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

Chapter 8: Quantitatve MChapter 8: Quantitatve Methods in Health Care Maethods in Health Care Managementnagement

Yasar A. OzcanYasar A. Ozcan 11

Chapter 8.Chapter 8.SchedulingSchedulingChapter 8.Chapter 8.SchedulingScheduling



OutlineOutline 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



Now that you know how many Now that you know how many FTEs you need. . .FTEs you need. . .

Now that you know how many Now that you know how many FTEs you need. . .FTEs you need. . .

Staff SchedulingStaff Scheduling involves the allocation of the involves the allocation of the budgeted FTEs to the proper patients in the budgeted FTEs to the proper patients in the proper units at the proper time.proper units at the proper time.– CoverageCoverage– Schedule QualitySchedule Quality– StabilityStability– FlexibilityFlexibility– CostCost



How long should FTEs work?How long should FTEs work?How long should FTEs work?How long should FTEs work?Advantages of various scheduling patterns.

8 10 12Traditional XOption to choose shift XSeveral consecutive days X XMore weekends off X XIncreased personnel during X busy periodsStaff able to take adv. of X meetings, continuing educ.Increase in care continuity XFewer staff positions needed XRecruitment drawing card X



How long should FTEs work?How long should FTEs work?How long should FTEs work?How long should FTEs work?

Disadvantages of the various shift patterns.8 10 12

Fewer weekends off XFewer consecutive days off XRequires increased staff XPossibility of increased X X fatigue timesAppearance of less time X X for relaxation Administrators plan for X X 3 shiftsHalf hour change of shift X may not be adequateAttendance at educational X conferences



7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7

Nights EveningsOverlappingShifts Days

10 Hr.Shifts

8 Hr.Shifts

Figure 8.1: Comparison of 8 and 10 Hour Shifts



Mon Tue Wed Thu Fri Sat Sun

Days Evenings Nights

Figure 8.2: Pattern of Alternating Eight and Twelve Hour Shifts



Scheduling TypesScheduling TypesScheduling TypesScheduling 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 systemsstaggered start-- does not change # of hours worked; employee chooses when she/he startsstaggered week-- average 40 hrs a week 8 hr days, but alternate weekly schedules (e.g.., 4/32 and 6/48)



Employee S M T W T F S S M T W T F S S M T W T F S S M T W T F S

A 0 0 0 0 0 0 0 0

B 0 0 0 0 0 0 0 0

C 0 0 0 0 0 0 0 0

D 0 0 0 0 0 0 0 0

# of Staff Schedule

d

2 3 3 3 3 3 3 2 3 3 3 3 3 3 2 3 3 3 3 3 3 2 3 3 3 3 3 3

The Four Week Schedule

Exhibit 8.1 Cyclical Staffing Schedules for Four Weeks



Flexible Scheduling SystemsFlexible Scheduling SystemsFlexible Scheduling SystemsFlexible Scheduling Systems

Very common in health care

Part-time shifts and float pools are necessary to meet staffing needs

Enhanced by computerized scheduling technology



Implementing Work SystemsImplementing Work SystemsImplementing Work SystemsImplementing Work Systems

Employees should be involved in the planning Employees should be involved in the planning and implementation processand implementation process

Forums should be held to answer staff’s Forums should be held to answer staff’s questionsquestions

Effectiveness and efficiency of the new system Effectiveness and efficiency of the new system should be periodically evaluatedshould be periodically evaluated

Consider workforce values, alternative work Consider workforce values, alternative work systems, and employee acceptancesystems, and employee acceptance



Surgical Suite Resource SchedulingSurgical Suite Resource SchedulingSurgical Suite Resource SchedulingSurgical Suite Resource Scheduling

Major hospital revenue sourceMajor hospital revenue source Extremely high costs and traditionally low Extremely high costs and traditionally low

facility and/or personnel utilization ratesfacility and/or personnel utilization rates Provides a significant portion of the Provides a significant portion of the

demand served by other hospital demand served by other hospital departmentsdepartments

Efficient scheduling can therefore enhance Efficient scheduling can therefore enhance profitabilityprofitability



Surgical room resource scheduling refers to Surgical room resource scheduling refers to the assignment of patients, staff, equipment, the assignment of patients, staff, equipment, and instruments to specific rooms within the and instruments to specific rooms within the operating department.operating department.

Poor scheduling results in idle time, increased Poor scheduling results in idle time, increased costs, increased patient anxiety, dissatisfied costs, increased patient anxiety, dissatisfied surgeonssurgeons– Must be carefully coordinated with other Must be carefully coordinated with other

hospital units, e.g.., PACU (post anesthesia hospital units, e.g.., PACU (post anesthesia care unit)care unit)

Surgical Suite Resource SchedulingSurgical Suite Resource SchedulingSurgical Suite Resource SchedulingSurgical Suite Resource Scheduling



Measures of OR productivityMeasures of OR productivityMeasures of OR productivityMeasures of OR productivity

total minutes OR is in usetotal minutes OR is in use total utilized OR time divided by total total utilized OR time divided by total

