An anesthesiologist’s solution to outdated OR case scheduling [PODCAST]

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In this episode, we speak with Michael Bronson, an anesthesiologist, founder and CEO of AnesthesiaGo, about his journey into healthcare entrepreneurship. Michael discusses the pain points he encountered as a scheduler for anesthesia staff and how he discovered an empty niche waiting to be occupied. We explore the challenges of creating daily case schedules by hand and the benefits of using technology and automation to solve these problems. Bronson shares how his platform, built with powerful algorithms, auto-generates better schedules, distributes completed schedules instantly, and helps to reduce burnout among medical professionals. Tune in to learn how technology relieves the pain point of daily anesthesia scheduling.

Michael Bronson is an anesthesiologist, Providence Mission Hospital of Mission Viejo, CA, CEO, Ketamine Wellness Clinic of Orange County of Laguna Beach, CA, and founder and CEO, AnesthesiaGo, which was acquired by PerfectServe in January 2022.

He shares his story and discusses his KevinMD article, “Does your OR case scheduling process need a revamp?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Michael Bronson. He’s an anesthesiologist and health care executive. His KevinMD article is titled “Does your OR case scheduling process need a revamp?” Michael, welcome to the show.

Michael Bronson: Thank you, Kevin. Thanks for having me.

Kevin Pho: We’ll get into your article in a little bit, but first off, briefly share your story and journey to where you are today.

Michael Bronson: Yeah, so I’m a full-time anesthesiologist. I’ve been in private practice for about 10 years, and I took a very traditional route to get to where I am. I went from undergrad straight to medical school, straight to internship and residency, and then out to private practice. As well trained as I was to be an anesthesiologist, when I came to private practice, I realized I didn’t really know anything about owning a business, which is a lot of what private practice is, being able to manage finances and accounting, grow the business, and maintain the business.

So about three years into my practice, I started to get really involved with the group and then at the hospital level, and with that, I got to be around some very intelligent people, some very business-savvy people. So I started to learn kind of business development processes through them, and through their mentorship, I gained a lot of tools and techniques and, for me, a lot of the encouragement and the ideas to go out and start my own business. So that’s kind of where AnesthesiaGo came from. I saw a problem, I had the tools and the confidence to tackle that problem, and so I went out and tried to accomplish that.

Kevin Pho: So I hear this a lot, about how doctors really, really don’t get a lot of business training, and a lot of doctors just kind of go into private practice blind, without that business background. So where can they find that business background? Do they need to get MBA degrees? How can they search out some of that business knowledge that you talk about?

Michael Bronson: That’s a great question, and I agree with you. I think we’re lacking in medical training when it comes to giving clinicians the tools to run their own businesses. One of my goals early on was to get my own MBA, and to me, the certificate wasn’t the reason to do that. It was to gain those business skills.

But I think it’s just getting involved early on, and being involved in billing, in collections, in financial planning, and on the accounting side, when year-end accounting comes along, and learning those skills and those techniques to do that. So the more you can get involved, the better. You don’t need an MBA to do that. I think just training alongside some very smart people, some people who know what they’re doing, is the best way to learn.

Kevin Pho: So you mentioned you’re a full-time anesthesiologist, but you also founded AnesthesiaGo. Talk about those two sides of you, the business side and kind of the clinical side, and how do you manage that day to day?

Michael Bronson: Yeah, so in doing AnesthesiaGo, there were a lot of synergies with what I was doing on the clinical side. One of the tasks I was given in my group was to make the daily schedule. The first day I was assigned to do that task, the OR scheduler sent me a stack of about 30 to 35 papers in the OR with a pencil and said, “Well, your job is now to pencil a name next to every case on this schedule.” That took about an hour to do. I spent about an hour, I thought I did a good job, I sent it back to the schedulers, the schedule went out to everyone, and then I got this.

Kevin Pho: Why did it take an hour? What was the thought process when it comes to scheduling?

