A Norm Utilisation for Scarce Hospital Resources: Evidence from Operating Rooms in a Dutch University Hospital

Abstract

Background Utilisation of operating rooms is high on the agenda of hospital managers and researchers. Many efforts in the area of maximising the utilisation have been focussed on finding the holy grail of 100% utilisation. The utilisation that can be realised, however, depends on the patient mix and the willingness to accept the risk of working in overtime. Materials and methods This is a mathematical modelling study that investigates the association between the utilisation and the patient mix that is served and the risk of working in overtime. Prospectively, consecutively, and routinely collected data of an operating room department in a Dutch university hospital are used. Basic statistical principles are used to establish the relation between realistic utilisation rates, patient mixes, and accepted risk of overtime. Results Accepting a low risk of overtime combined with a complex patient mix results a low utilisation rate. If the accepted risk of overtime is higher and the patient mix is less complex, the utilisation rate that can be reached is closer to 100%. Conclusion Because of the inherent variability of healthcare processes, the holy grail of 100% utilisation is unlikely to be found. The method proposed in this paper calculates a realistic benchmark utilisation that incorporates the patient mix characteristics and the willingness to accept risk of overtime.

Operating room planning and scheduling: A literature review

“…Wullink et al [120], for instance, examined whether it is preferred to reserve a dedicated operating room or to reserve some capacity in all elective operating rooms in order to improve the responsiveness to emergencies. Using discrete-event simulation they found that the responsiveness, the amount [71,72,112] of overtime and the overall operating room utilization significantly improved when the reserved capacity was spread over multiple operating rooms. Bowers and Mould [17] group orthopaedic urgencies into trauma sessions and use Monte-Carlo simulation to determine which session length balances the amount of session overruns with an acceptable utilization rate.…”

“…Note that simulation is often preferred as the solution technique to study complex stochastic set- [3,5,6,9,10,17,20,25,26,27,28,41,43,44,49,54,60,62,63,64,70,75,76,78,79,82,83,84,86,88,92,94,97,104,109,110,111,112,113,114,115,120,122] other [20,35,37] tings, as it features an extensive modeling flexibility. Next to arrival and duration uncertainty, other types of uncertainty may be addressed.…”

Suitability and managerial implications of a Master Surgical Scheduling approach

“…Obviously, the more robust the program, the more time needs to be reserved, and thus the lower the OR utilization. Consequently, robustness and utilization should always be jointly considered as performance criteria (Van Houdenhoven et al 2007a).…”

“…Capacity planning involves resource dimensioning and allocation within the constraints set by target production agreements, and agreements on utilization and availability of resources (Van Houdenhoven et al 2007a). It also involves reserving slack time for dealing with the inherent variability of the process.…”

Private theatre utilisation in South Africa: A case study

“…[8] Utilisation of 100% is referred to as 'the holy grail' , because it is essentially sustainably unattainable owing to unavoidable variations in procedures and loading. [9] This study investigated the efficiency of an operating theatre complex in a large private hospital in SA by measuring utilisation levels and using the result as a proxy for the effectiveness with which the complex can generate income for the hospital.…”