DIGITAL TRANSFORMATION OF CORE OR PROCESSES AT

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DIGITAL TRANSFORMATIONOF CORE OR PROCESSES AT35 2000 500KHealth SystemsOperating RoomsROI per OR per Year

ProblemSolutionOhioHealth is a family of not-for-profit hospitals and healthcare facilities inThe Surgical Services Leadership Team partnered with LeanTaaS toCentral Ohio. Serving patients since 1892, Riverside Methodist Hospital inimplement iQueue for Operating Rooms. iQueue’s Exchange and CollectColumbus, Ohio, is a 1,059-bed teaching institution and the largest hospitalmodules helped transform traditional business operations at Riverside toin the OhioHealth system. The flagship hospital shares the OhioHealthdrive increased access and enhance accountability for the use of allocatedmission “to improve the health of those we serve”. It is recognized locally,block time:regionally and nationally for quality healthcare and consistently ranked oneof the nations best hospitals.In trying to increase access to the operating room and accountability for theuse of allocated block time, the Surgical Services Leadership Team had toconsistently balance surgeon satisfaction with a focus on achieving operatingmetrics (volume, utilization, growth). The leadership team perceived thereto be significant operating capacity and unused block time, but had littleinsight into where the opportunities existed. Furthermore, previous blockExchange identified and exposed the inventory of open time to surgeonsand their clinic schedulers. Based on historical booking patterns, Exchangewas able to identify surgeons who had not booked cases into their block andproactively remind them to release potential unused time. After inventorywas exposed, the “OpenTable” feature allowed for immediate access toavailable operating time for surgeons who did not have allocated block orneeded additional operating time.management approaches, based on broken metrics like block utilization,Collect provided the leadership team with a surgeon centric metric tomade it challenging to hold surgeons accountable for unused block time. Inevaluate the performance of all block owners. The module mined patternsorder to drive the right outcomes at Riverside, the leadership team knew theyof OR usage by block owner and identified portions of time that could trulyneeded a solution with embedded predictive and prescriptive analytics thatbe repurposed or “collectable”. It allowed the leadership team to repurposewould help transform core operational processes.unused block time without impacting surgeons existing case volume.ResultsLess than 6 months into the partnership, OhioHealth Riverside Methodist Hospital reportedboth increased capacity, access and accountability.211,00062,000Minutes of capacity releasedthrough ExchangeMinutes of operating time requested through Exchange(50% of top beneficiaries were surgeons without block time)(Equal to more than 422,000 minutes ofreclaimed capacity annualized)(Assuming a 60% utilization, 62k minutes corresponds to 5.58 million in revenue)13012Number of blocks identified using CollectNumber of blocks a month repurposed using Collect(Opening a strong opportunity to increaseshare of wallet with non-employed physicians)(Creating opportunity to re-allocate to new andexisting surgeons)info@leantaas.comwww.leantaas.com

ProblemUCHealth’s hospitals and clinics have been trusted health caredestinations for generations of Coloradans. Today, based on fourconsecutive years of recognition of its superior nursing processes andquality patient care from the American Nurses Credentialing Centerand its ranking as one of the top 15 hospitals in the country by US Newsand World Report, UCHealth hospitals are uniquely positioned tomeet the health care needs of families throughout the Rocky Mountainregion and the entire United States.Previous rapid improvement events focused on first-case-on-timestarts and turnover times had not significantly improved utilization ina substantive, sustainable manner. Leadership knew their volume waslikely to continue to increase before new ORs could be built. Feeling asense of urgency and pressure to increase OR utilization with a scalableapproach, UCHealth turned to LeanTaaS, a partner with whom they hadworked with to improve operations in its 10 infusion centers.SolutionUCHealth partnered with LeanTaaS to deploy iQueue for OperatingRooms’ Exchange and Analyze modules throughout 25 inpatientand 8 outpatient ORs at their metro Denver location at Universityof Colorado Hospital. After seeing the impact those two moduleshad on improving their utilization, UCHealth extended its use of thesolution to its other community hospitalsand ambulatory surgery centers. iQueue forOperating Rooms’ modular approach allowshealthcare providers the flexibility to deploymodules individually or in any combination.With access to data-driven performancemetrics and the ability to release and/orrequest block time without an endless seriesof phone calls, emails, and faxes, UCHealthsurgeons have enthusiastically embracediQueue for Operating Rooms.Results47%10%Median increase in blocksreleased per monthEarlier block releases4% 400kIncrease in ORutilizationEstimated additional revenueper OR per year

