You’re looking at your charts and your idle operating rooms and thinking of ways to increase utilization. You’re already running campaigns to attract more elective surgeries in your hospital, but your specialists are already full. 

So you turn to surgeons outside of your network. Like many directors, you’re probably asking how to attract them. Getting teams to go out and recruit seems like a good idea, but actually getting them to schedule is another problem.

And if partner surgeons don’t have a good experience booking rooms, they have no reason to book your facilities and you could easily lose them to your competitors.

While working with Navicent Health, a 600-bed, 60+ O.R. hospital in Georgia, we discovered that their out-of-network surgeons still relied on fax and phone calls to find available schedules. Their manual process left plenty of room for costly scheduling errors and lots of back and forth between the surgeon’s own clinic and the hospital—which meant that patients had to wait up to two weeks for a knee joint surgery date.

To help make the scheduling experience better, we helped them put in place a surgery portal where the out-of-network surgeon, once credentialed, could easily book operating rooms. The system allocates a slot based on availability of room, equipment, staff so that the surgeon and their staff can immediately know the schedule and tell the patient about it in as little as two hours.

One consequence of the digital transformation we helped the hospital undergo is their ability to capture data about the surgery bookings—including trends, expected vs actual surgery duration, cancellations, and more. With this data, they generated insights that helped improve their schedule allocation to reduce delays, avoid costly scheduling mistakes, and improve OR utilization. With over 20,000 requests made through the portal, the hospital generated millions of dollars of additional revenue.


While there are plenty of ways to improve OR utilization, improving how partner surgeons book your OR facilities could hold the key to improving your utilization rates while building stronger bonds with partner providers.

Anyone who’s ever called up a large organization knows the pain of waiting for an agent to answer while insincere slogans about valuing you repeat ad infinitum. Calling again doesn’t solve the problem because it’s hard to catch the right time when there are enough agents. If the caller ever reaches the agent, they take out on the agents all the pent up anger from the waiting.

What you don’t want is for this to be the experience in your hospital or health organization’s call center. But even call center directors with the best intentions will find wait times a challenging problem to solve. Hiring more agents to match peak level demand would leave them idle during non-peak times and become an unsustainable option in the long run due to high labor costs.

This was the dilemma of one hospital we worked with. They wanted to figure out how to reduce annoying wait times to improve patient acquisition and satisfaction. We solved this issue by helping them shift their inbound demand to outbound callbacks, which helped them smooth out spikes in call volume, reduce average hold times, and make an additional 50,000 calls in a year—without having to hire more agents.

Automated callback scheduling

But it wasn’t enough to just tell agents to line things up as a callback task. They were, in fact, already doing that, but mostly using ad hoc tools and sticky notes and their own initiative. This resulted in long wait times in between callbacks, plenty of idle time, and even failures to call back.

As part of our solution, we employed a callback system that captured contact details, automatically allocated agents, and handled the calls and retries.

ASAP vs Scheduled callbacks

When talking about callbacks, the most common type is an as-soon-as-possible callback typically made 30 to 60 minutes after the call request. However, this doesn’t really solve the peak period problem since it’s still within the same window. Moreover, the unpredictability of the callback time could increase patients’ frustration with the whole process.

That’s why we worked with the hospital’s call center to support scheduled callbacks. By moving callbacks to another time of the caller’s choosing, they smoothed out demand and lowered telco costs by reducing their average handle times while creating better experiences for their potential and existing patients.

Omnichannel callbacks

In addition to callbacks triggered by an inbound call, we also helped the hospital transform their inbound calls by offering ways to request callbacks through online forms, like those that are part of the hospital’s provider directory.

Patient-centric productivity

Talk a stroll around the corridors of any call center and you’ll see agents struggling with a multitude of tabs as they wrestle with their telephony solution, patient management system, and scheduling tools. That’s because most call centers aren’t specifically designed for patient relationship management, resulting in inefficiency and inaccuracy. 

