Using an at-risk salary model to improve throughput in academic medical center operating rooms.
OBJECTIVE
The objective was to analyze if an at-risk salary model for faculty anesthesiologists could improve on-time first case starts (FCSs) and case turnovers (TOs) in an academic hospital inpatient operating room (IOR) and ambulatory surgery center (ASC). Organizational goals were 65% and 70% on-time FCS and case TO times for IOR and ASC, respectively.


METHODS
This was a retrospective study.


METHODS
Surgical cases performed at both the IORs and the ASCs at a large academic medical center were included.


METHODS
We converted 5% to 7% (academic rank dependent) of anesthesiologist salary from guaranteed to an at-risk salary model. Salary was earned back on a case-by-case basis by starting cases on time or by documenting a valid reason for case delay in the anesthesia record. On-time first case and goal TO times were determined using American Association of Clinical Directors standard definitions.


METHODS
Data were reviewed for 1 year prior to implementation of the at-risk salary model and for 1 year after the implementation. Monthly average on-time FCS and TO times were compared between the preimplementation and postimplementation time frames. Data were analyzed using analysis of variance for repeated measures.


RESULTS
After the implementation of the at-risk salary model, the organization experienced a 33% and 86% improvement in on-time FCSs (P< .01) in the inpatient and ambulatory operating rooms, respectively. A 41% (IOR) and 44% (ASC) improvement in timely case TOs (P< .01) was also seen.


CONCLUSIONS
Anesthesiologists can drive efficiency in an operating room setting. By incentivizing on-time FCS and timely case TO with an at-risk salary model for faculty anesthesiologists, we were able to demonstrate a sustained significant improvement for these metrics. In both an inpatient and an ambulatory setting, operating room efficiency may be best served by aligning provider financial incentives with desired outcome metrics.
Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Ave, Mailstop B113, Aurora, CO 80045. Electronic address: Rachel.kacmar@ucdenver.edu.
Rachel M
RM
Kacmar
Department of Anesthesiology, St Mary's Medical Center, 2635 N 7th St, Grand Junction, CO 81501. Electronic address: Brian.davidson@sclhs.net.
Brian M
BM
Davidson
Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Ave, Mailstop B113, Aurora, CO 80045. Electronic address: matthew.victor@ucdenver.edu.
Matthew
M
Victor
Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Ave, Mailstop B113, Aurora, CO 80045. Electronic address: ken.bullard@ucdenver.edu.
Ken
K
Bullard
Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Ave, Mailstop B113, Aurora, CO 80045. Electronic address: jose.melendez@ucdenver.edu.
Jose
J
Melendez
D000046:Academic Medical Centers / Q000458:organization & administration*; D000072080:Anesthesiologists / Q000191:economics / Q000523:psychology*; D004526:Efficiency; D017598:Efficiency, Organizational / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D009873:Operating Rooms / Q000458:organization & administration*; D010816:Physician Incentive Plans; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits
At-risk salary model; Incentive; Operating room efficiency; Performance metric