Are you calculating your OR KPI metrics correctly?
In this episode of Employing data analytics to improve healthcare operations, Sharon Ulep and Chris Moshier of Plante Moran, discuss how operational team leaders can leverage data as a tool to run their operating rooms like a well-oiled machine.
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Continue reading below for the complete podcast transcription.
Narrator: When it comes to making lasting improvements in your operating room (OR) utilization, are you where you want to be? Welcome to Employing Data Analytics to Improve Healthcare Operations, a podcast series that helps you turn data into action. Today, we’ll explore how data analytics can be used to improve the metrics that drive your success in the OR.
Chris Moshier: Hi, I’m Chris Moshier, leader of Plante Moran’s Analytics Center of Excellence. I’ve invited Sharon Ulep, a principal in our healthcare operations and performance improvement practice to talk to us today about employing data analytics to improve healthcare operations. Welcome, Sharon.
Sharon Ulep: Thanks, Chris, I’m glad to be here.
Operating room efficiency data points that matter to senior leaders
Chris Moshier: Sharon, you and I often work together helping healthcare clients better leverage their data. At the end of the day, as I lead our Analytics Center of Excellence, I recognize it’s not about the data. It’s not about the data at all. It’s about the client’s issue. We’re talking about operating room utilization today. What are a couple of the key issues around operating room utilization that you’re seeing?
Sharon Ulep: A couple of data points that would be outcome data points, that senior leaders would be looking at, would be utilization of the OR and block utilization. Those are outcome metrics. Outcome metrics come forth from process metrics that are underneath. So, in simple terms, do you start on time? Do you stay on time? Do you finish on time? How much overtime are you paying to complete your caseload each day? Looking at utilization from both a room perspective and a physician perspective is an important metric for leaders to know the health of their operating room.
Room utilization verses block utilization
Chris Moshier: I know that oftentimes CFOs look at their dashboards, and they’ll see their room utilization and their block utilization. Which one’s more important?
Sharon Ulep: Block utilization is really looking at how physicians are using time that the facility has allocated to them. There’s a way of recognizing that. An efficient surgeon who is loyal to your hospital will fill their block each day that they are given block time. And, giving a physician block time is a way of creating loyalty. It’s a way of saying, we’re investing our operations team, our nurses, our scrub techs, our staff, and giving you time to do surgical cases at our facility. There’s a relationship there. If the physician has block time and they’re not utilizing that block time, no one else can actually use that block time. And, so you end up in a situation where sometimes a facility becomes fully blocked. Every hour of operational time every day is filled up, but they’re not actually patients on the table.
So, looking at surgeon block time is a way of understanding, are we getting that loyalty transaction between the surgeon who has block, and the time and resources we’re investing in being open and available for them to do cases? There’s a second utilization measure that’s important. And, that’s OR utilization. Quite frankly, that’s the one that most organizations fail to look at. They’ll put block utilization on their scorecards, but they don’t put OR utilization on the scorecards. OR utilization is about room use, and has nothing to do with the surgeon. What you’re looking at in OR utilization is how well the operational team, the OR charge nurse, the management crew, are taking cases that are coming to them through scheduling, and making sure that every team in every room is as busy for all of your business hours each day. OR utilization is a clear indication of the quality of management in your OR services.
When to have a conversation with your surgeons
Chris Moshier: So, we want to hit 100 percent OR utilization, right?
Sharon Ulep: No. So, in both cases, when you’re looking at surgeons, and when you’re looking at OR rooms, the sweet spot, the place you want to be is about 75-85 percent utilization. So, if we’re talking about physicians who are operating at 85 percent utilization of their block, it’s time to have a conversation with them. Do you have more cases that you’d like to be doing, but you don’t have enough room in your block hours to get them done? Are you going to another facility in order to get those cases on the book? If you were to look at a surgeon who’s operating at say 25 percent utilization, they probably have had block time for a long period of time, and have not actually been able to fill it for several quarters or even several years, and it’s time to have that crucial conversation about whether or not it would make sense to reduce their block time.
