OR Manager August 2022 - 20

OR Business
Preventing culture shock with a new approach to block time
BY SHAWN SEFTON
he passage of the Health Information
Technology for Economic
and Clinical Health (HITECH) Act in
2009 brought electronic health records
(EHR) to the forefront, but the concept
existed long before that.
T
Larry Weed and Jan Schultz at the
University of Vermont developed a preliminary
system in the 1970s. In 2014,
the American Recovery and Reinvestment
Act added a financial incentive
for healthcare providers to make the
switch to digital, requiring them to show
" meaningful use " of EHR technology, or
to demonstrate usage of digital records
to improve quality, safety, efficiency,
and reduce health disparities; engage
patients and family; improve care coordination,
population, and public health;
and maintain patient health information
privacy and security in order to qualify
for Medicare EHR incentive payments.
While the HITECH Act was a historic
step, it was not an immediate
game changer. In 2012, for example,
an estimated 63% of physicians were
still using fax machines as their main
means of communication. By 2014,
only one out of four hospitals had a
basic EHR system. An early Harris Poll
of primary care physicians (PCPs) from
Stanford Medicine found that, although
most PCPs saw value in EHRs, many reported
that they were experiencing more
challenges than benefits.
Where are we now?
Today, more than a decade later, EHR
technology has finally moved patient records
away from paper, with more than
96% of hospitals and 86% of physician
offices in the US having access to EHR
data for their patients.
Yet, even with all of the promise it
offers for improving efficiency, quality,
and safety, the EHR has not proven to
be the panacea it was once expected
to be. Legacy systems continue to trap
critical patient information in silos, making
it nearly impossible for healthcare
providers to ensure optimal outcomes
20
OR Manager | August 2022
for their patients. Users still create
workarounds to compensate for inadequacies
they find in EHR software.
And healthcare organizations, by and
large, continue to rely on manual and
paper-based processes. A recent study
found that hospital clinicians continue
to use handwritten notes to document
patient information, emails, and verbal
communication when handing off patients
between care teams.
Providers are also frustrated when it
comes to accessing data and systems
that can deliver meaningful insights. In
today's era of value-based care, many
are still using tools like Excel and Tableau
for data analysis. A recent survey
from Black Book found that, even
though most (93%) health systems believe
that data analytics would be crucial
to help them meet future healthcare
demands, most described their use of
advanced analytics as " negligible. "
Unfortunately, this situation is affecting
the quality of patient care. In a
recent survey of healthcare professionals,
nearly all (91%) agreed that fixing
the burden of time-consuming, manual
administrative processes is the most
urgent need to improve patient care.
A new approach to block time
When addressing the need to transition
away from manual processes, one conspicuous
example is the clinical operations
and business management of the
perioperative suite. Today, even though
the majority of hospitals use EHRs,
many continue to use manual processes,
whiteboards, and sticky notes
to post and adjust OR assignments.
Large and small health systems
have adopted block scheduling to offset
the unpredictability, lack of transparency,
and underutilization of OR time
that resulted from the traditional firstcome,
first-serve method.
While typical block scheduling does
provide a certain level of predictability,
it does not solve the issue of OR underutilization,
which is often a direct result
of blockholders' resistance to releasing
unneeded time. Utilization of ORs at the
more than 10,000 US hospitals and
surgery centers is 60% at best, per the
Medical Group Management Association.
As
long as block scheduling with
manual processes and phone tree
systems continues, improving these
systems will be a daunting challenge.
The good news is that innovations in
technology like artificial intelligence (AI)
and machine learning (ML) are already
enabling the automation of tasks and
analysis of patient data to create an
optimized business unit that enables
quality and safe patient care.
Predictive AI-driven digital platforms
can help perioperative leaders eliminate
the issues that are inherent in the
rigid, limited manual methods of managing
the OR schedule. By moving from
static to dynamic management of their
block schedules, they can significantly
improve the cycle of OR utilization by
increasing block release lead time, creating
schedule transparency, enabling
real-time block management, and performing
holistic block management.
Taking on a culture of
resistance
Adopting innovative solutions is particularly
challenging within healthcare,
a fragmented ecosystem of disparate
stakeholders operating in silos, and
with a deep-seated reliance on continuing
to do things the same way.
That risk-averse mindset is prevalent
among perioperative leaders and surgeons.
Even in the face of increasing
operational bottlenecks and squeezes
on OR capacity, frontline staff and executives
alike are hesitant to try gamechanging
new tools that could significantly
improve utilization.
The introduction of new tools designed
to transform the way block scheduling
is managed requires a long-term
strategy that encourages buy-in from
stakeholders and drives a major change
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OR Manager August 2022

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