ProblemSolutionMultiCare is a not-for-profit health care organization caring for theWashington State community for well over a century. Consistentlyranked as one of the nation’s Most Wired health care organizationsby Hospitals & Health Networks magazine, MultiCare is committedto providing outstanding care to residents of the Pacific Northwestthrough its eight hospitals, as well as through its robust network ofprimary, virtual, urgent and specialty care services.Working with their LeanTaaS counterparts, MultiCare executives andphysician leadership initiated a pilot program to:MultiCare schedulers, administrators and department chairs wereburdened with reconciling the needs for more OR access and the day-today constraints limiting surgeon satisfaction. Leadership was also awarethat the prerequisites for attracting new surgeons and accommodatingthose already hampered with a significant backlog was reaching atipping point. MultiCare leadership needed a scalable, cost-effectivesolution that would address these challenges, maintain their innovativebrand and ensure a strong return on investment. MultiCare turned toLeanTaaS, with whom they had worked to overcome challenges in theirMultiCare Tacoma General Hospital Infusion Center. Reduce the number of fully blocked operating room schedules Accommodate new surgeons and day-of add-on cases Eliminate surgeon case backlogsIn February 2018, MultiCare deployed iQueue for Operating Rooms’three modules: Exchange, for releasing and requesting open time via any webbrowser, mobile or desktop Collect, for reviewing the real-time block supply table, and Analyze, for immediate reporting of OR utilization.Less than four months following the pilot’s launch, the results revealedthat 75 active clinic schedulers and over 77 surgeons – out of the 100active – had participated in an Exchange transaction. Within the nextseveral months, iQueue for Operating Rooms enabled thousands ofblock transactions and reclaimed millions of dollars of block time.ResultsResults extracted from first 4 months of pilot throughout 34 MultiCare Operating Rooms50%3XOf beneficiaries were surgeons without block timeMinutes released(Drastically increasing total numberof requests and overall share volume)(Allowing more than 93,000 minutes ofOR time to be requested and reclaimed)20 35%Blocks reclaimed per quarterFewer exclusively unused blocks(Enabling hundreds of new and existing surgeonsto be afforded OR access per quarter)(Promoting higher OR utilizationand department transparency)info@leantaas.comwww.leantaas.com

