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Block booking Is it antiquated?
By Stephen W. Earnhart, MS
Earnhart & Associates
If your block booking of procedures is working for you great! You are one of the few. Pat yourself on the back, and go have lunch. If, however, you are among the majority of us, read on.
It makes no difference if you are hospital-based or freestanding; an effective block schedule is difficult to manage really difficult. Since I get paid to deal with issues like this all the time, I am going to take some editorial license here and speak from a position of authority.
First, block scheduling is an active, dynamic process. Unlike what many might believe, you do not set it up and forget it. It is a fluid process that demands attention and massaging always massaging. By the end of this column, most of you will change the way you block schedule your cases.
Let's start with the basics. Block scheduling is nothing more than a management tool to accommodate as many surgeons as possible. It is nothing more (or less). A poorly designed block schedule (which accounts for 90% of the problems we see) causes far more problems than it solves, so pay attention to details. A well-designed block should look something like this.
It is not complicated, but it needs to be comprehensive. Below is a bulleted list of the common mistakes we find. I know that they don't always apply, and there always are exceptions. However, most of the time they do apply to you.
Avoid full block days. They are rarely fully utilized, and you are better served breaking them up.
Allow your surgeons office to post into your system directly from their office and bypass calling you. What?! Of course you can! Call your IT/IS people and tell them to do it. Don't give them an option. What? Then get rid of them, and get someone who can! Good heavens. This is not rocket science.
Do not be the heavy and establish the priority of who can pick their block first. This is especially an issue if you are new or just setting up a block schedule.
If the surgeons don't play well together, then have the medical executive board, the physician advisory board, or the executive committee establish the pecking order. Do not get caught in that crossfire. If all else fails, go by seniority, age, or rock /paper /scissor. Bribes apparently work well too.
Unutilized block times should be released 24 hours (or 36, 48, or 72 hours) beforehand so others can capture those slots.
If an underutilized block occurs greater than three times in a time period, then the block needs to be reduced in size. I suggest a one-month time period. Others use a quarter, but I think that is too long.
If the number of operating rooms allow, always try to have a "free, unblocked room" for first-come, first-served cases.
Allow for trading of block time among the surgeons, if you have the equipment available.
You might want to have the same grid as on p. 49 for your treatment rooms as well. Some surgeons like to block their local cases separate.
You need to add your own rules and expand the above. Just remember that this is also a management tool that you should use for staffing, equipment, and budget. Use it wisely. Happiness is a full block!
[Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: email@example.com. Web: www.earnhart.com. Twitter: SurgeryInc.]