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Tactical Decision Making for Selective Expansion of Operating Room Resources Incorporating Financial Criteria and Uncertainty in Subspecialties' Future Workloads

Dexter, Franklin MD, PhD; Ledolter, Johannes PhD; Wachtel, Ruth E. PhD, MBA

doi: 10.1213/01.ANE.0000149898.45044.3D
Economics, Education, and Health Systems Research: Research Report

We considered the allocation of operating room (OR) time at facilities where the strategic decision had been made to increase the number of ORs. Allocation occurs in two stages: a long-term tactical stage followed by short-term operational stage. Tactical decisions, approximately 1 yr in advance, determine what specialized equipment and expertise will be needed. Tactical decisions are based on estimates of future OR workload for each subspecialty or surgeon. We show that groups of surgeons can be excluded from consideration at this tactical stage (e.g., surgeons who need intensive care beds or those with below average contribution margins per OR hour). Lower and upper limits are estimated for the future demand of OR time by the remaining surgeons. Thus, initial OR allocations can be accomplished with only partial information on future OR workload. Once the new ORs open, operational decision-making based on OR efficiency is used to fill the OR time and adjust staffing. Surgeons who were not allocated additional time at the tactical stage are provided increased OR time through operational adjustments based on their actual workload. In a case study from a tertiary hospital, future demand estimates were needed for only 15% of surgeons, illustrating the practicality of these methods for use in tactical OR allocation decisions.

IMPLICATIONS: Financial information can be coupled with estimates of future surgical demand to predict the operating room (OR) workload of various subspecialties, providing valuable tactical information necessary for the design and outfitting of additional ORs. We show that data predicting future demand are needed for only a small percentage of surgeons, making this method practical for routine use.

Division of Management Consulting, Departments of Anesthesia and Health Management & Policy, Department of Management Sciences, College of Business, and Department of Anesthesia, University of Iowa

Franklin Dexter is the Director of the Division of Management Consulting within the Department of Anesthesia. He receives no funds personally other than his salary from the State of Iowa, including no travel expenses or honoraria, and has tenure with no incentive programs.

Accepted for publication October 21, 2004.

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to

© 2005 International Anesthesia Research Society