Author Archives: Brian D Gregory MD, MBA

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.

butterflies and nails…


Below is a graph of durations in the scheduling and process of just the in-room surgical parts of a typical OR case.  Most of the items can be altered by policy and by the conscious effort of the people involved … Continue reading

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Big Bwana and little bwana…


Everything in the below graph is adjustable (and is derived from less data than is normally collected in an OR). It’s quite useful when deciding how to create your portfolio of surgeons, anesthesiologists, or nurses to limit the short-comings, and … Continue reading

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the surgeon as a constraint…


This graph shows components of surgical time during a typical surgical case: red bar:   primary surgeon needs to be present and is present top yellow bar:   surgeon needs to be present, but isn’t–he’s late and everyone is waiting … Continue reading

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divide and concur….


Once you visually see the requirements for anesthesia presence during a case, you can also see the potential for saving down-time and better utilizing particular skills when personnel are scarce.   I did leave out the pre-op visit in this … Continue reading

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the cost of late surgeons… and the revenue from early surgeons


The purple bars represent the time saved for nursing staff and anesthesia if there is a policy for the surgeon to be ready to cut 30 minutes (adjustable) before the scheduled start of cases in the morning.  The effects of … Continue reading

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Typical OR case dissected with details…


These are the relevant milestones and intervals in a typical OR case.  I left off the details so as not to detract from the comparison to the normal representation of an OR case as a single block of time with … Continue reading

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So much data…so little time


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Simulations… let’s not repeat the same old mistakes


Simulations (for scheduling) have for the longest time been the realm of computer nerds.  Not any more. There is now the ability (with some initial assistance) to let the workers on the ground modify and correct the black-box algorithms that … Continue reading

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Visual analytics for an OR case…


Visual analytics for an OR case:  Lots of information if you understand the code….   You can tell whether surgery, anesthesia, or the hospital personnel are on top of things and you can compare differences in techniques with resulting effects … Continue reading

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FT: “Chief profitability officers still rare”


The Financial Times has new articles emphasizing that the CFO needs to know more systems engineering, have better analytical skills, and understand IT better.  Surprised? Chief probability officers still rare Competitive difference is in the analysis Finance heads need much … Continue reading

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FT: “Competitive difference is in the Analysis”


I’ve been discussing this, and showing examples, on my weblog for some time.  Here’s a (The) major financial newspaper saying the same thing: Competitive difference is in the analysis

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FT: “Finance heads need much wider view of IT”


For those of you who won’t subscribe to Financial Times… Finance heads need much wider view of IT The Financial Times is a premier newspaper dedicated to the finance world: CFOs, CEOs, CFAs. If you pass the article along, a … Continue reading

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sample requirements for vice-chair of anesthesia department…


Below is a copy of a letter I sent for a position as vice-chair of anesthesia at a large teaching hospital.  I’ve long thought that most vice-chairmen needed to expand their skill sets. . Dear Dr. —-, As you proceed … Continue reading

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new scheduler…timeline and map integration


Operating rooms are expensive assets; you don’t want them sitting idle when people need them. Each room may be equipped differently; you want to schedule procedures in the most appropriate room. To complicate matters, some procedures require special equipment that … Continue reading

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practical uses for emotional intelligence…


Emotional Intelligence

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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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non-expert decison making: perils of democracy…


When making an individual decision, or whether voting as a group, the ‘strength’ of one’s conviction on a topic should be modified by one’s expertise before coming to a final resolution.  All decisions have pros and cons, all of different … Continue reading

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new OR scheduler…


I’ve been experimenting with a new scheduler.  There are many options for visually representing information about OR cases. The scheduler is easily adapted for collecting data to analyze later. The scheduler also has a map view that can include even … Continue reading

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sample new OR scheduler


For all those OR schedulers out there, here’s a new approach.  I left most of the data off on purpose to emphasize the information that the graphics—lines, blocks, fonts, colors, sizes, and proximity— can show.  When in the program, pages … Continue reading

