The Electric GOMER Block Utilization Policy

“The House of God”, Hospital Analytics & Strategy.

Samuel Shems’ 1978 book “The House of God” is a cynical semi-autobiographical expose of medical residency training.  In the book, the chief resident known as “The Fat Man” is showing the new interns “The electric GOMER bed”.   The purpose of this bed is to get patients to present any blood pressure the residents need in order to either discharge or admit the patient.  By changing the tilt and height of the bed, residents can essentially control the outcome of blood pressure measurements.

We sometimes see similar behavior with surgical block metrics.  There are so many different policies to evaluate how well surgeons are using their assigned blocks and each hospital seems to have a few new ones.  The most common policy is “room agnostic” – this means the scheduled room assigned a surgeon on the day of surgery is not the actual room the surgeon operates.  So if a surgeon is assigned room 15 and they operate in room 18, the surgeon should still get credit for having used room 15.  At most hospitals, most rooms, or groups of rooms, are interchangeable, so this policy makes sense.

From here, policies go in many different directions.  Adding in block release policy as well as variations in turnover time policy can produce wide variations in surgical utilization.  Double-booked, flipped rooms, multiple cases, and multi-surgeon surgeries further complicate a clear narrative of how well surgeons are using blocks.

Similar to the electric GOMER bed, cynical use of block policy can produce any block utilization a surgeon or service desires. Services that need more block time can usually find a consultancy or analyst who can navigate a path through the thicket of policy options to the desired outcome.  OR Executive committees that make block policy decisions can be faced with different reports from different services and practice groups, each showing the need for more surgical block.

Hospital IQ cloud-based block metrics platform has no magic that makes it immune to this manipulation.  But by applying the same policy to all services and surgeons, it makes sure all comparisons are on a level playing field.  Individual practice managers have full control to experiment with different policy selections and this is a good thing – correctly used, the policy should reflect the shared cultural and clinical expectations of an institution.  These policies are then shared with OR Executive committees with full transparency.  A policy configuration that shows a service needs more time might show another service needs even more time.  OR Executive committees are not forced to make apples-to-oranges comparisons when different groups apply different metrics to achieve departmental block allocation goals.  

There will always be actors who play by the rules to game the system.  By providing data-backed transparency, everyone can see how the sausages are being made.