CommonSpirit Health, a combination of DignityHealth and Catholic Health Initiatives, is a nationwide health system of more than 350 hospitals.

THE PROBLEM

With this many hospitals, it can be difficult to implement technology across the entire system that employees will actually warm to, said Brian Dawson, system vice president of perioperative services at CommonSpirit Health.

"We struggled with a lot of unused operating room time," he recalled. "For reference, every unused minute in a prepared, ready-to-use operating room costs a hospital about $100. So, unsurprisingly, we wanted to solve this issue to avoid unnecessary expenditures across the health system.

"With that in mind, I've always looked for ways to improve operations in healthcare," he continued. "About three-and-a-half years ago, someone working in strategy for DignityHealth approached me about an initiative they had started called 'Rock the block.' The team there was looking for ways to reduce unused OR block time since it was really costing us a lot of unnecessary money."

The "Rock the block" process would start with nurses at certain hospitals looking through each individual OR schedule to find openings and emailing those openings to surgeons in hopes they would claim the time and the OR would not go unused.

"We have these sorts of scheduling and utilization systems in so many industries, such as retail and travel. Why shouldn't we adopt it for healthcare?"

Brian Dawson, CommonSpirit Health

"Working in perioperative services, I was called in to chat over this process of 'mining the schedule' and knew immediately that it was a wonderful idea," Dawson said. "However, I simultaneously realized that it was extremely labor-intensive – sorting through individual schedules manually.

"By continuing this way, the process would be put on the back of OR leaders," he added. "From that point, I knew we needed to invest in a solution that would ease this scheduling burden while also continuing the great utilization work that already had been started by the dedicated folks within the hospital."

PROPOSAL

Dawson already was aware of IT vendor LeanTaaS and its iQueue product suite. The tool was developed with pilot participation from one of the UCHealth medical centers, coincidentally less than 2 miles from Dawson's home.

"I knew that using artificial intelligence and machine learning solutions, the point of iQueue was to solve for empty ORs and match with surgeons looking for block time," he explained. "It seemed apples to apples with what we were trying to do at DignityHealth, just with the technological support and foundation that we needed to scale and continue.

"iQueue works by prompting surgeons to release unused time, in part by suggesting release dates timed to maximize prospects for filling as many of those unused staff operating rooms as possible," he continued. "They're often marketed to surgeons in the area who haven't previously considered performing surgeries at the hospitals reaching out to them."

Dawson met with the vendor and discovered one of CommonSpirit Health's Bay Area hospitals already had reached out to their team about onboarding the technology. While on a site visit to that hospital, Dawson ran into LeanTaaS President and COO Sanjeev Agrawal and got an in-depth overview of the tool, both from Agrawal and the hospital onboarding team.

"With those proof points, I was able to return back to our team leadership and work with them to discuss what adopting iQueue would look like," Dawson said. "Once you collect the data and can see how it would improve utilization and cost at your own hospital, it's pretty simple to understand that it's far favorable to a manual solution."

MEETING THE CHALLENGE

Initially, Dawson worked with the IT department and leadership to determine how the technology would work within the health system. This was a tool the IT department had not been familiar with, but the tool would require the department's sign-off – that initial discussion was important.

"Once our CEO and COO had given us the dollars, we deployed the technology across all 32 hospitals," he said. "Almost immediately, it began filling and unlocking unused time, moving auto-release dates in EHRs, and ultimately improving utilization numbers.

"Something else we noticed was iQueue's commitment to our idea of 'systemness,'" he continued. "Our leadership is focused on creating a patient and provider experience that delivers the same comfort and reliability at each and every one of its facilities – an idea of one cohesive system, or 'systemness.' The vendor immediately caught on to that idea and helped us achieve it."

Once Dawson and company deployed the OR tool, administrators, surgeons, OR nurses and the IT department saw improvements with OR time, managing block time, using common metrics and block policies.

"The tools also were used to manage cross-team huddles, all of which ultimately led to improved systemness," he said. "iQueue took the manual work out of the process while still combing schedules, flagging unutilized OR block time, pushing notifications on availability to surgeons and more.

"It also maintained volume, which was a big item for our team," he added. "We wanted to adopt and learn this solution, but didn't want to sacrifice volume while doing so. We wanted to grow our volume – hence, the entire undertaking of this project. That's where the implementation team was a huge help – boots on the ground to help get iQueue implemented, help staff understand the use case and best practices, and ultimately answer our many questions was a necessary factor in getting everyone on board."

RESULTS

21% release fill rate

"This metric is one that shows just how much iQueue is improving our utilization numbers," Dawson explained. "First of all, with the tool, we've garnered a 14.5 times ROI [return on investment]. This is important to note with this release fill rate metric because once iQueue recognizes and releases open OR blocks, 21% of them are being picked up by surgeons.

"21%, and we're getting 14.5 times ROI," he continued. "Imagine what we could be doing with 100%. This is an extremely strong indicator of what the technology is providing us – filling unused OR time, bringing new surgeons into our hospitals and taking volume away from our competitors."

153% increase in blocks released

"Marketing is a big proponent for block release," Dawson noted. "With released blocks, our marketing team is able to go out to surgeons who don't operate within our hospitals and weigh their options – sort of a 'We can give you something better.'

"Giving surgeons the ability to operate when and where they want is a huge draw," he added. "As a result, we've seen a 153% increase in staffed OR blocks released by surgeons to drive the higher utilization."

Further, the organization is playing to the surgeon's preferences. If a surgeon wants to be notified of an available block via text as opposed to email, the tool can make it happen. The organization is bringing the availability to surgeons' doorsteps, and it's making it easier for them to capitalize.

ADVICE FOR OTHERS

"Throughout the COVID-19 pandemic and beyond, the name of the game has been utilization," Dawson noted. "Healthcare providers across the globe have had to do more with less, and it has led to increased burnout, staff shortages, patient dissatisfaction and scarce resources.

"Utilization solutions don't just exist to make hospitals more money and pump more cases through at an increased rate – they exist to make hospitals more efficient, more informed and more connected to one another," he continued. "ORs specifically are massive costs to hospitals – they require huge amounts of resources and staff in order to remain open."

But they're also critical to the success of a hospital.

"In situations like this, it's worthwhile to invest in a tool that will optimize your operating rooms," he advised. "It not only will return your investment, it will cut down on staff burnout, bring new surgeons to your hospitals and improve overall systemness within the health system.

"However, not every hospital needs an OR optimization tool," he cautioned. "There are some limitations. Small, critical-access hospitals with fewer than four ORs are not a good fit yet for this type of technology."

There are a number of hospitals within the health system in small rural areas that have fewer than four rooms and might have five surgeons. In cases like this, the tool will not be very advantageous outside of collecting data, Dawson said. It's likely surgeons have their own day of the week and operate with little-to-no scheduling conflict or overlap.

"Overall, it's time healthcare providers look closely at the ways technology can help us do our jobs better," Dawson concluded. "It's important to consider all the options and possibilities and make a conscious list of what your health system is most in need of. We have these sorts of scheduling and utilization systems in so many industries, such as retail and travel. Why shouldn't we adopt it for healthcare?"

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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