OverviewProblemParkview Medical Center is a community hospital basedParkview Medical Center faced a series of challenges that contributed to decreasedin Pueblo, Colorado, offering general acute healthcare andefficiency in their operating rooms. These included:behavioral health specialty services. Inaccurate performance metrics due to non-standard EHR workflows. The processAs a private, non-profit organization, Parkview is licensedof compiling and validating manual reports was far too cumbersome, and as afor 350 beds and provides a full range of healthcare servicesresult, there wasn’t a credible set of KPIs that could be used to make decisions.including the region’s only certified and verified Level IITrauma Center as well as the region’s first certified Stroke No existing mechanism to right-size block time. Block utilization data was notcredible, and prevented the OR Committee from being able to identify low-Center.performing block owners. This made it difficult to find additional OR time forParkview Medical Center is the leader in cardiac, women’s,emergency, and neurological services as well as behavioralhealth programs. As a vital healthcare source, Parkview’sservice area includes Pueblo County and 14 surroundingcounties, which together represent 350,000 total lives.physicians with growing practices, as well as for new physicians. Limited access to available open (first come first serve) time that required severalback and forth phone calls with OR scheduling. This would result in affiliatedsurgeons potentially losing potential patients to other neighboring markets.SolutionParkview Medical Center has always been a leadingEach of iQueue for Operating Rooms’s three modules has provided tremendous value forhealthcare innovator in the Pueblo community, and inParkview. The Analyze module has, for the first time, given the leadership team timely,searching for an innovative solution to the problems theyactionable metrics based on credible data. Given the way that Parkview had set up theirfaced in their operating rooms, they partnered with LeanTaaSEHR, they weren’t able to extract meaningful data from it. But through working with theto deploy iQueue for Operating Rooms.iQueue team in the implementation phase, Parkview is now able to capture their keyperformance metrics as intended, and are able to understand the true nature of their ORThey initially launched the product in February 2018 for theperformance.12 ORs on their main campus and saw the following results inThe Collect module allowed Parkview to establish an independent block committee fortheir first year using iQueue:block management, and gave them a powerful, surgeon-centric metric for right-sizingblock allocation in the form of collectable time. With collectable time, Parkview was ableto make data-backed decisions about which block owners they should take time away1511blocks per monthreleasedblocks per monthrequestedfrom in a way that didn’t impact existing case volume.Finally, the Exchange module has provided visibility into the inventory of open time in theOR which has made it far more liquid and accessible. iQueue has significantly streamlinedthe scheduling process at Parkview, which has been a huge satisfier to both the physicianand patient populations. In the words of Dr. James Caldwell, Medical Director of SurgicalServices at Parkview: “Exchange has made the surgeons so happy, and we’re gettingpatients in faster, so it has increased surgeon satisfaction, increased patient satisfaction,2120%day average blockrelease lead timedecrease in minutesfrom entirely unusedallocated blocksand has made the whole scheduling process outside of normal block time smoother. It hasfixed so many problems and streamlined our systems so much.”Parkview was so happy with the results of their initial implementation that they decidedto expand the scope of the tool to serve their outpatient and endoscopy centers, bringingthe total number of ORs using iQueue for Operating Rooms from 12 to 20. The partnershipbetween LeanTaaS and Parkview is poised to be a success in the years to come.

ProblemSolutionDignity Health is the fifth-largest health system in the nation and the largestSequoia Hospital partnered with LeanTaaS to deploy iQueue for Operatinghospital provider in California. Its network of community hospitals spansRooms’ three modules across their 12 ORs.California, Arizona, and Nevada and collectively includes over 250 operatingrooms. Dignity Health’s Sequoia Hospital in Redwood City, California, is a 12OR facility that serves the larger Peninsula community. As is true with manycommunity hospitals, Sequoia’s surgeons are not directly employed by thehospital, and perform their surgeries across multiple facilities.Sequoia Hospital partnered with LeanTaaS with the following operationalchallenges in mind: The Exchange module has increased the total inventory of open timeacross the hospital and exposed that inventory to the broader surgeonpopulation, allowing those looking for time to easily find it and bring moreof their individual case volume to the hospital.The Collect module has introduced a far more surgeon-centric way ofthinking about how well block time is being used, and has helped ORadministration re-purpose block time while leaving block owners enoughSurgeons felt that it was hard to find time to schedule cases at Sequoia,time to meet their existing case volume. The methodology is now anand would take their volume elsewhere.established best practice for Sequoia Hospital’s block committee meetings.OR administration was unable to repurpose any poorly used blockThe Analyze module has enhanced the visibility of key performance metricstime.in the OR, vastly improving the management team’s ability to monitorPerioperative leadership lacked visibility into what was truly happeningperformance in a timely manner with credible data. It has also helpedinside the ORs, and how well they were being utilized.surgeons engage with their data, creating a culture of data-drivenness.ResultsThe following results were calculated by comparing the six month period post-iQueue launch tothe analogous six months in the previous calendar year.10%3%Percentage point increase in block utilizationPercentage point increase in prime time room utilization44%2XPercentage decrease in minutes from entirely unused allocated blocksIncrease in released minutesDignity Health Corporate Leadership saw the immense benefit of iQueue for Operating Rooms at the Sequoia location, and ultimately made the decision toimplement the product across 35 of its hospitals and 250 ORs in California, Arizona, and Nevada. The partnership between Dignity Health and LeanTaaS ispoised to be a huge success in the years to come.info@leantaas.comwww.leantaas.com

