are patients saying about your facility? How are your surgeons’ websites and web presence?

Optimal Utilization

This is truly the holy grail. Let me know if you find it, because in my experience, this is virtually impossible to achieve consistently.

Optimal utilization occurs when all of your ORs are starting at 7:30 am, you have short turnovers, surgeons are on time, cases are consistent, patients are thin and healthy, there are perfect gaps of 15 minutes at 10:00 am and 30 minutes at 12:00 pm and all cases end at 3:00 pm, which allows all employ- ees to leave 15 minutes later. Okay, wake me up.

This type of facility closely resem- bles a small one- or two-OR single- specialty ASC with four physicians who work there consistently with con- sistent practices. These metrics are nice to have but rare.

Over-Utilization Is over-utilization a good problem to have? For everyone out there who is in a center that is underutilized, read on. The grass is not always greener on this side. An over-utilized center has ORs that are continually humming, busy from 7:30 am to 6:00 pm however, there might be significant underlying problems. First, what are the cases you are

doing? What is the insurance mix? What are the costs to do these cases? In other words, how much are these cases contributing to your bottom line? Filling up your ORs is great, but if the cases are costing you money to per- form, don’t perform them, unless the physicians performing those proce- dures are contributing in other ways, for example, with more lucrative cases. Second, as your ORs see increased utilization, your schedule gets more unpredictable as you go later into the day. Cases run over, equipment gets tied up, and these situations impact start times and surgeon and patient


Is over-utilization a good problem to have? For everyone out there who is in a center that is underutilized, read on. The grass is not always greener on this side.”

—Arne Brock-Utne, MD Issio Solutions Inc.

satisfaction. Who likes a delayed sur- geon? If you have ever had a patient write a bad review on Yelp, you already know that these situations are not fun. Studies have shown that the higher your utilization, the more these kinds of events will impact you. Finally, your staffing costs and impact on employees have to be exam- ined closely. Your operating theater (OT) costs may go up. Employee turnover will increase. People get tired of com- ing home at 7:00 pm day after day, and they will look for work elsewhere. High turnover drives high recruitment costs. Every time your ORs run past 3:00 pm, the clock is running, not only on over-

time, but also on your employee turnover rates. How do you mitigate this? Reward your employees on those extremely busy days. Get pizza in for everyone, hand out gift cards, etc. People will appreci- ate those gestures more than you expect. There is a lot to think about with utilization, and a lot of those things may be out of your control. As they say, don’t worry about those things, worry about the things you can control and hit those hard.

Arne Brock-Utne, MD, is the president of Issio Solutions Inc. in Concord, California. Write him at

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