A "zero tolerance for overtime" increases surgical per case costs

One technique which some hospitals have used in an attempt to control Operating Room costs is a "zero tolerance for overtime" policy. We used a case cost analysis to determine if this policy was always cost effective.

A case cost analysis was designed based on a "test case" which would start late in the day. The case would last for three hours of which 1 1/2 hr would be during regular hours, and 1 1/2 hr would incur overtime. Costs were analysed using a "patient pays," "society pays," and "hospital pays" analysis. Costs were based on figures determined from the SMBD-Jewish General Hospital budget, Québec Health Insurance fees, and Government of Canada statistics.

Regardless of who pays, in this case scenario it was more cost effective to proceed than to postpone surgery. Costs of proceeding with the surgery in the "patient pays," "society pays," and "hospital pays" models were $1,832.00, $1,227.40, and $1,215.00 respectively. The costs of postponing the surgery in the same three models were $1,937.00, $1,336.80, and $1,436.00.

A "zero tolerance for overtime" policy may be too rigid to be consistently cost effective.