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Department of Anesthesia; Division of Management Consulting; Departments of Health Management and Policy; University of Iowa; Iowa City, IA; franklin-dexter{at}uiowa.edu
In Response:
There are multiple stages of operating room (OR) managerial decision-making. (a) Strategic decisions are made years before the day of surgery. (b) Tactical decisions are made many months before the day of surgery. For example, an 8-h "session" or "block" is planned for an orthopaedic surgeon on Mondays. (c) Staffing decisions are made based on the expected OR workload from stage (b), 2 or 3 months before the day of surgery, as reviewed in our article (1). (d) Cases are scheduled into the hours from stage (c).
The usefulness of the service-specific staffing decision (c) is sensitive to the preceding strategic (a) and tactical (b) decisions (1). Pandit et al. (2) ask whether the statistical methods for providing recommendations regarding stage (c) "might apply to the more socialized or centrally-funded and managed health services in the United Kingdom (UK)." Yes, the methods are valid (i.e., give the right answer). However, their usefulness depends on the decisions (a) and (b) (see last section of Ref. 1). The method of service-specific staffing that we reviewed was by day of the week, which is always valid. Less staffing is needed to complete the cases that the facility currently completes by changing the workdays on which surgeons work (3–5).
Pandit et al. state that "to change staffing to match the reality of the workload ... cannot be enacted in the UK because the National Health Service (NHS) cannot, or will not, meet the additional staff costs that are necessary ..." That is an issue of strategic and tactical decision making (6,7), and has nothing to do with our article (1). From the Definitions, "OR workload for a service is its total hours of cases including turnover times" (i.e., the cases that were performed, not a single extra case). Since surgery cannot be performed without staff, the staff must have been present. The method that we reviewed can always be applied, because the cases analyzed are those that were performed. The report by Pandit et al. (8) that 42% of 8 h lists take longer than 8 h 20 min shows quite nicely that the staffing at their studied facility was not 8 h¡ The methodology that we reviewed (1) or the concomitant version among workdays (3–5) may be useful at their studied hospital.
Finally, Pandit et al. state that "at least one problem" with the inefficiency of use of OR time is that "the proposed formula will always yield a higher absolute value for inefficiency for a larger center." Yes, and that is why I am unaware of any suggestion that the efficiency of use of OR time be used to compare hospitals. Rather, it should be used to compare a manager to the best that he or she could have done in retrospect, as we referenced throughout our article (1). Comparison among hospitals can be made using productivity, defined as the ratio of OR (anesthesia) workload divided by labor costs (1).
REFERENCES
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