Author Archives: Brian D Gregory

About Brian D Gregory

Board Certified Anesthesiologist for 20 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.

Managerial Accounting Primer


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Root Causes of US Healthcare Design Conflicts


Single payer means single customer. If there is just one customer (no others exist) who no longer needs your services, or has an alternative to your services, then that customer, the single payer, can set the price just above the … Continue reading

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MIT news: “flexibility in resources drastically improves wait times”


From MIT news (August 6, 2013)—    From theory to practice “In work beginning with his master’s thesis, Xu has shown that having even a little flexibility in resources drastically improves wait times”: I blogged about this in January 2010 … Continue reading

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Finance Leaders Bemoan Talent Shortage


http://www3.cfo.com/article/2013/4/training_finance-function-training-skills-talent-corporate-executive-board-kruti-bharucha?utm_source=taboola Read the comments in the article.

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Why OR staffing and scheduling is different than ER staffing and scheduling…


The OR case load has a very high daily variability of patient arrivals similar to an ER. However, unlike an ER patient’s arrival that normally may monopolize a single (or shared) ER nurse and room until the next caretaker (physician, … Continue reading

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Protected: TA vs GAAP (from a LinkedIn conversation)


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What is the cost of a minute of intra-unit patient transport time….from LinkedIn conversation


Follow Brendan What is the cost of a minute of intra-unit patient transport time? The cost of a minute of time in patient transport is a questions we get asked quite often by acute care leaders. Is anyone aware of … Continue reading

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Protected: Strategy: Graphic examples of Orthopedic cases using PAs, Flipping Rooms, and Early Starts


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constraint theory and Pareto Optimals…


Brian Gregory, MD, MBA • Wayne, good question. Healthcare is a funny animal–you have constraints within constraints. One of the main tenets of ToC is to pick what you want to be the constraint. In the case of the OR (ER, radiology, … Continue reading

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increase strategy to increase throughput: …data in context…lean in context…flipped rooms…


Why is this important? It can significantly increase total throughput and throughput as referenced by a particular agent (surgeon, anesthesiologist, hospital). Increased throughput can be converted into large increases in revenue. It can decrease cost for all agents. It can … Continue reading

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Protected: the art of flipping rooms…


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Posted in Ambulatory Surgical Center, anesthesiologist, ASC, board of directors, CEO, healthcare reform, scheduling, surgeon, Uncategorized | Tagged , , , , , , , , , , , ,

FTE, utilization, and cost accounting … when PUNs equal CUEs


also see: Graph of CRNA usage for optimized Surgeon Schedule also see: TA(throughput accounting) and TDABC (time driven activity based costing)….the fabric, the ‘warp and woof’ of healthcare — Cost accounting (whether standard costing or TDABC) is based on the concept … Continue reading

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Protected: labor analysis of CRNA from collectible time data…


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Protected: conundrum…


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getting your hands dirty…


Sometimes, to get what you want, you have to jump in and get your hands dirty… It’s been a month since my last post, a series of posts dealing with ‘what ifs’ and some simple simulations dealing with scheduling OR … Continue reading

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things you’ll probably never see…


Turnover Time (TOT) does not have an ideal value of  zero.  When you finally learn how to make it zero (or negative) you’ll discover the idiosyncrasies of your surgeon.  If fact, you will have achieved the proper TOT for your … Continue reading

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constraints, risk, and ego in OR start delays… simple example


First off, there must be a 100 different reasons for late OR starts.  Everything from surgeons, anesthesiologist, nurses, equipment, meetings, policies, traffic, school age children and equipment…to a mix of any of the above.  The trick is in understanding the … Continue reading

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board can struggle with data puzzle…


Board can Struggle with Data Analysis I’ve discussed visual analytics before, and its ability to bring actionable information to both the CEO and worker on the floor.  The Financial Times has just published the above Special Report saying that boards … Continue reading

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Fiscally responsible OR expansion…


This post is in response to a question posted in the Yahoo group (hme) about ‘triggers’ for OR room/suite expansion.  As usual, in healthcare, nothing is easy: The decision to increase the number of OR’s can’t be made solely on … Continue reading

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Protected: Process control revisited…Information architecture


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Process control…


All the charts and graphs that you see in this blog are process control charts—like every efficient, productive industry (Boeing, GE, Toyota) uses. Every day, even during the day, you use these charts to see where processes need changes to … Continue reading

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Protected: How to Tell the Productive Surgeons from the non-Productive


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Protected: the fungible anesthetist…


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The bottom line…


Each row represents an individual CRNA.  If over half of each time unit (10 minutes) is billable on an anesthesia record, then it is red.  Less than half is yellow. Exactly half is green. Lines that are all yellow belong … Continue reading

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Graph of CRNA usage for optimized Surgeon Schedule


also see: FTE vs cost accounting … when PUNs equal CUEs also see: Wasting surgeons’ time This is a graph of the CRNA usage for the Optimized Surgeon schedule from the blog post dated Jan 20, 2010.   Compare this graph to … Continue reading

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Graphs of Actual and Optimized Surgical Schedule


Warning! Not for the graphically challenged. In reference to the graphs I posted on January 14, 2010, I’ve added several graphs with detailed information. The first graph is of the actual room schedule (non-optimized) before optimizing it by a better … Continue reading

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With whom should I do my cases?


<click on the above graph for a larger image> The above graph is an example of finished data analysis for three different orthopedic groups (Arizona Cutters, ORO Pods, Tucson Bones) which are deciding in which hospital, and with which anesthesia … Continue reading

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Do you know where your CRNAs are?


<click on graph to enlarge in separate window>  [Note that the scale for the upper and lower graphs are different] I mentioned in the prior post that my client had wanted an analysis of how well they were using their … Continue reading

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Wasting surgeons’ time? One hospital– $27 Million opportunity Loss per Year from scheduling


click here:  3 Graphs of Actual and Optimized Surgical Schedule « ORTimes – Healthcare Systems Engineering Analysis The above chart was derived from data from a client who wanted to know if they were using their CRNAs efficiently. (we’ll show that … Continue reading

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