OR Manager - Vol. 25 No. 7 July 2009 - A toolkit for managing block scheduling

Sep 25, 2026

OR Manager Vol. 25 No. 7 July 2009 presents a toolkit for managing block scheduling in operating rooms developed by CA Inc. It outlines 10 decision points covering whether block scheduling is the right time, policy elements such as block utilization reporting, automatic block release enforcement, and advanced notice rules, plus governance structures, physician champion roles, grace periods, and tiered surgeon communication. Guidance also addresses blocked versus open time proportions and reserving OR capacity for first-come booking, emergencies, and case adjustments.

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OR Manager

10 decision points for block scheduling

Is it the right time for block scheduling?

Does your policy include key elements?

Is there a physician champion?

Is there a grace period?

How is utilization rate communicated?

Should ORs be reserved for first-come booking?

Is there an OR for add-ons, emergencies, and flip-flopping?

OR Manager Vol. 25 No. 7 July 2009 A toolkit for managing block scheduling CA Inc, the national health care company, has developed a block Hspcheduoints, lianglgotroitolkithmsffoorritsm16an5 hoaginsgpbitlalsock.sT, he tooand slakit includes dmple policiesecision Here are HCA Inc’s 10 decision points for block scheduling. Is this the right time for 1. block scheduling? About 75% to 80% of HCA Inc’s hospitals use block scheduling, estimates Stephanie Davis, RN, MS, CNOR, assistant vice president, surgical services for the HCA Clinical Services Group, Nashville, Tennessee, who developed the toolkit. If an OR isn’t using block scheduling, she suggests asking: “What are the reasons for not offering this service? Are those reasons still valid in today’s environment?” Not every OR decides to use block allocations.“If you don’t have a lot of volume and are trying to get every case you can, you might not want to rock the boat with the medical staff,” she notes. In some parts of the country,“surgeons are really anti-block,” says Jerry Ippolito, Jerry Ippolito, MBA, MHSA, director of perioperative services and pain management business development, Southeast Anesthesiology Consultants, Charlotte, NC. That can happen if they have had a bad experience. To some, block scheduling means “preferential treatment.” Surgeons may be more receptive to another term, such as “reserved time,” he suggests. An OR schedule with all open time has its own problems, he adds. Open time favors surgeons who perform mostly elective cases, such as ENT and ophthalmology, and can schedule far in advance. Even in an OR with all open time, surgeons tend to establish patterns that are, in effect, like block time. Leaders may have success getting the surgeons to accept block scheduling if they show them data demonstrating that their cases already fall into regular patterns, he suggests. How much time should be blocked? Typically, 55% to 80%, though how much open time to offer depends on the situation, Ippolito says. A high-volume trauma center can’t allocate as much time as an OR with a more predictable caseload. How much time to leave open is also a strategic issue. Amore mature setting may have 80% to 85% of its time blocked, while a facility trying to attract new surgeons will want more open time available. OR Manager Vol. 25 No. 7 July 2009 2. Does your block scheduling policy include key elements? Davis suggests key elements of the policy should include: • A block utilization rate is calculated monthly and reported to each surgeon quarterly. The toolkit recommends a block utilization rate of 70%. But thereis no hard-and-fast rule, Davis says. “It’s up to our facilities to set the level they think is appropriate.” Davis says monitoring of blocks requires discernment: “Your OR governance team has to look at each situation and be able to back up its decisions with facts.” (From a scientific point of view, adjusting blocks according to utilization isn’t the best choice, notes a leading researcher, Franklin Dexter, MD, PhD. See related article, p 11.) • Automatic block release times are stated and enforced consistently for all surgeons. In a general OR with a lot of specialties, a 72-hour release is appropriate, Davis says.“Some will argue 48 hours is better; others will argue 1 week. You have to decide with your group what fits.” One option is release times by specialty (sidebar). • The policy states that if a surgeon notifies the OR in advance to release block time, unused time will not count against the surgeon in the block utilization report. Advanced notice allows other procedures tobe booked into the unused time. 3 Is there a physician . champion? Blocks are best managed by an executive committee made up of the OR director, the administrator responsible for surgery, the chief of surgery, and the chief of anesthesia. “Everyone on the committee has a vested interest in making block scheduling work,” Davi

FAQs

What factors determine whether block scheduling is the right approach?

About 75% to 80% of HCA Inc’s hospitals use block scheduling, but leaders should consider local acceptance, surgeon experience, and whether there is sufficient volume to justify blocks without disrupting medical staff.

What key elements should a block scheduling policy include?

The policy should define monthly block utilization reporting (toolkit recommends 70%), set and consistently enforce automatic block release times, and specify that unused block time released with advance surgeon notification does not count against utilization.

How should block scheduling performance be communicated and reinforced?

Utilization should be communicated to each surgeon quarterly using a tiered approach (congratulation for 70%+; actions requested for 70% to 50%; privilege loss if below 50% and not improved by the next quarter), supported by OR governance review and a physician champion.

Sep 25, 2026

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