BUSI 611 Week 6 Discussion Board Forum 6 Example

Discussion Board Forum 6: Capacity Management and Scheduling

BUSI 611 Operations Management for Health Organizations, Discussion Board Forum 6

Thread by [Student Name]

The hospital, its operating room data and the classmates are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

Our hospital's 14-room surgical suite allocates most of its operating time in blocks, reserved days for surgical groups. Last quarter the orthopedic group used 62% of its allocated block hours, leaving the equivalent of more than one full room idle on most of its days, while general surgeons waited an average of three weeks to schedule urgent but non-emergency cases such as gallbladder removals and hernia repairs. Anesthesia and nursing staff were paid for idle rooms, and patients with painful conditions waited for time that sat empty. When I raised the issue with our perioperative director, the response was that the orthopedic surgeons had held those blocks for years and would protest any change. That answer explains the politics but not the operations. Each idle room-hour cost the hospital roughly the same in staff and overhead as a busy one, and the general surgery waiting list kept growing.

Langabeer and Helton (2016) describe capacity in health care as perishable: an hour of staffed operating room time that is not used cannot be stored and sold later. They explain that scheduling systems exist to match that capacity to demand and that allocations should follow actual use and the variability of demand, not tradition. Block scheduling helps surgeons plan and keeps teams together, but when blocks are allocated by history and never released, the system protects the surgeon's convenience at the expense of the patients waiting and the hospital paying for idle rooms. The textbook's approach suggests two questions: how should blocks be sized, and when should unused time return to the pool?

On sizing, Hosseini and Taaffe (2015) note that the traditional method assigns blocks based on a group's average historical demand and present an algorithm that instead accounts for the variability of each group's caseload, balancing the cost of underused time inside a block against overtime beyond it. A group whose demand swings widely may need a smaller standing block plus access to open time, while a steady group can safely hold a larger block. On measurement, Abouleish et al. (2003) reviewed thirteen months of data covering 12,245 operations by 15 surgical services, and whether or not turnover time was credited, the same services were identified as underusers and overusers of their blocks. That finding matters politically, because it removes a common objection, that utilization numbers are unfair, and allows the hospital to adopt one transparent formula for every service.

Using those findings, I proposed three rules. First, any block time not booked 72 hours before the day of surgery is released automatically to an open scheduling pool. Second, every quarter, services whose adjusted utilization falls below 75% for two quarters lose part of their block, and services above 90% become eligible for more, with allocations sized by each service's demand variability. Third, one room each day remains open for urgent cases and released time, so general surgeons always have a path.

The orthopedic group will likely argue that its demand is seasonal and that a release rule will cost it time it needs in winter. The variability-based sizing answers that concern directly, since a seasonal service can hold a smaller standing block and draw on open time in its busy months. To keep the orthopedic surgeons engaged, the policy applies to every service equally, uses the same published formula and gives each group its own utilization report monthly, so no one is surprised by a reallocation.

Jesus noticed guests choosing the places of honor at a feast and advised taking the lowest place, since the host might say, "Friend, move up higher," while the one who claimed the best seat might be asked to give it up (English Standard Version Bible, 2001/2016, Luke 14:7-11). A reserved seat left empty while others stand at the door serves no one, and a fair host gives it to someone who will use it.

Reply to Joy

Joy, your thread focused on a related source of lost operating room capacity: first cases that start late and push the whole day into overtime. You proposed setting deadlines for each preoperative task and posting start times publicly. Langabeer and Helton (2016) describe how a delay at the start of a sequential process propagates through every later step, so the first case sets the pace for the room, and your focus on it is well placed.

Two recent studies support your approach. Parikh et al. (2026) introduced explicit deadlines for perioperative tasks, known as a 5:10:15:20-minute model, along with feedback to late surgeons and central tracking boards at a level 1 trauma center. Across 14,609 patients, first-case on-time starts rose from 39.0% before the change to 74.0% after it, and with a five-minute grace period the monthly average rose from 54.8% to 83.2%. Saad et al. (2026) applied a structured execution model in Veterans Affairs operating rooms with a target of 85% on-time starts. Among 1,467 first cases, on-time starts averaged 76% at baseline, dipped to 68% early in the intervention and then rose to 87%, while weekly delay-related costs fell from about $5,000 to $3,000, an estimated $200,000 in annual savings.

The Saad study's temporary dip is worth noting for your plan. Performance can worsen while teams adjust to new deadlines and measurement, and leaders who expect immediate success may abandon an intervention just before it begins to work. Building that expectation into your communication plan could protect the project. The cost data are also useful when you present the proposal, since a finance committee will respond to a figure like $200,000 more readily than to percentages. You could estimate your own hospital's cost per minute of operating room time and multiply it by the minutes lost to late starts each month.