Best practices for efficient operating rooms
Sharon Ulep: When we talk about OR utilization, so that’s the utilization of the rooms itself, you want to again be at about 75-85 percent utilization. If all of your rooms are at 85 percent utilization during your regular business hours each day, that’s an indication you may need to build more ORs. It’s very uncommon for a facility to be in that situation. But, if you are at 85 percent utilization or greater every day, it’s an indication that you do not have enough geography in order to meet the demand in your community. If you get to 100 percent utilization, your metric is actually probably not being calculated correctly. Because you have to allow time to turn over the room. And, that is nonproductive utilization time, but it is necessary in order to obviously prevent infections, clean up the mess from the previous case, and turn over the room for the next patient coming in.
Chris Moshier: It’s one of the biggest challenges I think I’ve observed in healthcare is, how do you define certain KPIs? Are you following a best-practice definition for a KPI? We were approached by a CFO of a hospital who heard from his surgeons that they were not able to get enough time in the operating room. But, when he looked at his dashboards, he saw a dashboard showing that they had utilization available. And, so there’s this dichotomy they were challenged to solve, and it came down to the fact that, one reason was how they were calculating their KPIs just was not correct. It didn’t account for every variable that it needed to account for. I guess I would ask you though Sharon, I know that you can almost have two ends of the spectrum. You can have a hospital have its OR be fully utilized, but that’s not the right output to measure. What is the final output that you should measure?
Use volumes to measure OR health
Sharon Ulep: The final output is always volumes. So, in any OR, that the health measure is your volumes. Are your volumes on track with what you’ve budgeted and what your cost and expenses are? Proper utilization should translate into efficient volumes that really indicate a healthy OR. One of the things I would bring up is, what do you do when you have worked through your KPIs and you recognize that your block utilization isn’t where you want it to be? It is a difficult conversation to take a surgeon who has been loyal to your facility for 5, 10, 15 years, and tell them that you’re going to take away their treasured block time. They will have arranged their clinic schedule, the time that they see patients in their offices around having block at the hospital on certain days at certain times. So, it’s important that that conversation be approached carefully.
Blocking OR time
Sharon Ulep: My first recommendation, rather than taking block away from a surgeon, is to have the conversation if they’re below say 40 percent utilization, about moving their release time back. So, if they’re in a situation where their release time is about seven days, talk to them about moving the release time to 14 days. They still have first dibs on the room, it’s still their block time, but by releasing that room to other surgeons at the 14-day mark, you’re more likely to fill that block, rather than being in a situation where it’s really seven days before, and you’re not able to have other surgeons utilize that space and time.
Chris Moshier: I mean, that makes sense. And, other approaches that we’ve observed, or I would say, uncovered through data analytics, is that there’s always a story behind why a surgeon is at 40 percent utilization. You know, that story might be that the surgeon is utilizing some of their days, but that every other Friday a month, they’re not utilizing the room at all. Other times, you may have a surgeon who’s prioritizing specialty block time, or practice block time, before they’re using their own individual block time.
Sharon Ulep: A critical point when you recognize these difficulties in block, is to take a look at your OR utilization, and identify, do you have open rooms available? If every one of your ORs has surgeon block filling it, you do not allow for any growth in your OR. So, if there’s a new surgeon that moves to town and you want to bring them into your facility, you will not have any place to actually take their new cases. A healthy OR has figured out how to strike that balance between offering block time to increase surgeon loyalty, but also keeping one to two rooms open every day to handle add on cases. But also, as open block time that would allow new surgeons to bring new cases to the facility.
Controlling case start and room turnover times
Chris Moshier: Sharon, have you ever seen an operating room that has very, very high utilization, but it feels like a well-oiled machine?