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hold the mayo…


Unfortunately, I forgot to take a picture of my poster presentation at the Mayo Clinic’s 3rd Annual Healthcare Systems Engineering meeting. However, I did take a picture as I was putting it together the week before.  Here it is, in … Continue reading

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business interest…


When we started this blog, we didn’t know how well it would be received.  Even though there were few comments, we could follow how many viewers had dropped by to have a look and download our graphs and articles.  We … Continue reading

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time to call it a day…


About two weeks ago, I returned after having honored a request from a Mayo researcher to give my poster presentation (a rational and extremely profitable OR scheduling and analysis system that I’ve actually used) at the Mayo Clinic’s 3rd Annual … Continue reading

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Visual analytics wins again… :)


Gamers beat algorithms at finding protein structures

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Protected: theory, tools, and techniques… abstract


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understanding visual analytics… and others


What’s wrong with this picture; I see what you mean; I hear where you’re coming from; Something doesn’t feel right: These statements represent analytics. Analytics can be defined as the presentation of input in such a way that it taps … Continue reading

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the law of unintended consequences…staffing anesthesiologists


Value: easily and potentially > than $1,000,000 a year Let’s suppose that a hospital wants fellowship trained anesthesiologists to do all their cases: pediatric anesthesia fellowship for all pediatric cases, neuroanesthesia fellowship for all neuro cases, ob-gyn fellowship for all … Continue reading

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Using what you have…


The graph below contains sets of useful abilities/tools for running a hospital. Each black line connects a group of people to abilities and tools they use (solid black) or might use (dashed black).  Every hospital will show a different set … Continue reading

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Conflict of interests for surgeons?…


I’ve seen this potential for abuse over the years.  It’s probably just jealousy on my part… we get donuts from the reps, some of the surgeons get all expense paid trips to exotic (well, sometimes exotic) locations.  There may be … Continue reading

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Operations-a-Finance….cost accounting vs managerial accounting vs others


“If discussing shop with a Finance person, one thought is to get a feel of where they are coming from. How difficult is it to get them to use “GAAP” in the conversation and what is their attitude about it?” … Continue reading

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Protected: Concerning hospitals hiring physicians…


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Protected: Scheduling Abstractions…


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disruptive physician?


Police: Former colleague kills Yale doctor at home

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the power of graphics…


It looks as though politicians have finally discovered the use of graphics to discover relationships and elucidate truth.  The Huffington Post today hand an article commenting on the ‘Jedi Master’ of graphics, Edward Tuft and his potential affect on political … Continue reading

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OR throughput, flipping rooms with fast and slow anesthesia…


I found some graphs that I put together a couple of years ago.   The results are born out empirically (at least by my experience in the OR). Lots of information about who to hire, who to fire, who to … Continue reading

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only the beginning…


In my last year of anesthesia residency, an attending told the graduating class “You’re just beginning.  We hope we’ve taught you enough so that you won’t kill anyone.” A surgical friend of mine said that he was very good technically … 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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Comments…SPC vs SQC


Thanks Wayne for clarifying… “We agree much more than disagree – especially about using all the tools and methods at one’s disposal.   🙂  Yes, if you say “process control” that covers a lot of ground.  But SPC really is very … Continue reading

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Process control revisited…Information architecture


In reference to comments about the graph on the blog “How to Tell the Productive Surgeons from the non-Productive” I agree, it’s a terrible graphic, but it’s not the real graphic. The ‘real’ graphic is actually a set of data … Continue reading

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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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Geek humor…


On spaghetti and resource locking: A brief, yet helpful, lesson on elementary resource-locking strategy « The Reinvigorated Programmer

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Disruptive behavior… zero tolerance by Joint Commission; Is your hospital in compliance?


