Building Blocks: How Block Scheduling Promotes Efficiency

Don Sadler

When it comes to effective OR management, it’s all about maximizing efficiency in order to realize cost savings. A growing number of hospitals today are turning to block scheduling to make these objectives a reality.

“Block scheduling is gradually becoming a common practice in OR management,” says Lucy C. Lee, RN, MBA, BM, PMP at Hospital Performance Management. “It’s a way to better manage operating room time, which is an OR’s most valuable resource.”

What is Block Scheduling?

“Block scheduling is the process of allocating OR resources to a surgeon or group of surgeons for a specified day and time,” explains Michelle Jackson, St. Luke’s Health System’s supervisor of surgical scheduling systems.

“Other authors have likened it to a reservation at a restaurant in which the doctor shows up and everyone is expecting him and is ready,” Jackson says.

The resources reserved with block time may vary by facility but typically include an identified room, staff and equipment, she notes.

“Block scheduling is a tool that allows physicians to have a guaranteed day and time when they know they will have an OR to use and a team of staff to work with on a continued basis,” adds Rachel Le Mahieu, RN, MSN, CNOR, RNFA, the director of surgical services at Spring Valley Hospital in Las Vegas, Nevada.

Lee explains in more detail how block scheduling works: “A block scheduling system assigns a block of OR time to an individual surgeon or a group of practicing surgeons for a particular period of time.”

“The block is reserved for the owners’ exclusive use,” Lee continues. “When unused, the blocked OR time will be made available to other physicians according to the relevant block scheduling policies of each facility.”

Benefits of Block

There are many potential benefits to block scheduling for hospitals and patients. “First, it is a more efficient use of time,” says Jackson. “The same surgeon or service line with subsequent cases results in fewer equipment and instrument changes and room positioning adjustments.”

In addition, block scheduling allows the staff and surgeon to establish a routine and then repeat it through subsequent cases, Jackson adds.

“Second, block time can be used to entice surgeons to bring cases to your facility,” Jackson continues. “Consistent access to the OR can be an incentive when recruiting new surgeons and a motivator for existing surgeons to maintain their case volumes in an effort to meet established block utilization targets.”

“The most significant benefit of block scheduling is increased utilization of OR time,” says Lee. “This improves the operational efficiency and financial performance of an OR. The OR schedule becomes more predictable, which leads to less surgeon and patient waiting time and higher satisfaction for everyone.”

Le Mahieu believes that the biggest benefit of block scheduling for hospitals is that “you know your basic volume guarantee and can plan equipment, instrumentation and staffing based on this guaranteed business.”

Meanwhile, the only real drawbacks to block scheduling occur when it is poorly managed, says Le Mahieu.

“A lack of usage or releasing blocks in advance would prevent other physicians from bringing your facility business and can result in poor OR utilization,” she notes. “This can affect your volume, productivity and revenue.”

Best Practices for Block Success

According to Jackson, block utilization policies can be “incredibly cumbersome.” Therefore, clear rules and expectations must be laid out in the form of thorough policies.

“A clear policy regarding block time allocation, expectations and consequences is essential,” says Jackson.

“These policy decisions include how much of the OR’s time can be assigned with block, how block will be assigned, utilization expectations, and consequences for not meeting utilization expectations, to name a few,” Jackson adds.

A best practice is to allocate 80 percent block time and leave 20 percent open time, Jackson notes. “Blocking too much time can limit access to the OR,” she explains.

Concise data also must be maintained and made available.

“This can be a very tedious process,” Jackson says, “which is why an enforcement structure must be established, implemented and followed.”

Accurate data is essential when enforcing policies, Jackson stresses.

“Data should be reported at least quarterly to the block holding surgeon and leadership,” she says. “Constant communication enables everyone to understand the goals of efficient block utilization and help when difficult decisions must be made.”

Jackson adds that decisions regarding the amount of block time to be allocated are critical to ensuring access to the OR.

“If too much time is assigned to specific surgeons or surgeon groups, doctors without block or those trying to schedule urgent or emergent cases may find it difficult to schedule cases,” she says.

Manage the Block Schedule

Le Mahieu recommends actively managing your block schedule.

“If a physician is not using his or her time, have a personal conversation with the physician and go over the usage data,” she says.

“Give the physician the opportunity to make corrections and adjustments and work with him or her to find the right block time ‘fit,’ ” Le Mahieu adds. “If still unsuccessful, make an adjustment to the physician’s block yourself.”

At Spring Valley Hospital, Le Mahieu says they use a tiered release program based on block usage. In addition, they have a corrective action plan in place for poor utilization that allows them to work with surgeons to get them to the goal of 80 percent utilization.

“This ensures that the facility will not need to turn down business and will have time to backfill the time not used,” Le Mahieu says.

Lee believes that a successful implementation of block scheduling policies depends on “robust support and governance of executive sponsors, effective communication with the surgeon community, and collaboration of anesthesia and nursing staff leadership.”

“Block scheduling policies must be consistently implemented and applied to all block holders,” Lee adds. “Also, blocks should be assigned by the day as opposed to stints of hourly blocks. No block should be shorter than four hours and blocks should start at the same time as the operation hour starts.”

A Block Success Story

In 2010, Jackson helped launch an initiative designed to improve block utilization at St. Luke’s Health System. At the time, the facility had an unmanaged system of block scheduling without monitoring and lacked a systematic approach.

Since then, block utilization at the campuses where it’s used has increased from the low-70 percent range to the mid-90 percent range. This exceeds the average target for all physicians, according to Jackson.

Surgeons are expected to maintain utilization of 75 percent or greater with less than 25 percent of their available time released. “Failure to do so may result in a reduction of block allocation,” Jackson says.

One key to the success of this initiative has been creating a multi-disciplinary block committee comprised of surgeons, administration, anesthesia and surgery scheduling personnel.

“They all came together to create a new OR scheduling and block utilization policy,” says Jackson. “The committee reviewed best-practices and formulated a plan they felt would work in our environment.”

Another key was obtaining high-level hospital support for block management and building strong partnerships with surgeons. Jackson defines high-level support as the chief of surgery, COO, CFO or even CEO.

“Without this support, the task is impossible,” she says.

Increasing OR efficiency and saving money will only become more important in the future. Given this, it’s probably wise to experiment with block scheduling to see if it can help your facility achieve these goals.