Statistical analysis reduces OR costs
Statistical analysis reduces OR costs
Staffing costs smaller in seven of nine suites
Statistically derived staffing solutions resulted in anesthesia staffing plans with costs that were at least 10% less than the costs of the plans used by managers in seven of nine surgical suites, in a study conducted by Franklin Dexter, MD, PhD, of the University of Iowa College of Medicine in Iowa City. The software, CalculatOR, was developed by Medical Data Applications Ltd. of Jenkintown, PA. It combines previously published algorithms giving the smallest possible staffing costs with graphical and inferential tests. "That gives you a significant trend over time, and also indicates that, based on what has happened in the past, this is what will happen in the future," Dexter explains. "This software incorporates tests I’ve used over several years."
The CalculaTOR software was used to assess weekday anesthesia group staffing at nine independently managed surgical suites that were concerned about costs. Staffing and operating room [OR] data from those suites were used to test whether the statistical method could identify staffing solutions that covered all cases, but for which nurse anesthetist costs were less than those in plans implemented by the groups’ managers.
Dexter has some thoughts about why a purely statistical analysis would results in lower costs than those devised by people, even though those people clearly were charged with controlling costs. "First of all, there is not any one answer for a given surgical suite," he explains. "In one hospital, it was recently decided, politically, that it would not decrease first-case-of-the-day starts. Our analysis showed, for example, that Mondays raised the relative cost of under- and overutilized hours. We used that value for the best distribution of OR time to maximize efficiency."
Some of the managers had too many rooms, and some had too few, Dexter says, but often those decisions were made on a political basis. "What we asked was, given the number of rooms, what is the best way to staff?" he notes. Managers also tend to do the same thing every day of the week, says Dexter. "They try to keep it simple. But the computer doesn’t care whether people are covering on weekends or on afternoons."
It’s more than just money
In his study, Dexter focuses on staffing costs, because that was the task with which he was charged. "Although we talk about costs," he notes, "the mathematics actually maximize the efficiency of use of operating time. The client wanted information for internal use, where the goal was to reduce costs. What the math actually does is maximize efficiency use of time. If you do that, you will naturally reduce costs. You won’t minimize costs, but you will maximize the efficiency use of operating time."
This is an important distinction when dealing with physicians, Dexter notes. "Some say that politically, surgeons don’t want to hear about another cost-saving measure. However, they will listen to plans to improve efficiency." In addition, he points out, the data he derived were only for the nurse anesthetists. "However, I would say the staffing analysis also would apply identically to nurses. After all, it’s no good to have an anesthesia provider there without an operation, and therefore OR nurses. Thus, you could extend the analysis to operating room staff productivity."
Is mandatory overtime a good thing?
Another issue that arises from the study is mandatory overtime. At many surgical suites, including those studied, surgeons and patients can schedule elective cases on whatever future workday they choose; thus, there is no limit on the number of cases performed each workday. Cases are scheduled in each OR without planned delays between cases, and overtime is essentially mandatory.
"This isn’t spur of the moment, unplanned overtime, but you have to have it," says Dexter. "We mean mandatory in the way a particular health care system might mean it. The way to practically implement it is set things up where you have three teams who plan on staying late if necessary."
Is that a threat to quality? "Theoretically, yes, but practically, no," Dexter asserts. "If people who stay late planned it, if they are not surprised and if they are paid overtime, and if you have planned the proper number of ORs and staff efficiently, it should not have that much effect on quality. Could it happen that one of the surgeons decides he’d like to work until midnight? It could, and I don’t know if that’s good or bad. I am very amenable to the argument that it could be bad because of the number of work hours. But I’m also amenable to the argument that the patient needs surgery, so getting the care done could be good. For health care systems, what’s most important is that this not be unexpected overtime."
If a facility says as part of its mission statement that "we are here to take care of all patients on whatever workday the surgeons and patients choose," then there isn’t a concept of overscheduling, says Dexter. "Instead, what you’re saying is, We have a service commitment,’" he observes. "Then, the concept of overscheduling goes away. The question becomes, how do we provide appropriate staff to give safe care?"
Taking a statistical look at OR staffing also can lead to a reevaluation of your physical plant, Dexter offers. "Let’s say you have five ORs; you do the analysis, and it says you need seven ORs. You have your mission statement; you plan your staffing to increase efficiency and to keep productivity high. If your option is to plan not to have an eight-hour work day, but a 13-hour work day, that probably tells your administration that you need more ORs."
Need more information?
For more on OR costs, contact:
• Franklin Dexter, MD, Division of Management Consulting, Department of Anesthesia, University of Iowa College of Medicine, Iowa City, IA 52242. Telephone: (319) 351-4465. E-mail: [email protected].
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