This is getting to be fun. Now, for a bit of applied constraint theory…
In this simulation we’re considering the surgeon as the most important person…the constraint. We don’t want him to wait for the case to start, but neither do we want to waste the nurses’ time nor the anesthesiologist’s time waiting on the surgeon. In a different simulation, we could as easily have chosen the nurses or anesthesia as the constraint (nursing shortage or anesthesia shortage).
Each bar in the following graphs represents a task or event involved in a normal surgical case. The first graph is a scenario for a surgeon who is normally ready to cut 15 min before the scheduled start of his case. For him, setting up for the case needs to begin 2 hours before he arrives (note ‘Free Slack’ 2h…the fifth line down):
Now, lets’s make a few changes:
1. A different surgeon is doing essentially the same case; this surgeon usually shows up early and can cut 45 min before start of case,
2. There’s an anesthesiologist who takes an extra 15 minutes to start because he puts in all the patient’s lines before letting the patient prep begin,
3. The patient takes an extra 10 minutes to get into the OR room because she’s being wheeled from the farthest wing of the hospital,
4. And the physician’s assistant for this surgeon always helps prep the patient which cuts off 5 minutes of prep time.
In this scenario, with these alterations, the room setup needs to start 2 hours and 50 minutes before the scheduled start time (5th line down); or 50 minutes earlier than the prior scenario: