Optimizing Surgical Forecasting, Predictive Scheduling for the OR
By Hakan Ilkin
Managing an OR was challenging enough prior to COVID-19. With added complications such as uncertain demand, increased patient anxiety, complex staffing and operational logistics, and the pressure to recoup lost revenues, the demands on surgical services and OR leaders have only increased.
The pandemic has already cost U.S. hospitals billions of dollars. To stabilize their financial situation and regain their financial footing, hospital leaders are leaning hard on their most reliable profit center: surgical services. Yet even before the pandemic, surgical services faced a number of constraints preventing most ORs from achieving best practice, prime-time utilization of 80% to 85%. Among these constraints are decades-old scheduling methods and tools.
To meet challenging demands for productivity amid unprecedented disruptions, OR leaders need tools that empower them to claim control over their resources and schedule in ways that have not been possible before. New forecasting and predictive scheduling tools make this control possible by providing clear visibility of future schedules and enabling the proactive “pulling in” of cases, as opposed to traditional scheduling processes. Using new data streams and machine-learning technology, these tools create accurate forecasts of a surgical services’ schedule weeks to months ahead—thus allowing OR leaders to more effectively allocate their resources and market their capacity.
Before the pandemic, hospital leaders focused intensely on surgical throughput: Surgical services often accounted for about 50% of hospital revenue even as those services were used in only about 30% of hospitalizations.1 It is not surprising that institutions invested heavily in traditional OR scheduling systems to facilitate throughput;yet due to their limited analytical capabilities, these yielded marginal, if any, tangible results in this area. OR leaders have long been tasked with hard-to-reach targets with limited problem-solving assistance from the tools they have on hand.
Hospitals and OR leaders have not shied away from investing in tools that showed potential, yet few of these efforts have resulted in applicable innovations. Every so often, an initiative to “think outside of the box” would come along, requiring OR leaders to seek to arrange their schedules and staff to enhance workflow. However, these initiatives often provided only short-term improvements and ultimately increased managers’ workload and staff’s frustration.
One wish of hospital and OR leaders has been to accurately predict demand and utilization in the future. Yet most commercial or home-grown forecasting methods base their prediction models on retrospective data alone. Relying on past schedules and historical patterns is especially a problem in the COVID-19 era, when the present—in terms of community infection, time-consuming protocols, patient behavior and even closures—deviates so sharply from the past.
Hospitals now need to perform at least 15% to 20% more surgeries per month for the next several months to work through the backlog of postponed cases, as the number of surgeries declined by more than 60% in the second quarter of 2020.2 Under the right circumstances, OR leaders could accomplish this leap if they had access to unlimited qualified staff. A more likely scenario, of course, is that they use their current resources to achieve previous utilization levels—and then ask for more staff when they exceed historical utilization performance, which will be difficult given the financial pressures that hospitals face.
A more likely way to enhance OR utilization is to take proactive control of the OR schedule. Instead of waiting to fill unscheduled time until blocks are officially released—when it is often too late to effectively seek new cases from other surgeons unwilling to come in without a predictable start time—OR leaders need to be able to identify “white space” far enough ahead of time that they can make appropriate, and even strategic, allocation decisions.
To get a fuller, holistic picture of coming demand, next-generation forecasting tools draw directly from clinic schedules to visualize the surgical patient pipeline. They incorporate models of surgical clinic visits to surgery conversion rates by surgeon, and supplement them with other relevant historical scheduling patterns and add-on and cancellation models. With this mix of data, these tools forecast surgical schedules weeks to months in advance. Next-generation forecasts, which are displayed visually and shared, can be mapped on to staff availability, block schedules, block releases and budget requirements. They also flag any variation in expected demand.
This forecasting capability makes possible the active marketing of OR capacity, which has typically been treated more passively. Instead of accepting regular bouts of unnecessary downtime, OR managers can now clearly see which surgeons have a backlog and reach out to them to “pull through” higher volumes. Meeting surgeons’ needs in this new way leads to increased surgeon satisfaction, and these physicians are more likely to bring new, sustained volume to their facility.
COVID-19-Related Obstacles to Change
Most hospitals are trying to recover from the severe financial impact of COVID-19 and have a great need for increased revenue. This may tilt the scale in favor of plug-and-play, fully managed services—especially when they can be deployed in less than a month, with minimal IT staff time, and promise to restore and expand capacity in a critical area.
Next-generation tools and configurations may also help both OR and hospital leaders address current, pressing challenges related to COVID-19. Such tools include COVID-19 cancellation recovery trackers, phased restart models, and the ability to address operational changes due to COVID-19 within the forecasting models. Because they draw on so many data streams, these forecasts remain accurate regardless of which phase the hospital is in during the COVID-19 recovery.
In a time of uncertainty and upheaval, surgical services is being asked to work optimally through a significant backlog of demand. Modernizing the tools that OR managers have at their disposal can help them address this massive backlog and better control their resources in more predictable times. More importantly still, updated tools can help OR leaders earn a new space for themselves in the hospital’s strategic decision-making landscape. OR leaders can finally be in the driver’s seat when it comes to OR time allocation, all the while improving patient, surgeon and staff satisfaction; increasing throughput; and enhancing the overall profitability of surgical services.1. According to a report issued in 2014 by the Agency for Healthcare Research and Quality, hospitalizations that involved operating room (OR) procedures constituted 29% of the total 38.6 million hospital stays in the United States and 48% of the total $387 billion in hospital costs. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb170-Operating-Room-Procedures-United-States-2011.pdf
—Ilkin is the CEO and founder of Brighthospital, a hospital analytic and consulting company.