Hospital management

What is block scheduling system?

With block scheduling system, a block of OR time is assigned to each surgeon or group of staff. Normally, Blocks range from one-half to a full day in length. The block is reserved for the staff member’s exclusive use until a cutoff date, usually a day or two before surgery for surgeons. The unused time is made available to other surgeons. Scheduling for resources and staff is a recurring activity for health care managers. When scheduling is not carried out in a skillful manner, it can either waste resources or reduce the revenue of the organization. A block system scheduling allows staff to plan their days off in advance. Staff scheduling ensures that staff are assigned to the proper patients in the proper units at the proper times. Organizations have different scheduling plans that determine their efficiency and effectiveness. They vary on shift length. The choice of a scheduling system has an impact on absenteeism, turnover, and overall job satisfaction. Furthermore, scheduling communicates directly to the quality of patient care by affecting continuity and coverage of care and staff morale. (Gahan et al., 1975)

What are the advantages and disadvantages?

Block scheduling system proves valuable in many ways.  The first advantage of the block system is that it improves utilization through better use of the resources. The system also allows staff to know the start times of their duties well in advance.  Any overruns are attributable to the staff performing, thereby giving them nowhere to shift responsibility their delay. Block scheduling reduces staff competition, and may reduce cancelations, administrative work, and the overall surgery waiting list. It provides for more equitable staffing and decreases scheduling time. The flexible staffing program helps the health care organization to attain flexibility. Adequate coverage can be maintained by changing staffing patterns when required while ensuring continuity of care. From the literature, flexible scheduling appears to promote schedule quality that arises from job satisfaction.  While flexible staffing does not often permit stable schedule for nurses, it allows nurses to choose when they wish to work.  In this sense, block scheduling system enables the organization to meet the needs of the staff.  Additionally, block scheduling system usually cuts costs by minimizing the need for overtime or employing temporary staff.  The manual scheduling of staff was an inefficient method.  Unlike the manual scheduling, block scheduling system creates consistencies in staff take paid time off, make a switch, or trade a shift. The type of system is more equitable as staffs are involved in making the schedule.  To the organization, a block scheduling system allows the accurately tracking of schedules that provide a system-wide view of the entire scheduling process. (Rowland & Rowland, 2001)

The major drawback of the block scheduling system is that unused block time often held by staff until the cutoff day, even when they may not require it. This leads unavoidably costly idle time. Additionally, blocked OR time might hold up urgent surgery cases pending the patient’s surgeon block schedule. Another disadvantage of block scheduling is that some employees may receive individualized treatment at the expense of their coworkers. Sometimes, work schedules may be used as a reward-punish system.  Block scheduling is also time-consuming. It takes staff from other duties or forces them to carry out scheduling when they are off duty. Depending on the schedules, it may cause stress for some nurses depending on their schedule. This may affect their quality of work. Without appropriate implementation, the most thought-out flexible program can fail. (Gahan et al., 1975)

How can the hospital increase the utilization of operating rooms from 60% to 80%?

If the service is operating at 60% mark, forcing a 3-day release can raise the utilization without losing a considerable number of cases. On average, operating rooms with 60% utilization will only lose about 1.25% of their cases in a day but increases utilization by approximately 10%. In every case, moving from no block release to having block release allows for an improvement in utilization.  It shows that there is a percentage of change in room utilization and cases.  In general, it having block release decreases room for unscheduled cases while allowing for an increase in room utilization.

Consider the factors that affect OR scheduling.

There are various factors that affect operating room (OR) scheduling. The first factor is the number of required individuals. Scheduling process takes into consideration the number of staffs needed in the operating time. Over-allocation results in inefficiency while under allocation affects the effectiveness of the staff.   The second factor is the availability of staff. Different staff may be available at the different time of the day depending on other schedules.  This affects OR allocation. The third factor is the health organization’s policies and procedures.  Other factors include individual knowledge and experience applicable to the care of the patients.

What the hospitals needs to do to reduce infections rate?

The Spread of infection can be controlled and reduced by through different measures. The first measure that the organization should take is to adopt strict hospital infection control policies and procedures. A hospital needs to streamline its process for identifying patients’ infections and those at risk while complying with increased reporting requirements. For example, vascular catheter-associated infections may be prevented through (Davey, 2013)

·         Use maximal barrier precautions during catheter insertion

·           practice good hand hygiene

·           securing the catheter to prevent biofilm dislodgement and irritation

·          Removing the catheter when no longer needed.

·         Ventilator-associated pneumonia can be prevented through

·         Elevation of the head of the bed deep venous thrombosis prophylaxis

·           Peptic ulcer disease prophylaxis

·           Removal of the intubation tubing when deemed unnecessary.

CABG-associated infections should be reduced owing to the high mortality rate. Key indicators for prevention of surgical site infections are such as

•    Giving the patient the most appropriate, effective antibiotic within 1 hour of incision

•     discontinuing the antibiotic within 24 hours of incision closure

•    Use of clippers for hair removal or

•     Not removing hair at all in cardiothoracic surgery patients

•     Glucose levels should be monitored during the first 48 hours after surgery and maintained below 200 mg/dL.

Technology can also be used to reduce infection rate in the healthcare setting. An enterprise data warehouse can aid health care professionals to easily track patients with a urinary catheter or a central line as part of their treatment. By utilizing near visualizations and real-time data that an EDW offers, staff involved in infection prevention can quickly assess automatically generated up to date reports to identify actual infection rates. It also allows them to focus on clinical interventions and education for placement of catheters, sterile techniques and hand hygiene and analysis of at-risk patients to provide further prevention strategies.  While the technology itself cannot decrease infections, it allows the organization to drive change by using quality data to improve outcomes. (Pablo et al., 2007) 

The organization’s culture is also a factor in infection prevention. The Commitment to changing the culture should start with hospital leaders, clinicians, and physicians. Particularly, Infection Prevention leadership should show commitment to pulling together a multidisciplinary team of infection team dedicated to preventing infections, experts, clinicians and quality assessors who can work as a team to ensure compliance with best practices.  As it turns out, preventive measures are fairly straightforward.  Other measures include screening patients for disease-causing germs and thorough environmental cleaning. (Loveday et al., 2014)

How hospital management need to deal with the famous surgeon?

The hospital can take various measures to deal with the surgeon who does not comply with surgery start time and may show up late ultimately compromising the OR schedule. The hospital management can implement a pay system based on time worked.  A fixed pay system allows employees to receive pay for the un-worked time. The management should establish a system to document start time and end time of schedules.  The second measure is to create an organizational culture of timeliness and train staff on the importance of timekeeping and the consequences that can result from contrary behavior. It is easier to change a person’s behavior by first creating a workplace gestalt of the desired behavior. The third strategy is to enforce disciplinary measures routinely and consistently. Sufficient warning should be given to the surgeon. There should be a documented recourse against employees. (Tsui & Lai, 2009)

 References

Rowland H., & Rowland B. (2001) Nursing Administration. Jones & Bartlett Learning

Gahan, Karen; Talley, Rosanne (1975) Block Scheduling System Journal of Nursing Administration November/December 1975 - Volume 5 - Issue 9 - pg 39-41

Pablo Santibáñez,  Mehmet Begen, Derek Atkins (2007)  Surgical block scheduling in a system of hospitals: an application to resource and wait list management in a British Columbia health authority. Health cares management science. September 2007, Volume 10, Issue 3, pp 269-282

Tsui, A. P., & Lai, K. T. (2009). Practices of human resource management: HRM (Vol. 2). Hong Kong University Press.

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in Online Writing Services if you need a similar paper you can place your order from free essay writing services.