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Chapter 8. Scheduling

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  1. Chapter 8.Scheduling Yasar A. Ozcan

  2. 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 Yasar A. Ozcan

  3. 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 Yasar A. Ozcan

  4. 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 Yasar A. Ozcan

  5. 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 Yasar A. Ozcan

  6. Figure 8.1: Comparison of 8 and 10 Hour Shifts Yasar A. Ozcan

  7. Figure 8.2: Pattern of Alternating Eight and Twelve Hour Shifts Yasar A. Ozcan

  8. 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) Yasar A. Ozcan

  9. Exhibit 8.1 Cyclical Staffing Schedules for Four Weeks The Four Week Schedule Yasar A. Ozcan

  10. 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 Yasar A. Ozcan

  11. Implementing Work Systems • Employees should be involved in the planning and implementation process • Forums should be held to answer staff’s questions • Effectiveness and efficiency of the new system should be periodically evaluated • Consider workforce values, alternative work systems, and employee acceptance Yasar A. Ozcan

  12. 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 Yasar A. Ozcan

  13. 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) Yasar A. Ozcan

  14. 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 Yasar A. Ozcan

  15. 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 Yasar A. Ozcan

  16. 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 Yasar A. Ozcan

  17. 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 don’t need it; urgent cases may be delayed until a particular MDs block comes up Yasar A. Ozcan

  18. Exhibit 8.2 An Example of OR Block Schedule Yasar A. Ozcan

  19. 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 Yasar A. Ozcan

  20. 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 Yasar A. Ozcan

  21. 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 Yasar A. Ozcan

  22. 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 Yasar A. Ozcan

  23. 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 Yasar A. Ozcan

  24. Estimating Procedure Times • Surgeon’s estimates • Scheduler estimates • Historical averages • Data base/ information system models Yasar A. Ozcan

  25. The End Yasar A. Ozcan