ProblemPortland-based Oregon Health & Science University – the only academichealth center in Oregon – focuses on improving the health of all Oregoniansand is dedicated to advancing the health sciences. OHSU’s 16,000 employeesconcentrate on research to prevent and cure disease, on education thatprepares physicians, dentists, nurses and other health professionals tosucceed in an evolving health care environment, and on patient care thatincorporates the latest knowledge and discoveries.OHSU faced a shortage of available block time to allocate to new surgeonscoming on-board at its South Operating Rooms (SOR) and DoernbecherChildren’s Hospital (DCH). Surgical services lacked visibility of availableblocks; all block owners operated independently and there was noaccountability for inefficient block owners. To compound matters, therewas no “single source of truth”; unclear metrics and the lack of standardizedrelease times for blocks fomented a lack of trust in the performance metricsby which surgeons were being evaluated. Before deploying iQueue forOperating Rooms, OHSU assumed – as many hospitals do – that the keyto solving poor prime-time utilization patterns meant improving on theirfirst-case on-time start delays and turnover times.SolutionBy deploying iQueue for Operating Rooms at SOR and DCH, OHSU hopedto improve access to the OR, increase the accountability of its surgeonsfor their use of their allocated time, and add transparency through a set ofobjective, data-driven performance metrics that eliminated ambiguity andhelped surgeons develop trust in their key performance indicators. A majorthrust of the effort was also to adopt a new framework for measuring ORutilization that focuses on Collectable Time – segments of time in which acase could have been scheduled but wasn’t – and on scheduled downtimeto drive OR utilization upwards.ResultsOHSU has experienced a 1% year-over-year increase in prime time utilization, a 5% increase in staffed room utilization, a 5% year-over-year increase in blockutilization, and a corresponding 51% drop in completely abandoned blocks. Collectable Time has steadily decreased, as more surgeons now release time they knowthey can’t use and other surgeons claim that open time for their cases. Now, for example, OHSU’s Block Review Committees can put a block owner on notice andsee dramatic improvement much faster than ever before. For example, a urology block owner was able to drop their collectable blocks from 6 to 3 in a matter oftwo months, using the data from iQueue to drive change in their scheduling practice. iQueue for Operating Rooms data now supplements existing infrastructure,helping perioperative leaders determine when to proactively close ORs when hospital is at high census.As a collaborative partner with LeanTaaS, OHSU has taken an active role in working with the LeanTaaS team to brainstorm and develop new features, including anAvailability Alerts management portal feature that automatically notifies surgeons when OR time matching their needs becomes available.251%5%5%51%additional cases permonth in prime time(Main OperatingRooms)increase inPrime TimeUtilizationincrease inStaffed RoomUtilizationincrease inBlockUtilizationreduction inabandonedblocks

ProblemSolutionBaptist Health is a nonprofit, mission-driven healthcare system in theBaptist Health Jacksonville partnered with the LeanTaaS team togreater Jacksonville, Florida area. The system includes 5 Magnet-designatedimplement iQueue for Operating Rooms initially across Baptist South’s 11hospitals with 74 operating rooms and 14 endoscopy suites. Opened in 2005,ORs.Baptist Health Medical Center South includes 11 ORs and is consistentlyrecognized both regionally and nationally for providing high-quality patientcare.The Exchange module encouraged block owners to release time that theydid not plan to use. Baptist could then advertise the newly open time usingthe “OpenTable” feature to maximize utilization of available OR time.When trying to increase access to Baptist South’s ORs, surgical servicesleadership faced several challenges:The Collect module allowed surgical services leadership to assess blockusage in a surgeon-centric, defensible manner. They were able to identifyThe block schedule had limited open (first come, first served) time, makingopportunities to repurpose “Collectable” block time without negativelyit challenging for surgeons without block time or needing additional time toimpacting surgeons’ practices.access the OR. When there was time open and available in the OR, there wasno easy way to advertise the time to surgeons and their schedulers.The Analyze module gave both leadership and surgeons deep visibilityinto one source of truth for key operational metrics. Surgical servicesWhen trying to reallocate block time, surgical services leadership found itleadership used this data to identify specific opportunities to improvedifficult to make defensible decisions using traditional methods of measuringOR efficiency and take targeted actions. Surgeons were able to accessblock utilization.their data anytime on both mobile and desktop, allowing them to betterBoth surgeons and leadership had limited visibility into operational metrics.understand their OR usage.Acquiring reports often took a significant amount of manual work, and it wasnot easy for surgeons and leadership to see detailed data when desired.ResultsOne year after launching iQueue in October 2019, Baptist Medical Center South realized the followingimprovements in access to OR time across 11 ORs when compared to the previous year.11%8%Percentage point increase in block utilizationPercentage point increase in prime time utilization excluding thethree month period impacted by COVID57%25Percentage decrease in abandoned blocksDays average lead time for released time, allowing time foradditional cases to be scheduled into released timeBaptist leadership saw the measurable value realized using iQueue, and iQueue has since rolled out to 74 ORs and 14endoscopy suites in the Baptist Health Jacksonville system.info@leantaas.comwww.leantaas.com