Paul urged the Ephesians to walk carefully, making the best use of the time (English Standard Version Bible, 2001/2016, Ephesians 5:15-16), and a punctual first case is a small but real way to use time well for the patients waiting behind it. One caution from both studies is to measure what the patient experiences, not only the time the incision begins. A case can start on time on paper while the patient waited in the preoperative area since dawn, so tracking the interval from patient arrival to incision alongside the start-time measure keeps the improvement honest. Staff morale deserves attention as well, since explicit deadlines and public feedback can feel punitive if they are introduced without explaining their purpose. The teams in both studies paired the deadlines with problem solving about why delays happened, which helped staff see the measure as a tool rather than a scoreboard. Would your surgeons accept public start-time data if every team's results were shown, including anesthesia and nursing?

Reply to Hector

Hector, your thread argued that most operating room improvement projects fade within a year because teams return to old habits once leaders move on, and you asked what makes start-time gains last. Langabeer and Helton (2016) emphasize that process improvements must be built into standard work and monitored, or variation returns. Two recent studies describe programs that held their gains over longer periods.

Glauser et al. (2026) used a Lean Six Sigma approach at a quaternary academic medical center from April 2024 to July 2025, building a perioperative checklist of the steps needed for an on-time start, a visual management board, daily huddles and shared responsibility across departments, with surgeon-level data shared with department leaders. The share of patients ready for anesthesia induction on time rose from 52% to 77%, incision times moved 7 minutes earlier and comparable cases ended 47 minutes earlier. The surgical team accounted for the largest share of remaining delays, 19.6%. Mitreska et al. (2026) applied a 12-step continuous quality improvement process with low-cost interventions at a tertiary metropolitan hospital and raised first-case on-time starts from an average of 20% to more than 70% within six weeks, with the gains sustained over 20 months.

Both programs share features that answer your question. They made the steps visible on a board and checklist, assigned ownership across departments rather than blaming one group and kept reporting results long after launch. Neither program relied on expensive technology, which means a community hospital can copy the approach. The Glauser finding that surgical teams caused most remaining delays also suggests that sustaining gains requires surgeon leadership, not only nursing and anesthesia changes. I would suggest that your hospital name a surgeon co-lead for any start-time project and keep the measure on the monthly operating room committee agenda permanently, so the result never stops being watched.

Paul told the Galatians to keep sowing what is good without losing heart, since the harvest comes to those who persist (English Standard Version Bible, 2001/2016, Galatians 6:9), and improvements in a busy operating room need that same persistence after the first success. It also helps to celebrate the plateau, not only the jump. Teams usually notice the dramatic improvement in the first weeks, but holding a 75% on-time rate for a year is the harder achievement, and recognizing it at department meetings tells staff that the steady discipline matters. When the rate slips, the review should look at the process first, asking which step of the checklist failed and why, before looking at individuals. That habit keeps the improvement from turning into blame, which is often what makes staff stop cooperating. Who would own the start-time measure at your hospital once the project team disbands?

References

Abouleish, A. E., Hensley, S. L., Zornow, M. H., & Prough, D. S. (2003). Inclusion of turnover time does not influence identification of surgical services that over- and underutilize allocated block time. Anesthesia & Analgesia, 96(3), 813-818. https://doi.org/10.1213/01.ANE.0000049690.93361.8B

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Glauser, G., Srivatsa, S., Steele, S., Guzman, J. A., Sulzer, K., & Augustin, T. (2026). The devil is in the details: Sustaining first-case on-time starts at a quaternary care center. Journal for Healthcare Quality, 48(3). https://doi.org/10.1097/JHQ.0000000000000518

Hosseini, N., & Taaffe, K. M. (2015). Allocating operating room block time using historical caseload variability. Health Care Management Science, 18(4), 419-430. https://doi.org/10.1007/s10729-014-9269-z

Langabeer, J. R., II, & Helton, J. (2016). Health care operations management: A systems perspective (2nd ed.). Jones & Bartlett Learning.

Mitreska, K., Tran, P., Grygiel, R., & Chircop, A. (2026). A practical model for improving first-case on-time starts performance. International Journal of Health Care Quality Assurance, 1-17. https://doi.org/10.1108/IJHCQA-03-2026-0080

Parikh, S., Corrado, T., Gnolfo, J., Khan, A., Stanely, S., Arrigo, A., DiRusso, C., Hoffman, D., Jorgensen, C., Knipe, M., Setaro, J., Murphy, P. F., & Bennett-Guerrero, E. (2026). Implementation of 5:10:15:20 minute model with improvement in first-case on-time starts. Journal for Healthcare Quality, 48(2). https://doi.org/10.1097/JHQ.0000000000000515

Saad, M., Gifford, C. G., Christopher, A., Hayes, D., Rodriguez, A., Robinson, N., Piantino, J., Meade, L., Czaplewski, T., Whybrew, D., Chang, T., Robles, J. A., & Slater, E. D. (2026). Optimizing first case on-time starts in Veterans Affairs operating rooms: A quality improvement initiative. American Journal of Surgery, 260, 117122. https://doi.org/10.1016/j.amjsurg.2026.117122