TOC in the OR visualized…

Ah….  theory of constraints…

This is a visual representation to help with handling constraints in the OR.  For those who use TOC, be aware that the person represented by the green bar (‘Anes MD presence’) could be simultaneously supervising four rooms at once; and he acts more like a fireman in that he may be called to any of them (and to any other room in the OR) at any time to put out ‘fires’ that affect the patient’s safety.

All of these durations can be optimized (shortened) by the normal six-sigma, lean, etc. techniques; and said techniques are often implemented by personnel who have never heard the words ‘six sigma, lean, etc.’  Common sense and experience are  the words they use. Interestingly, I’ve never heard any one say that they had a black-belt in common sense…

‘Anes presence’ could be a CRNA, an RA, or MD anesthesia.  If it’s an MD, then 7.5 is redundant.

‘Surgeon assistant presence’ could be a ‘Physician Assistant (PA)’, a ‘first assist’, an RN or the surgeon herself.  If it’s the surgeon herself, then 7.4 is redundant.

About Brian D Gregory MD, MBA

Board Certified Anesthesiologist for 30 years. TOC design and implement for 30 years. MBA from U of Georgia '90: Finance, Data Management, Risk Management. Practiced in multiple US states and Saudi Arabia at KFSH&RC and KFMC Taught residents in two locations. Worked with CRNAs for 20 years.
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1 Response to TOC in the OR visualized…

  1. Thanks Vijay. I have already implemented these ideas with tools that work well, but I haven’t used an Excel tool. I think that an Excel tool would not be flexible enough for the task, but I haven’t played with Excel in a long time, preferring a true multidimensional spreadsheet. For the OR, I’ve finally figured out a way to use a particular software to easily handle playing what if’s in real time in the OR so that all the rapid changes in the schedule can be handled, and constraints for part of the schedule for the day can be changed in a matter of a couple of minutes to optimize whatever resources you have. This should apply to other industries also where resource availability changes quickly and unpredictably. It’s a bit like driving a race car…. nice tool. Some of the other tools for longer time analysis work well, I just need an big OR to practice with. Lots of the ideas I’ve used for years, but without software to handle things on a larger scale.

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