What Your Colleagues Are Saying“iQueue is a far more scientific way of managing OR capacity andcreating access to OR time, accountability for block time, andtransparency into operating metrics. OHSU deployed iQueue forOperating Rooms in October 2018. From start to finish, the processtook less than eight weeks. On day one of the go-live, there weremore than 100 transactions to request and release OR block time.In fact, we have unlocked more OR time within the first week ofusing iQueue than we had in an entire year. The changes to ourcore processes for release and request, block rightsizing, andtransparency into the metrics is exactly what we needed. This is thefuture of OR capacity management.Dio SumagaysayAssociate Chief Nursing Officer“““It will allow for very immediate – almost ‘live’ – access to usagedata related to my block time in the OR, and will let me see if I ameffective in using the alloted time.Jens Peter Witt, MDAssociate Professor, Neurosurgery-SpineExchange has made the surgeons so happy, and we’re getting patientsin faster, so it has increased surgeon satisfaction, increased patientsatisfaction, and has made the whole scheduling process outsideof normal block time smoother. It has fixed so many problems andstreamlined our systems so much. Without Exchange, we’d be deadin the water again.Dr. James Caldwell, MDMedical Director of Surgical ServicesI can’t speak enough about the team. The iQueue team has beentremendous. There is one-on-one training with staff. They havereached out to every office, spoken to every staff member, givenus resources to give them just in case. The iQueue team has beenso responsive. There is continuously communication between myscheduler and the iQueue team in real time.Roseann DiBrienzaDirector of Perioperative Services

What Your Colleagues Are Saying“The tools streamlined surgeons’ and their offices’ abilities to findopen time and how open time was advertised, and made it very easyfor surgeons to proactively release any block time that might notbe needed far enough in advance to where it can be efficiently filledby another surgeon. This has not only helped our existing surgeonseliminate their case backlogs, but also has provided ease of accessto open time for surgeons who were looking to bring new or morecases to MultiCare.Dr. Michael Myer, MD, MBACardiothoracic Surgeon and Physician Executive“““In the past, the clinic scheduler would need to call the surgeryscheduler, which slows down the process for our patients. iQueueautomatically factors in when an operating room will be free and it’san incredibly efficient way to grab up open time.Kim CombsManager of Surgical SupportWe are excited to utilize iQueue for our operating rooms becauseit gives us access to data that we previously did not have. iQueueenables us to have a better understanding of our true capacityand where we have opportunities to optimize our operating roomutilization.Leslie BarrettPresident and Chief Operating Officer,Novant Health Medical Park HospitalLeanTaaS’ technology predicts when blocks will be underutilized andenables surgeon offices to release them sooner than auto-releasedeadlines, so a large pool of shared open time can be created. LikeOpenTable makes it easy to book restaurant tables, their tools wouldmake it really simple to see open OR time anytime, anywhere, and askfor it. The data availability and transparency to everyone involved inmeeting our goals [have] been critical in our collaboration efforts inpolicy writing and adoption.Dr. William MarxMedical Director of Perioperative Services

CONTACT USfor a no obligation demoinfo@leantaas.comwww.leantaas.com

OhioHealth is a family of not-for-profit hospitals and healthcare facilities in Central Ohio. Serving patients since 1892, Riverside Methodist Hospital in Columbus, Ohio, is a 1,059-bed teaching institution and the largest hospital in the OhioHealth system. The flagship hospital shares the OhioHealth

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