Michael Bronson: Yeah, so when you get those lists of cases and you go through the notes, some patients are going to want a specific anesthesiologist, and some surgeons are requesting a nerve block or a cardiac anesthesiologist or maybe a TEE, so you have to take those into account. You need to know where your anesthesiologists go. Not everyone may go to all of your locations. So if you cover a GI center and surgery centers and hospitals, not everyone may go to all those centers. Some people may just work in shifts, and so they need to be done at three o’clock or five o’clock or seven o’clock, so you can’t schedule them cases beyond those times. So a lot of complexities go into this daily scheduling process.

So as you’re putting it together and you’re putting names next to every case, you need to make sure that it makes sense, that you’re not double-booking someone or even triple-booking someone, which has happened before in the manual work days. You need to make sure you’re making efficient schedules as well, so you’re not giving someone a case in the morning and then a huge four-hour gap in the cases in the afternoon, when they could just be doing seamless cases throughout the day. So a lot of complexities go into that process.

So it was common to finish the schedule an hour later, give those cases to the schedulers, and the schedule goes out, and then you start getting calls and texts that you’ve made mistakes. Now you’re spending another half an hour fixing those mistakes and rearranging, and as you fix those mistakes, sometimes you make other mistakes, and there’s really no quality control in that process.

So once I identified how painful that process was, I looked for a solution. I did a Google search looking for anesthesia daily scheduling solutions, and I think that’s an important point to mention. Once you do a Google search for anesthesia daily scheduling, you’ll see a lot of companies, a lot of products that you think offer that solution. What you see is the other side of anesthesia scheduling, which is the monthly scheduling, or who’s on call, who’s on vacation, and who’s working what shifts each day. But no one automated the daily scheduling part, which was what I was looking for. So after spending a bit of time looking for a solution and seeing that there was not one on the market, again, with the business confidence and the tools I had gained over my 10 years, or I guess seven years at that point, I put a team together, and we went out to solve that problem.

Kevin Pho: All right. You talk more about that story in your KevinMD article, “Does your OR case scheduling process need a revamp?” So how did this article come together, and tell us the next part of the story.

Michael Bronson: Yeah, so it took about 18 months to really build the product and the algorithms and the structure to develop an OR scheduling tool. What we basically are doing is we’re taking the daily anesthesiologists and we’re taking the daily cases, and we’re merging those two pieces of information together and giving groups a starting point, if nothing else.

So it doesn’t need to be 100 percent automated. I think some people feel that their opinions on how to leverage the daily schedule are being infringed upon by having a 100 percent automated model, and that’s not what we’re doing. We’re giving people a starting point to start the daily scheduling process, and the quality control portions. So as you move cases around on your platform, it’ll identify errors that you’re creating. If you’re creating an overlap, or if you’re creating a situation where the patient requested a different anesthesiologist, it’ll alert you to those things. Looking back at the manual process, you didn’t get those quality checkpoints.

Kevin Pho: And so you said that patients would request a certain anesthesiologist. When I talk to my patients during pre-op, not to say anesthesia isn’t important, but they rarely talk about the anesthesiologist in my pre-op. So how common is that?

Michael Bronson: It’s actually quite common. Every day we’ll see a couple of requests for anesthesiologists. I think one of the reasons is that patients are allowed to choose their primary care physician and their surgeon. They research them before they go in. But the anesthesiologist, for the most part, is assigned the night before, and they don’t know who that person’s going to be. So once they’ve had a good experience with one provider, they’re going to want to request that provider more often than not for any subsequent surgeries or any surgeries on their family members. And a lot of times, what we see is that the nursing staff or people that we work with at the hospital will have certain requests for people, because they just get along with them better. They know how they operate.

Kevin Pho: Excellent. OK, go on in terms of the solution. Give us a little before and after, because you told us the situation before, about how cumbersome scheduling was and how errors can lead to more errors. Tell us how it works now.

