OR Management

Why Interest in OR Management is in Every Anesthesiologist's Best Interest

OR scheduling is unlikely to be at the top of any busy anesthesiologist's "To Do" list. But maybe it should be. Though hospital administrative duties and OR management would seem to fall beyond the scope of a contracted anesthesiology group's responsibilities, the group that is unwilling to shoulder its share of the burden does so at its own risk. Patient outcomes may not be affected, but there are real impacts on the hospital's and thereby the anesthesiology group's efficiency and effectiveness in the OR, which translate to its bottom line as well.

The frustrations inherent in servicing an under-utilized or inefficient OR are obvious. Long turnover times, schedule disruptions and overstretched but underused call obligations are just the beginning. While some delays are unavoidable -- as not every surgery can be timed to the minute -- others are, and should be, unacceptable. Waiting for late-arriving doctors, nurses or other personnel, missing medications, unverified patient insurance authorizations, supplies or paperwork should not be acceptable in any well-run OR. Moreover, a schedule that is unevenly balanced or open and unused for portions of the day is a drain on everyone's time and revenue.

The ill will caused by delays, loss of time and a schedule so porous that an anesthesiologist group must struggle to cover its costs may create such fractures that both the hospital and the anesthesia provider inevitably believe the other is not pulling its weight.

There are ways to reach a consensus, but it cannot be done unless both the OR management and the anesthesia providers are willing to work together to repair the system. This means that anesthesiologists must be willing to assume an "administrative" role to ensure a well-run, well-utilized OR, and the first step is the schedule.

Call obligations, room availability, room staffing, nurse and CRNA coverage and turnover time must be defined and delineated. The current OR schedule must be evaluated, either by an objective consultant or by a combination of hospital management and anesthesiologists. But, above all, expectations, both on the part of the hospital and its staff, and on the part of the anesthesiologists and the anesthesiology group, must be established.

Whether the solutions come from consolidating open ORs, reducing unused OR time, reallocating personnel or taking steps to reduce turnover time, having their voices heard will offer anesthesiologists the best chances of establishing the highest possible percentage of on-call hours as billable hours.

By taking an active role, anesthesiologists not only create good will with the hospital, but are better prepared to anticipate the needs of the OR, to be proactive and to tailor their availability to their customers' needs, minimizing overlaps and underutilization. Scheduling that promotes maximum OR utilization, optimizes on-call hours and substantially reduces turnover time creates the highest level of OR efficiency. The anesthesiologists can then capitalize on that efficiency, making them more effective, more efficient and, inevitably, saving themselves considerable time, aggravation and money.

With an agreed upon schedule in place, the anesthesiology group must also lend a hand in ensuring the enforcement of that schedule. Without enforcement, the group will find itself back where it started, losing time and revenue. Taking an active role will not only help to maintain a high level of efficiency, but will create a collaborative environment between hospital management and anesthesia providers, paving the way for future productive and profitable collaboration. Groups may consider appointing one anesthesiologist as leader for each call period, encouraging leadership within the group and clearly designating responsibility.

Certain administrative duties and management responsibilities within the hospital, medical directorships and chairmanships include a stipend, which may be a useful added source of revenue. This is a clear incentive, some would say obligation, for the anesthesiologist to understand and respond to the hospital's interests. Moreover, acting as an affiliate of the hospital creates a bridge between the anesthesiology group and the overall hospital management structure, retaining the group's autonomy while providing a secure avenue for consensus building and conflict resolution.

Clearly, the benefits of participation in OR management and other administrative tasks are numerous and are not limited simply to the image of cooperation they project. A well-utilized, well-organized and efficient OR establishes the conditions fo,r and promotes maximum efficiency for anesthesiologists servicing the many customers they are responsible to. Maximum efficiency yields higher revenues and, with an eye on the bottom line, is something anesthesiologists and hospital management can all agree on.

So, while it is true that the many years of medical school and trainings anesthesiologists undergo are not intended to be in preparation for a desk job, anesthesiologists should well consider pulling up a chair.