Baseball and Blocks: Optimizing Complex Schedules

By Michael Donoghue

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With the 2010 Major League Baseball season opening up this month, I thought it might be interesting to reflect on how the season schedule was created. Creating a unique schedule of 2430 games for 30 teams in a 180-day window covering 3100-mile landscape is not a trivial exercise. Add to that, special team requests, travel logistics and network preferences. (It is no coincidence that the Yankees opened the season against the Red Sox at Fenway Park (Sox-9 Yankees-7)) When speaking to clients about creating an optimized Surgical Block Schedule, we often compare it to the creation of the MLB schedule. Just as networks like to air rivals on Sunday night and teams like to host games on the fourth of July, surgeons like to operate at specific times on specific days. Filling all the requests can be a difficult task. An optimized surgical block schedule requires not only sophisticated constraint modeling to create but also efficient processes and strong governance to optimize.

The optimum amount of time that should be allocated in a block schedule is different for every hospital. Each institution must consider a myriad of constraints when designing a block schedule. A trauma center with a high volume of emergent cases would have different requirements than a cancer institution without an emergency room. The block time might be 70-80% for the trauma center whereas the cancer institution could allocate over 95% of time. Some facilities may want to separate emergent from non-emergent patient streams. Equipment, room, and anesthesia requirements and time for open booking can also be important to consider. We all know that mother nature doesn't cooperate and the baseball schedule created is not ever the schedule played. In the operating room, variable surgeon case loads, cancellations and other issues make it difficult to completely control the utilization of OR time however there are a few things related to processes and governance all facilities can do to optimize the utilization of the surgical schedule.

Starting the first case of the day on time and minimizing the time between cases (room turnover time) are crucial to maintaining the predictability of the schedule and the satisfaction of the surgeons.  A 30-minute delay in the first case of the day represents 5 points of utilization that cannot be gained back. The room turnover time when a physician follows himself or herself can be 25-30% shorter than with a different surgeon to follow. Combine late first cases with delays between cases and you have a very expensive asset that is sitting idle and dissatisfied surgeons who could take business elsewhere or tend to more predictable activities (rounding, office hours) while staff waits for them. Creating a culture of accountability for surgeons and staff may be slightly more difficult than controlling the movement of an August thunderstorm in Miami during a Marlins game.

Strong governance in the OR is the most important ingredient to maintaining an optimized block schedule and surgical suite utilization. (see Governing Your Governance Policy at A solid governance structure provides visibility to key metrics such as surgeon block utilization, first case starts and room turnover time and outlines policies and procedures to help drive behavioral change.

While the 2010 season kicks off this month with a unique schedule, things will happen every day that threaten to sub-optimize the season. Everyday occurrences in the OR happen as well. Optimizing the OR block schedule requires the combination of intelligent scheduling, streamlined processes and effective governance. Pitching and defense helps too.

Comments (2)

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  • JB April 21, 2010 5:30 PM


  • GJ June 5, 2012 2:56 PM

    Wicked good article...