OR time availableOR time available idle time of nurses as percent of total idle time of nurses as percent of total

available OR timeavailable OR time idle time of anesthesiologists as a idle time of anesthesiologists as a

percent of total OR timepercent of total OR time hours utilized within block time divided hours utilized within block time divided

by available block hoursby available block hours



Major OR Scheduling SystemsMajor OR Scheduling SystemsMajor OR Scheduling SystemsMajor OR Scheduling Systems

First come/first serve (FC/FS)First come/first serve (FC/FS) Block SchedulingBlock Scheduling Dynamic Block SchedulingDynamic Block Scheduling Longest Time First (LTF)Longest Time First (LTF) Shortest Time First (STF)Shortest Time First (STF) Top down/bottom upTop down/bottom up Multiple Room SystemMultiple Room System



FC/FSFC/FSFC/FSFC/FS

One of two most common methodsOne of two most common methods Allocates OR to first MD requesting itAllocates OR to first MD requesting it Limit on the number of times allocated to any Limit on the number of times allocated to any

MD may be imposedMD may be imposed Problems:Problems:

– high cancellation rate due to overbookinghigh cancellation rate due to overbooking– different levels of OR use among specialtiesdifferent levels of OR use among specialties– Existence of simultaneous overtime and idle Existence of simultaneous overtime and idle

timetime



Block SchedulingBlock SchedulingBlock SchedulingBlock Scheduling

Second most popularSecond most popular Block of time is allocated to each surgeon or group of Block of time is allocated to each surgeon or group of

surgeons (1/2 to 1 day in length)surgeons (1/2 to 1 day in length) Block is available to that MD or group up until a cutoff Block is available to that MD or group up until a cutoff

(e.g.., 2 days before surgery) at which time unused (e.g.., 2 days before surgery) at which time unused time is made available to otherstime is made available to others

Increases utilization, and “guarantees” a fixed start Increases utilization, and “guarantees” a fixed start time; reduces competition for OR timetime; reduces competition for OR time

MDs often hold unused time until theMDs often hold unused time until the cutoff even if cutoff even if they don’t need it; urgent cases may be they don’t need it; urgent cases may be delayed until a particular MDs block comes updelayed until a particular MDs block comes up



Exhibit 8.2 An Example of OR Block Schedule

RM MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

CYSTO

0730 0730 0730 0730 0730

1330 1130 1330 1130/1215 1130 CYSTO

1530 1530 1530 1530 1300

1730 1730 1730 1730 1730

0730 Urology Surgeon #1 0730 ENT Surgeon #1 0730 Urology Associates 0730 General Surgeon #1 0730 Oral

0930 Surgery

2 1130 General Surgeon #2 1130 1330 1400 Associates ORAL

1530 1530 1530 1530 1530

1730 1730 1730 1730 1730



Dynamic Block SchedulingDynamic Block SchedulingDynamic Block SchedulingDynamic Block Scheduling

Individual surgeons block time utilization is Individual surgeons block time utilization is evaluated at periodic intervalsevaluated at periodic intervals

Amount of block time per MD or group is Amount of block time per MD or group is adjusted based on this analysisadjusted based on this analysis



LTF/STF Scheduling MethodsLTF/STF Scheduling MethodsLTF/STF Scheduling MethodsLTF/STF Scheduling Methods

LTF allocates longest procedures priorityLTF allocates longest procedures priority– Certain specialists (e.g., thoracic surgeons) Certain specialists (e.g., thoracic surgeons)

inherently always get early slotsinherently always get early slots– Assume higher length means higher variabilityAssume higher length means higher variability

STF is used to maintain an even load in the PACUSTF is used to maintain an even load in the PACU– LTF systems can cause underutilization of the LTF systems can cause underutilization of the

PACU in the early morning hoursPACU in the early morning hours



Top Down/Bottom UpTop Down/Bottom UpTop Down/Bottom UpTop Down/Bottom Up

Modified block system where day is divided Modified block system where day is divided into 2 blocksinto 2 blocks

Long cases are scheduled FC/FS in the morning Long cases are scheduled FC/FS in the morning and short cases in the afternoonand short cases in the afternoon

If idle time develops during the long block, the If idle time develops during the long block, the next patient with a short surgery fills itnext patient with a short surgery fills it

Surgeons with multiple surgeries are Surgeons with multiple surgeries are scheduled in the same room to decrease idle scheduled in the same room to decrease idle time between surgeriestime between surgeries



Multiple Room SystemMultiple Room SystemMultiple Room SystemMultiple Room System

Surgeons rotate from room to roomSurgeons rotate from room to room Goal is to eliminate waiting time between Goal is to eliminate waiting time between

cases, leading to greater cost savings and cases, leading to greater cost savings and lower staff overtimelower staff overtime



In Summary. . .In Summary. . .In Summary. . .In Summary. . .

The method chosen depends largely The method chosen depends largely on organizational goals. Which on organizational goals. Which would you choose for the following:would you choose for the following:– Reduce staff overtime?Reduce staff overtime?

Top down/bottom up or LTFTop down/bottom up or LTF– Increasing PACU utilization?Increasing PACU utilization?

STFSTF



Estimating Procedure TimesEstimating Procedure TimesEstimating Procedure TimesEstimating Procedure Times

Surgeon’s estimatesSurgeon’s estimates Scheduler estimatesScheduler estimates Historical averagesHistorical averages Data base/ information system Data base/ information system

modelsmodels



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

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