Sharon Ulep: There are certain ORs that are very well-oiled machines. And, it comes down to that operational team. So, operation efficiencies come from the team, the OR charge nurse, the board runner, and the circulator and scrub nurses really understanding the ballet on how to make sure that they start on time, the rooms turn quickly, and that they’re really able to flex very fast in order to keep cases on the table. As I like to say, “You only make money when there’s a patient on the table,” and any time that is spent down, waiting for a case to either get started or for a room to turn over, is nonproductive time. So, a well-oiled machine, an operating room that’s really operating with full OR efficiency, is one where those times are kept to a minimum.
Know when your OR metrics are a cry for help
Chris Moshier: And, I think leveraging data analytics is a tool to understand reasons why you have patterns for utilization is important. Understanding in advance that you are going to have a day where you don’t need to open every operating room is important. Sharon, so we’ve talked about OR utilization and block utilization quite a bit. And, we’ve talked about what the benchmark or the goal would be. What’s average? What is the typical utilization you see? And, when would a CFO or an OR director know that they need to ask for help?
Sharon Ulep: So, typically, I see OR utilization running at 50 or 60 percent in a pretty well performing organization. What I often see is that the organization will look at block utilization as an individual physician metric, rather than looking at it as an aggregate metric that tells them, we need to review block utilization overall. Let’s just take the OR utilization metric. Most organizations, if their OR utilization is less than 40 percent, they probably need help. That’s a clear indication that they’ve got efficiency issues in their operating room. What I would recommend, if you’re looking at an OR utilization metric that’s in the 40s or lower, that you also get metrics around first case on-time starts and room turnover time.
First case on-time starts is getting off the blocks on time in the morning. If you were to look at a first case on-time start rate of less than 50 percent, it’s going to correlate to the fact that you have an OR utilization rate of less than 50 percent. Starting on time means that the operational team is ready to go. And, often what see is that, if the operational team is often slow, or late, or setting up the room in a way that’s not terribly efficient, or they’re in a situation where they’re doing a lot of testing on the morning of surgery, surgeons begin to sag. They start saying, “Ah, the OR’s not on time so it doesn’t matter if I show up on time,” and they start becoming tardy to the OR. And then, because the surgeon’s tardy to the OR, the operational team also starts to become slower and slower. And, I kind of refer to it tas the big sag.
It is incumbent upon the operational team to clean up their house and to do the game right to start, and set the stage for what efficient OR means. So, if you’re a CFO and you’re looking at an OR utilization of 40 percent, and you asked for that first case on-time start number, and you look at a trend over the last few months and see 40 percent in first case on-time starts, it may be time to shake things up. It may be time to ask for some help on, how do we get off the blocks on time in the morning. The other critical metric that would impact case volumes and impact OR utilization is looking at room turns. I’ve had many organizations when I am called in to work with them, and I say, “You should have an average room turn every month of about 20 minutes” look at me and say, “That’s impossible.” It’s because they’re currently running a room turn rate of 30-35 minutes. A 30-35 minute room turn rate is a loss of 15 minutes between every case.
Inspire you OR team to keep it moving
Sharon Ulep: If you’re doing six cases in the room, that’s more than an hour of lost time related to excessive room turns. If you got that hour back, you could actually get another small case on the table in that room. So, working with the operational team on how to turn quickly is important. I do feel the need to specify. When I talk about a room turn rate, I’m talking about wheels out to wheels in of the next case. Your surgeons will actually talk to you about close to cut. Because that’s the room turn time that they feel. If the wheels out to wheels in is above 30 minutes, I can guarantee that the close to cut is more than 60, and your surgeon’s hands are idle, and that’s not good for anyone.
Chris Moshier: That’s right, Sharon. And, if you’re listening to this podcast and ready to take the first step to improve your OR efficiency, take the brief survey found on our
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Narrator: Thank you very much for listening today. And, remember to visit plantemoran.com/healthcare to check out all our healthcare operation improvement resources.
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