As part of the system we deployed for the hospital, we provided integration between the telephony solution and patient data so that they can immediately see the patient’s recent actions, make recommendations as part of ongoing marketing campaigns, and any outstanding issues. For example, if John’s daughter missed her appointment, the agent immediately knows about it during the call with John so that she can offer to reschedule even if John had his own appointment in mind. John is delighted, appointments are up, and the call is shorter.


Giving a good call experience to patients doesn’t have to mean driving up labor costs. An automated callback system with an integrated patient relationship management solution can help your call center boost patient acquisition, retain patients, and reduce telco costs—without hiring more agents.

Elective day of surgery (DOS) cancellations are a common problem that causes operating rooms to lie empty, frustrates patients, wastes staff time, and extends hospital stays.

The financial impact can vary, but most of the healthcare organizations we work with recognize the need for reducing the rate of same-day cancellations. At a cancellation rate of 4.7%, day of surgery cancellations can cost US$ 1.4 million a year. In one estimate, for each percentage point of reduced cancellation, a single OR can deliver $100,000+ in savings to a hospital or surgery center. So imagine if you have 10 operating rooms, then that’s already $1 million in revenue.

While the reasons vary per hospital, in general, most of these cancellations are preventable. Among the avoidable reasons are lack of financial clearance, incomplete medical evaluation, patient not showing up for surgery, and operating rooms running behind schedule.

Let’s tackle these reasons.

Lack of financial clearance

One of the most common avoidable reasons for cancellation is a lack of financial clearance on the day of the surgery. This typically occurs as a result of inadequate coordination between the financial clearance and operating room staff, as well as not clearly defining a specific deadline for financial clearance prior to surgery days.

Some hospitals still use manual or outdated processes like fax that create room for coordination errors, such as lost H&Ps. Others have digital tools for scheduling operating rooms but they aren’t connected with the surgeons and financial clearance systems, and still require ad hoc coordination outside of these tools, which can exacerbate coordination errors.

In Navicent Health in Georgia, with 637 beds and 60 O.R.s, we solved this by putting in place a system that has the following criteria:

  • A digital system to manage the schedule of operating rooms, including a portal where in-network and partner surgeons can reserve operating rooms
  • Plug-and-play interconnectivity between the surgeons, operating room scheduling system, and financial clearance system
  • Automatic cancellation at a set amount of time prior to the surgery if there is no financial clearance and notification of the affected parties

Incomplete medical evaluation

We’ve also found incomplete or mischeduled pre-admission tests to be a common cause of same-day elective surgery cancellation. This happens when hospitals don’t have clear timelines of tests before surgery—including bottlenecks and latest allowable dates. In other cases, they have scheduling criteria but have no quick way to visualize which procedures are due or overdue, which ones are prerequisites to other procedures, and which ones are pending results. As a result, this creates poor patient experiences where the patient shows up but can’t proceed with surgery.

There are two components needed to address this cause: the first one is a visualization tool similar to a GANTT chart or kanban board that clearly indicates the procedures required to be finished for each person prior to a surgery, when they should be completed, and who is responsible. This tool should connect to all involved systems so that it is always updated as to the status of each procedure and test result. The second component is a notification system that automatically follows up all involved parties especially if they have upcoming or missed deadlines. In case the follow ups are insufficient, the scheduling system should flag the surgery at a sufficient lead time, e.g. one day prior, so that the O.R. can be freed up on that day for other surgeries and the preparations aren’t wasted. 

Patient didn’t show up for surgery

There can be a number of reasons for patients failing to present on the day of surgery. Cold feet about the procedure is tricky to address, but forgetting about or confusion about the schedule is entirely preventable with a systematic means of notification and follow-up. Among the hospitals we work with, we see a large variation of scheduling tools and notification systems, but the main issue we’ve seen time and time again is the lack of connectivity between their different tools. As a result, even when they do support scheduled follow ups via multiple channels (email, SMS, phone call), there is still no meaningful coordination across their systems that would make the notification system effective.

OR behind schedule

Another common cause of day of surgery cancellations is lack of OR time due to emergency surgeries or previous surgeries that have over-run their time due to underestimation. Block scheduling has been hailed as the solution to scheduling problems, but if not executed well, can exacerbate underutilization.

