Suitability and managerial implications of a Master Surgical Scheduling approach

Abstract: Operating room (OR) planning and scheduling is a popular and challenging subject within the operational research applied to health services research (ORAHS). However, the impact in practice is very limited. The organization and culture of a hospital and the inherent characteristics of its processes impose specific implementation issues that affect the success of planning approaches. Current tactical OR planning approaches often fail to account for these issues.Master surgical scheduling (MSS) is a promising approach for hospitals to optimize resource utilization and patient flows. We discuss the pros and cons of MSS and compare MSS with centralized and decentralized planning approaches. Finally, we address various implementation issues of MSS and discuss its suitability for hospitals with different organizational foci and culture

Managerial implications and suitability of a master surgical scheduling approach

Master surgical scheduling can improve manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. These surgery types need to be constructed with low variability to be efficient. Each surgery type is scheduled based upon its frequency per cycle. Surgery types that cannot be scheduled repetitively are put together in so-called dummy surgeries. Narrow defined surgery types, with low variability, lead to a large volume of such dummy surgeries that reduce the benefits of a master surgical scheduling approach. In this paper we propose a method, based on Ward's hierarchical cluster method, to obtain surgery types that minimizes the weighted sum of the dummy surgery volume and the variability in resource demand of surgery types. The resulting surgery types (clusters) are thus based on logical features and can be used in master surgical scheduling. The approach is successfully tested on a case study in a regional hospital

Exploring the relation between process design and efficiency in high-volume cataract pathways from a lean thinking perspective

Objective:\ud To compare process designs of three high-volume cataract pathways in a lean thinking framework and to explore how efficiency in terms of lead times, hospital visits and costs is related to process design. \ud \ud Design:\ud International retrospective comparative benchmark study with a mixed-method design.\ud \ud Setting:\ud Three eye hospitals in the UK, the USA and the Netherlands participated in this study. All are major international tertiary care and training centres in ophthalmology. \ud \ud Participants:\ud Data on all patients who underwent first eye cataract surgery in 2006 were used.\ud \ud Interventions:\ud The study related six operational aspects of lean thinking in the process design to efficiency.\ud \ud Outcome measures:\ud Measures of lean aspects were operational focus, autonomous work cell, physical lay-out of resources, multi-skilled team, pull planning and elimination of wastes. Efficiency was measured with lead times (access time plus waiting time for surgery), hospital visits and direct costs. \ud \ud Results:\ud Operational focus was influenced by external circumstances leading to different orientations on efficiency. Pull planning with integrating activities in one-stop procedures conducted by multi-skilled nurses as well as eliminating wastes reduced both the number of hospital visits and costs. Short lead times were associated with the use of a general outpatient clinic and a high-volume cataract surgery clinic. \ud \ud Conclusions:\ud The environmental context and operational focus primarily influenced process design of the cataract pathways. When pressed to further optimize their processes, hospitals can use these systematic benchmarking data to decrease the frequency of hospital visits, lead times and costs