Chapter 8. Scheduling

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Chapter 8.Scheduling
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Outline

• 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

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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

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How long should FTEs work?
Advantages of various scheduling patterns.
8 10 12 Traditional X Option to choose
shift X Several consecutive days X X More
weekends off X X Increased personnel
during X busy periods Staff able to take
adv. of X meetings, continuing
educ. Increase in care continuity X Fewer
staff positions needed X Recruitment drawing
card X
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How long should FTEs work?
Disadvantages of the various shift patterns.
8 10 12 Fewer weekends off X Fewer
consecutive days off X Requires increased
staff X Possibility of increased X X
fatigue times Appearance of less time X X
for relaxation Administrators plan for X X
3 shifts Half hour change of shift X
may not be adequate Attendance at
educational X conferences
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Figure 8.1 Comparison of 8 and 10 Hour Shifts
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Figure 8.2 Pattern of Alternating Eight and
Twelve Hour Shifts
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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)

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Exhibit 8.1 Cyclical Staffing Schedules for Four
Weeks
The Four Week Schedule
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 Scheduled 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
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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
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Implementing Work Systems

• Employees should be involved in the planning and
  implementation process
• Forums should be held to answer staffs questions
• Effectiveness and efficiency of the new system
  should be periodically evaluated
• Consider workforce values, alternative work
  systems, and employee acceptance

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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

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Surgical Suite Resource Scheduling

• 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)

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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

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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

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FC/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

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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 dont need it urgent cases may be
  delayed until a particular MDs block comes up

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Exhibit 8.2 An Example of OR Block Schedule
RM MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
CYSTO 0730 0730 0730 0730 0730
CYSTO          
CYSTO 1330 1130 1330 1130/1215 1130 CYSTO
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
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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

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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

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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

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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

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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
• Increasing PACU utilization?
• STF

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Estimating Procedure Times

• Surgeons estimates
• Scheduler estimates
• Historical averages
• Data base/ information system models

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The End