Managing ORs like Swimming Pools

By | 2018-05-16T19:15:16+00:00 May 16th, 2018|

When I’m not working towards making hospitals more efficient, I like to swim. On a good day, I can do 500 yards in a hair under 7’30”. This makes me much faster than most people swimming laps in a community pool, but very average for a competitive master’s program. And when it comes to each swimmer completing their own workout with a minimum of interference, two pools of the same size with the same number of swimmers can have very different outcomes, depending on how a pool is managed. It’s a great metaphor for an OR.

Pools are divided into lanes, and each lane can support as many as 6 people. In a six lane pool, the first six swimmers will each take their own lane. The seventh person then needs to get in and share an occupied lane. The 13th swimmer must get into a lane with two people, forcing all swimmers in that lane to go in a circle. This is where the pool’s management style makes a difference.

When a pool gets to 3+ swimmers per lane, it makes sense to group swimmers by ability. And most pools have high-contrast signs stating “SLOW”, “MEDIUM” and “FAST” to organize swimmers. I strongly prefer swimming at these pools. If I’m in the fast lane with two other people, and they’re regularly passing me, then I need to go into a slower lane. And similarly If I’m in the medium lane and am too fast for my lane-mates, I need to go into a faster lane.

Some pools do not have signs. So instead of self-organized behavior, every lane winds up with swimmers of various speeds. It’s chaos. The slow swimmers are annoyed at being harassed by the faster swimmers, and the faster swimmers are frustrated at having to slow down. The slow swimmers become defiant and stop letting the fast swimmers pass — and the fast swimmers become risky and try to pass in the middle of the lane. Nobody is happy.

For a modest expense, the addition of signs to every pool would make a huge difference in the ability for swimmers to utilize the pool effectively. I certainly avoid pools without them, even though they may have better amenities; it’s not worth the nuisance of poorly managed lanes. During peak use times at these pools, I’ll see people waiting around for a lane to open up, knowing full well that if the pool just had signs, there would be more than enough room for everyone.

The lane signs at a pool are like block policy at an OR — it informs everyone how the resource is to be used. And an OR that is not actively managed is like a pool without the lane signs. Without a way to organize the flow of the OR, lanes get clogged, staff is unhappy, and the whole system is rendered inefficient. Given the expense of maintaining and staffing an OR, it’s important for hospitals to actively manage how the blocks are allocated to surgeons, services, and practices. For a minor expense when compared to the other costs of running a hospital, wait times could be reduced, and overall throughput and efficiency could be dramatically improved.

The best managed pools go beyond signage, and have a lifeguard actively managing all swimmers and lanes. The head lifeguard where I swam when I lived in California would not only only actively assign swimmers to lanes, but would move them during their workout as other swimmers enter and leave the pool. A minority of swimmers have a “this is my lane” attitude and felt judged when asked to switch lanes. But the vast majority of swimmers were very much on board with this level of intervention because it meant a hassle-free workout. The rules were clear about how swimmers were sorted. This lifeguard actively managed the pool resource to accommodate the most swimmers.

The best managed ORs follow a similar model. Not only do they use modern software to understand how rooms are being utilized, they have leadership that uses the data to ensure resources are fully utilized. Some surgeons do not like being measured, but we find that if the OR block policy is transparent and clear, surgeons are on-board with being actively managed, especially once they see they can fit in more cases with less wait and less conflict from their peers and staff.

Obviously an OR is much more complex than a swimming pool and switching blocks is much harder than switching swim lanes. But the similarities make this analogy instructive. Both are expensive to build and maintain, and both can be utilized much better with some degree of analytics and passive or active management. Active management can only happen when it’s supported by crystal clear policy and analytics. Like the lifeguard that may tell a swimmers to switch lanes, actively managing an OR may require a level of intervention hospital staff are not used to. But the results speak for themselves.

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