Michael Bronson: Yeah, so before, the process took about an hour. The process now takes about 5 to 10 minutes a night to put that puzzle together, so a very complex puzzle is being put together very, very rapidly. The process now, I go on the platform, the cases are already pre-assigned to certain providers, and it takes me a few minutes to glance over the current list of assignments and make any edits I wish to make. From there, I click finalize, and it goes to the OR schedulers, and it goes to all of my partners, so everyone knows where they’re going the next day. It goes to their phone, so they see their individual lineup of assignments for the next day. The board runner gets an individual report to tell them, this is the color-coded map of where every person’s going to be that day, so once the add-ons and cancellations and delays occur the day of, they could easily manage that.

And then the other thing we built in was the analytics platform. We’re giving groups the ability to look in reverse to plan for the future, to say, “Well, on Wednesdays we usually need this many people. Based on our caseload data, this is how many people we should schedule on Wednesdays going forward.” So we built a pretty robust analytics platform and dashboard to give groups the ability to have that 10,000-foot view of what the scheduling needs are.

Kevin Pho: So give us a sense of how big your department is and how many surgeries on a daily basis you have to manage.

Michael Bronson: Yeah, so our group covers about 130 cases a day. It’s a Level II trauma center, so we deal with add-ons and cancellations quite often. We cover many surgery centers and GI centers. We go to over 10 different sites in a given day, and again, not everyone goes to all of those sites, which made the complexities even tougher when it comes to daily scheduling.

Kevin Pho: And when you introduced this platform, what was the response in general from the anesthesiologists and surgeons?

Michael Bronson: Yeah, so with the anesthesiologists, it’s hard to change culture. Some people were set in their ways, and they liked the paper-and-pencil method to do the daily schedule. That’s what they were used to, and that’s what they wanted to do for a little bit of time. Once we introduced the AnesthesiaGo platform, when that schedule was made, everyone got the same email with the color-coded map of where everyone’s going each day, and it just was so superior to the prior method, where you didn’t get that. You got the completed schedule from the OR schedulers, but you didn’t get an individualized schedule, and you didn’t get the color-coded map of where everyone’s going to be every day. So it didn’t take long to create some peer pressure for those who wanted to stick with the pencil-and-paper method to change their ways, to modernize, and to get to that point.

Kevin Pho: In your article, you talk about how automation like this can help with clinician burnout. So talk more about that.

Michael Bronson: The pressure point of creating the daily schedule is how much time it took. It took about an hour to make the schedule, and then it took some time to correct any errors down the road. We’re taking a lot of that time and putting it into the hands of technology, and minimizing the amount of time it actually takes to make a good, functional, efficient schedule. So the time burden for me on a daily basis, if you’re taking an hour of time every day, five days a week, that adds up over the course of a year. So we’re minimizing that down to 15, maybe 20 minutes max to create the daily schedule.

So all that time savings goes back into the clinician’s hands, and it ultimately goes back to the patient’s hands as well, because the clinicians are doing this in between cases, during cases, and outside of work, and so it takes away from the ability to really care for patients. These are not meaningless tasks, but they are tasks that can be improved upon and done in a quicker fashion by leveraging technology.

Kevin Pho: And in the market, in most institutions, is it really a physician who comes up with the schedule? Is that typical of the culture?

Michael Bronson: Yeah, so in our market research, before we even started the product, we looked at groups on the East Coast, the West Coast, all across the United States, and we heard quotes of an hour to two hours to make the daily schedule. Sometimes two clinicians would work as a tag team to make the daily schedules, just so they could get the job done quicker.

It’s usually the anesthesiologist making the assignments, because they know the cases, they know the surgeons, and they know what’s being asked for. And when people have opinions about what they’re being assigned to, it’s better to go to one of their physician leaders to express those concerns, rather than to someone who’s not in the arena, and putting a target on their back. So it is mostly anesthesiologists making those schedules.

Kevin Pho: So I want to talk about kind of the development side. You identified a problem, and you came up with a solution. Did you have the technical know-how to actually build a product? Talk more about that. Who did you engage to be part of your team to come up with a technical solution to solve this problem?

