1. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 1 Chapter 8. Scheduling

2. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 2Outline   Staff Scheduling Overview – –The 8, 10, and 12 Hour Shifts – –Cyclical Scheduling – –Flexible Scheduling – –Computerized Scheduling System   Surgical Suite Resource Scheduling – –FC/FS – –Block Scheduling – –Dynamic Blocks – –LCF – –SCF – –Top Down/Bottom Up – –Multiple Room System   Assessment of Scheduling Alternatives   Estimation of Procedure Times

3. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 3 Now that you know how many FTEs you need...  Staff Scheduling involves the allocation of the budgeted FTEs to the proper patients in the proper units at the proper time. –Coverage –Schedule Quality –Stability –Flexibility –Cost

4. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 4 How long should FTEs work? Advantages of various scheduling patterns. 81012 TraditionalX Option to choose shiftX Several consecutive daysXX More weekends offXX Increased personnel duringX busy periods Staff able to take adv. of X meetings, continuing educ. Increase in care continuityX Fewer staff positions neededX Recruitment drawing card X

5. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 5 How long should FTEs work? Disadvantages of the various shift patterns. 81012 Fewer weekends offX Fewer consecutive days offX Requires increased staffX Possibility of increasedXX fatigue times Appearance of less timeXX for relaxation Administrators plan forXX 3 shifts Half hour change of shiftX may not be adequate Attendance at educationalX conferences

6. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 6 Figure 8.1: Comparison of 8 and 10 Hour Shifts

7. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 7 Figure 8.2: Pattern of Alternating Eight and Twelve Hour Shifts

8. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 8 Scheduling Types Cyclical work schedules employees do not rotate shifts planned for 4-6 week period; repeated provides stability and lower scheduling costs, but is inflexible best in a stable environment Discretionary/flexible work systems  staggered start-- does not change # of hours worked; employee chooses when she/he starts  staggered week-- average 40 hrs a week 8 hr days, but alternate weekly schedules (e.g.., 4/32 and 6/48)

9. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 9 EmployeeSMTWTFSSMTWTFSSMTWTFSSMTWTFS A00000000 B00000000 C00000000 D00 000000 # of Staff Scheduled 2333333233333323333332333333 The Four Week Schedule Exhibit 8.1 Cyclical Staffing Schedules for Four Weeks

10. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 10 Flexible Scheduling Systems Very common in health care Part-time shifts and float pools are necessary to meet staffing needs Enhanced by computerized scheduling technology

11. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 11 Implementing Work Systems  Employees should be involved in the planning and implementation process  Forums should be held to answer staff’s questions  Effectiveness and efficiency of the new system should be periodically evaluated  Consider workforce values, alternative work systems, and employee acceptance

12. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 12 Surgical Suite Resource Scheduling  Major hospital revenue source  Extremely high costs and traditionally low facility and/or personnel utilization rates  Provides a significant portion of the demand served by other hospital departments  Efficient scheduling can therefore enhance profitability

13. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 13  Surgical room resource scheduling refers to the assignment of patients, staff, equipment, and instruments to specific rooms within the operating department.  Poor scheduling results in idle time, increased costs, increased patient anxiety, dissatisfied surgeons –Must be carefully coordinated with other hospital units, e.g.., PACU (post anesthesia care unit) Surgical Suite Resource Scheduling

14. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 14 Measures of OR productivity  total minutes OR is in use  total utilized OR time divided by total OR time available  idle time of nurses as percent of total available OR time  idle time of anesthesiologists as a percent of total OR time  hours utilized within block time divided by available block hours

15. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 15 Major OR Scheduling Systems  First come/first serve (FC/FS)  Block Scheduling  Dynamic Block Scheduling  Longest Time First (LTF)  Shortest Time First (STF)  Top down/bottom up  Multiple Room System

16. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 16 FC/FSFC/FS  One of two most common methods  Allocates OR to first MD requesting it  Limit on the number of times allocated to any MD may be imposed  Problems: –high cancellation rate due to overbooking –different levels of OR use among specialties –Existence of simultaneous overtime and idle time

17. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 17 Block Scheduling  Second most popular  Block of time is allocated to each surgeon or group of surgeons (1/2 to 1 day in length)  Block is available to that MD or group up until a cutoff (e.g.., 2 days before surgery) at which time unused time is made available to others  Increases utilization, and “guarantees” a fixed start time; reduces competition for OR time  MDs often hold unused time until the cutoff even if they don’t need it; urgent cases may be delayed until a particular MDs block comes up

18. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 18 Exhibit 8.2 An Example of OR Block Schedule RMMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY CYSTO 0730 1330113013301130/12151130 CYSTO 1530 1300 1730 0730 Urology Surgeon #10730 ENT Surgeon #10730 Urology Associates0730 General Surgeon #10730 Oral 0930 Surgery 2 1130 General Surgeon #21130 13301400 Associates ORAL 1530 1730

19. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 19 Dynamic Block Scheduling  Individual surgeons block time utilization is evaluated at periodic intervals  Amount of block time per MD or group is adjusted based on this analysis

20. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 20 LTF/STF Scheduling Methods  LTF allocates longest procedures priority –Certain specialists (e.g., thoracic surgeons) inherently always get early slots –Assume higher length means higher variability  STF is used to maintain an even load in the PACU –LTF systems can cause underutilization of the PACU in the early morning hours

21. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 21 Top Down/Bottom Up  Modified block system where day is divided into 2 blocks  Long cases are scheduled FC/FS in the morning and short cases in the afternoon  If idle time develops during the long block, the next patient with a short surgery fills it  Surgeons with multiple surgeries are scheduled in the same room to decrease idle time between surgeries

22. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 22 Multiple Room System  Surgeons rotate from room to room  Goal is to eliminate waiting time between cases, leading to greater cost savings and lower staff overtime

23. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 23 In Summary...  The method chosen depends largely on organizational goals. Which would you choose for the following: –Reduce staff overtime? Top down/bottom up or LTF Top down/bottom up or LTF –Increasing PACU utilization? STF STF

24. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 24 Estimating Procedure Times  Surgeon’s estimates  Scheduler estimates  Historical averages  Data base/ information system models

25. Chapter 8: Quantitatve Methods in Health Care Management Yasar A. Ozcan 25 The End