation happened. Why the turnover instance was so long between cases. And to answer your question, collectable time effectively ignores turnovers in the surgeon’s favor. So it’s a more surgeon centric to look at turnover. So it gets rid of a common reason or common argument that surgeons have whenever you try to take block time away based on block utilization as a measure. 

MODERATOR: I want to thank all of you for joining us today. I also want to thank UV and Jessica for presenting today’s webinar. And a big round of applause for Jessica, who’s a rookie. This is here first webinar. So great job. Thanks again for joining us.

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