Schedule like a Hospital

Many years ago I visited a hospital CEO here in Ontario to entice them to attend a Manufacturing Conference thinking they could learn some tips and tricks from a bunch of seasoned Manufacturing Practitioners. I was soooo wrong, it soon became that I was the student. More importantly those lessons learned I was able to apply many times over within various organizations.

In order to understand how a Hospital schedules you need to first understand their patient demographics which fit nicely into three categories:

• Elective Surgery ... those patients that arrive the day before surgery and occupy a bed.

• Day Surgery ... those patients that arrive on the day of surgery and dont stay

• Emergencies ... unpredicted demand that requires immediate attention

In Traditional and Manufacturing terms we can classify them as follows:

• Elective Surgery = Runners (A-Items)

• Day Surgery = Repeaters (B items)

• Emergencies = Strangers (C Items)

Of course the lower the category the harder it becomes to forecast demand.

Most people think the biggest expense to a hospital is the housing of a patient at $400.00 per days but that pales in comparison to the cost of running an operating theatre at $23,000. to $50,000 per hour. Then it just makes sense that as a hospital you need to optimize running your Operating Theatres.

As a result Hospitals schedule surgeries in that manner, but like in all facets of real life schedule attainment is not always accomplished.

So let us build our hospital schedule ...

Emergencies (Strangers)

Here is where the domino effect of non-schedule fill begins.

These patients show up at the door and require immediate attention. Of course we do not know with what kind of ailment needs to be attended to, but if surgery is required they immediately step to the front of the line.

Day Surgery (Repeaters)

We know a lot more about this group of patients. Typically, patients assigned for Day surgery are already grouped and certain Operating Theatres are set-up to handle those specific surgeries ranging from Wisdom Teeth extraction, Cataract surgery, etc. These surgeries tend to be fairly simple and predictable in nature of time required.

Elective Surgery (Runners)

These patients have already underwent significant Pre-Operative diagnosis and the Surgeons are well prepped. These type of surgeries can be rather complex and lengthy which is why the patient is admitted to the hospital prior to the scheduled surgery to insure that they are properly prepped for surgery.

The Domino Effect

You can perhaps create a rough statistical model about the number of emergency intakes per day but modelling the severity is a whole other challenge. If you have a significant Emergency Intake one day resulting from some sort of natural or other wise disaster the chances of it happening again on the same day the following year is near zero chance.

If we do have an unusual high demand placed on our Operating theatre that consumes our available hours the first schedule change is to advise our Day Surgery Candidates to go home and their surgery will be rescheduled and they will be notified.

If Operating theatre requirement creeps into our Elective Surgery Window we just keep that patient for an extra day. It is cheaper to keep them for $400.00 that extra day.

Lesson Learned

In Manufacturing my favorite statement to sales was " Poor Planning on your Part, does not justify Heroics on my Part, unless you compensate me with a sinful amount of money", Unfortunately that does not work in my Hospital scenario.

• Emergency Intake is priority, unfortunately I have no idea of volume or complexity which also makes is impossible to forecast. In Manufacturing we all have experienced those urgent emergency Orders so I have learned to build my schedule to 80% capacity utilization and doing any sort of finite scheduling beyond 1 week out is futile.

  
  

• My Day surgery or Repeaters are fairly easy to schedule and require minimum Set-Up so I do build in a bit more Safety Stock as a buffer if I have to push out my build plan by a few days.

  
  

• Elective Surgery are already captive occupying a bed in the hospital and quite frankly they are not that concerned if they are operated on at 8AM or 8PM they are not going anywhere anyways.

• Work on your Strangers First and get them done

• Work on your Repeaters next

• Finish your day working on your Runners

• Dont try to forecast your Stranger Demand, load your schedule to 80%, you can pull ahead your Day Surgeries (Repeaters) and definitely your Elective Surgeries (Runners).

  
  

Operating Theatres are like work centers and they most likely stocked with the necessary components to perform specific procedures. Good chance that several Operating Theatres are properly equipped to do a specific procedure, for example appendix removal or Hip Replacement. While Elective Surgery is reserved for more traditional surgery done professionally by skilled professionals.

Conclusion

After gaining a better insight of how a Hospital Schedule is developed I have applied the same logic outside of Hospital settings. I have found if I schedule Strangers to be worked on first, they tend to get done, same for Repeaters which I schedule for Mid-Day. The teams all want to work on the Runners, because they are easy and they can fly through the schedule. Before I allowed my teams to pick (kind of), But i found that the teams really were good at ignoring the strangers, so they became late and just a bigger problem.

Preparing the Operating Theatre to perform a surgery is only part of the Set-Up or even Change-Over and can be completely futile unless you include scheduling and availability of your Professional Resources.