Physician and nurse executives team up to fight disruptive behavior The American College of Physician Executives and the American Organization of Nurse Executives are joining forces to stamp out disruptive behavior. The two organizations are providing resources and guidance to … Continue reading

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mathematician, technician, or healthcare professional…


There are different tools for evaluating what has been done and what should be done.  Confuse the two at your own risk. The finance industry caused significant damage to the world economy because they confused the two.  Given any set … Continue reading

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Tower of Babel…


One of the major anesthesia journals is still publishing articles on the financial benefits of using shorter acting drugs for anesthesia.  Anyone with two neurons and a synapse who practices anesthesia has known this for over a decade.  When will … Continue reading

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Let sleeping children lie…


While I was at KFSH&RC in Saudi Arabia, a Kiwi friend of mine who was head of the radiation oncology department asked me if my department (anesthesia) could help them expedite their pediatric radiation treatments.  It would take them all … Continue reading

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‘When Worlds Collide’…. Finance and Healthcare


There’s an insightful book authored by the current CEO and co-COO of Pimco (also past investment manager of Harvard Management Company, Harvard University) Mohamed A. El-Erian called ‘When Markets Collide–Investment Strategies for the Age of Global Economic Change’. The book … Continue reading

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“PowerPoint is evil”


In a prior post I made the statement that cost accounting was EVIL.  This recent article about Dr. Edward Tufte’s (Professor Emeritus of Political Science, Statistics and Computer Science at Yale University) appointment to a post in the Obama administration … Continue reading

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“We’re so good at medical studies that most of them are wrong.”


We’re so good at medical studies that most of them are wrong I ran across the above article this morning. The title is self-explanatory. It references other articles and discussions (JAMA, American Association for the Advancement of Science, National Institute … Continue reading

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When you’re lost, use a map…


see also: TA(throughput accounting) and TDABC (time driven activity based costing)…the fabric, the ‘warp and woof’ of healthcare accounting? I had a brief, but interesting conversation with a CMO of a large hospital recently.  To his credit, he’s trying to … Continue reading

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How to Tell the Productive Surgeons from the non-Productive


The previous blogs were concerned with economic gains for the different parties (surgeon, anesthesia, hospital) by optimizing the relationship each case had with another case (inter-case) — the OR schedule.  Each OR is dramatically different, and what works for one … Continue reading

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communication…life line


With today’s technologies, there are multiple ways for anesthesiologists and surgeons to keep organized and transfer documents while driving in the city, roaming the halls of the hospital, or during a case in the OR.  No one should have to … Continue reading

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Protected: the fungible anesthetist…


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incentive, compensation, transparency


Incentive, Competitiveness, Transparency If most of anesthesiologists are supervising CRNAs, the anesthesiologists’ job is to increase the amount of the CRNAs’ billable time at the facility. Have the anesthesiologists do all the pre-ops, IVs in the pre-op area, and care … Continue reading

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Same as last post. CRNA centric view of schedule for the day.


Here’s a different view of CRNA usage (bottom graph of last post –January 23, 2010).  It’s organized by CRNA—Follow the CRNA through the day to successive rooms. The CRNA (1aa, 1ab, 1af…) is listed to the right of every horizontal … Continue reading

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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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Can I trust my state medicaid and medicare system?


Missouri, one of only 3 states to receive an “A” in management information by Governing Magazine in 2008 is highlighted in the following article.  If Missouri is in the top 3, how can we trust the rest?  Best to have … 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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I don’t understand what you mean…


We were having a discussion the other day about whether it would be more profitable to teach finance concepts to the people doing the actual work on the shop floor (‘workers’) or to teach the finance and accounting people (‘suits’) … Continue reading

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I love my work, but…


As a follow-up from my post on Jan 14, 2010 “Are you wasting your surgeons’ time?” showing how surgeons can decrease their time in the OR, here’s a recent article from the Center for Healthcare Policy and Research and Department … Continue reading

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Who’s in charge here, anyway?


A big problem in the OR is that not everyone is working for the same goal.  The major players are surgeons, anesthesiologists, and the hospital (nurses, orderlies, administrators, etc.), each wanting to maximize their income and minimize their work and … Continue reading

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