Optimizing OR scheduling requires the ability to collect data about previous surgeries. We then use this data to avoid conflicts initially, but later on enhance the systems to better predict schedules, and provide real-time charts that are pushed to surgeons so they can view their own performance relative to their own past and relative to other surgeons. In many hospitals, one or more of these components is missing. They could still be using fax-based or siloed systems for scheduling, which prevents data from being consolidated and harnessed adequately. 


Day of surgery cancellations cause inefficiencies and frustration, but since most of the causes are entirely avoidable, there’s no need to live with them. The key things to solve the most common causes are:

  • Interconnectivity across systems through a coordination platform
  • Automatic notifications and follow ups for all parties—including surgeons, staff, and patients
  • Effective tools to visualize the entire process from pre-assessment to surgery
  • Accurate and real-time charts to analyze O.R. and surgeon performance

It’s been satisfying to see how these components have helped hospitals we worked with to dramatically reduce their same-day cancellation rates. In Navicent Health, having a good system to communicate between staff, surgeons, and patients was a win-win for everyone. We’d be delighted to discuss how we can apply these solutions to your hospital.

We are pleased to hear that Navicent’s Omer Awan has been named 2019 CHIME Innovator of the Year by the College of Healthcare Information Management Executives (CHIME). The award was presented last November 4 at the CHIME Fall CIO Forum in Phoenix.

As senior vice president and chief information and digital officer at Navicent Health, Awan was awarded for leading the organization’s innovative use of IT to break down care coordination barriers, improving patient experience and quality while saving millions of dollars.

Our team at acombina worked with Awan and his team to develop OrCarestra, a care coordination system built on top of our Outstanding Patient Experience (OPX) platform. The platform enabled the team to streamline delivery of care by seamlessly integrating new capabilities into their existing systems. While the system is comprehensive and touches nearly every aspect of their operations, some of the functionalities that were noted for the award were:

  • A scheduling portal that replaces faxes and phone calls to facilitate scheduling procedures at a hospital and eliminate schedule conflicts;
  • A convenient mobile and kiosk patient check-in module that removes the hassle of filling out paper forms and cuts down waiting times;
  • A patient management tool that makes it easy to to see the entirety of patient case activity in a single page and speeds up case workflows;
  • A physician directory with customizable biographies, photos and search terms to make it faster and easier for patients to find providers who match their needs

It has been a pleasure to work together with Awan and his team these past few years to achieve Navicent Health’s transformation goals. “Innovation is never about one person; it is a team sport and I am fortunate to have such fantastic teammates,” Awan said as he accepted the award.

As we continue to develop our OPX platform, we look forward to strengthening our collaboration with visionary organizations like Navicent Health to help them harness data to its fullest potential and propel them forward in the journey towards high-quality, cost-efficient care.

About the CHIME Award

The Innovator of the Year Award is given annually to a member of CHIME whose creative application of technology has demonstrated value to their healthcare organization with an innovative solution that can be shared widely with the CHIME membership.

The College of Healthcare Information Management Executives (CHIME) is an executive organization dedicated to serving chief information officers (CIOs), chief medical information officers (CMIOs), chief nursing information officers (CNIOs), chief innovation officers (CIOs), chief digital officers (CDOs) and other senior healthcare IT leaders.

About OPX and acombina

OPX is acombina’s platform that enables interconnected systems for healthcare organizations so that they can easily capture data, use that same data across the organization’s many subsystems, and collate all that data for management and analysis. It is comprised of three subsystems, which include:

  • Care Resource Planning (CRP) solution, which helps organizations match patient demands against supplied resources to improve utilization and capacity planning, streamline care, and provide actionable insights
  • Referral Chain Management (RCM), which lets organizations streamline communication among all providers involved in each patient’s care as the patient makes their way across the patient journey
  • Patient Relationship Management (PRM), which aids organizations to develop deep and long-term relationships with patients in line with the system-wide shift to a value-based model of healthcare

Acombina is healthcare IT provider that makes integrated cloud-based solutions for enterprise analytics, patient engagement, care transitions, and population health management.