Michael Bronson: That’s a very good question. I had some technical background. I had started my own website in the past and taught myself WordPress, those things, but I didn’t know advanced algorithms and those solutions. So I got two of my great friends involved, up in Los Angeles. They run their own company and focus on advanced programming algorithms and AI.

I presented the problem to them. I put together about a 15-slide pitch deck, sent it their way, and said, “Hey, look, this is the problem I have. This is what I’m looking for. I’m looking to take the anesthesiologists, I’m looking to take the cases, I’m looking to extract key information from those cases with known information about those anesthesiologists, where they work, what kind of cases they do, and produce an automated foundation that we could work off of, and then save data,” and so on and so forth. So I presented the problem to them. It took them about a day to get back to me and talk it over. We exchanged a couple more thoughts via Zoom and emails, and then really started to work on the product from there. So without their background and without their backing, I definitely could not have done this on my own.

Kevin Pho: So in general, how common is an automated platform like this when it comes to scheduling across the country?

Michael Bronson: This is the first time this has been done, automated for daily scheduling assignments. Going back to what we talked about before with the monthly scheduling side, that part’s been automated for decades. But the daily schedule, where you’re actually taking the actual cases and the anesthesiologists and pairing those anesthesiologists to cases, this was the first platform to automate that process.

Kevin Pho: And when it comes to market penetration, has there been good success in terms of convincing other departments about automation and automating the daily schedule?

Michael Bronson: Yeah, so we’re starting to gain a lot of momentum, a lot of traction, domestically and internationally as well. We’ve onboarded a group in Brazil, a group in Canada is being onboarded currently, and we’ve started to onboard some enterprise providers and academic centers. So we’re starting to gain a lot of market momentum and get that penetration that we’re looking for.

That goes back to the changing culture. It’s just so hard to change culture. To go to a group and say, “Hey, this is what you need as a solution,” that’s hard to do. But as you start to have changeover in leadership, and that younger generation takes over from the older generation, they’re going to look to leverage the technology that’s out there, and that’s where we’re looking to set ourselves up for, when that transition occurs.

Kevin Pho: We’re talking to Michael Bronson. He’s an anesthesiologist and health care executive. His KevinMD article is titled “Does your OR case scheduling process need a revamp?” So Michael, as you know, AI has been in the news. We read about it every day now. Where else in health care do you think AI can benefit us?

Michael Bronson: I do read a lot about AI in health care. I know radiology is seeing a huge momentum with the use of AI to help them with their diagnostic capabilities, and I think you’re going to start to see penetration of AI into different fields as well. I don’t think it’s going to take over the physician’s role. I think you’re always going to need that human touch, that physician involved, seeing the patient and solving the problems. But I think AI is going to help give clinicians the tools to do that easier, faster, with fewer errors. That’s one thing we wanted to work on, and in health care in general, it’s providing that quality of care, and the fewer errors we make, the better. I think AI is going to give us the tools to help get in that direction.

Kevin Pho: And my final question, Michael. Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Michael Bronson: Yeah, so I alluded to it earlier. I think we are approaching a generational pivot point, where younger leaders are starting to take over and transition into those senior leadership roles. That’s kind of how I came along in my position, as I transitioned into a daily scheduling role and looked to leverage technology. I think that’s what we’re going to see as those leaders take over. They grew up with technology. They’re going to look to leverage what we have on the market and not accept pencil and paper as a solution for current ways to solve problems. So they’re going to look to leverage technology, and as we start to see that transition happen, you’re going to see a lot more groups take on technology and innovation, and it’s going to be hard to go back.

I’ve used the example that it’s like going from the Thomas Guide to the TomTom. You just can’t go back. Once you make that transition, once you see how much easier things are with technology, you can’t go backwards. You’re only going to go forwards. So I think that’s coming up, and that’s what we’re positioning ourselves to be ready for.

Kevin Pho: Michael, thank you so much for sharing your time and insight. Thanks again for being on the show.

Michael Bronson: Thanks, Kevin.

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