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Category Archives: anesthesiologist
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
Getting Dr. Able out of the OR before 4pm…
narration for SHS1013 poster presentations supports #161 “SHS2013 Clarifying OR On Time Starts” supports #107 “SHS2013 Clarifying OR Turnover Time Concept Graph” supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model” also see The effects of late surgeons … Continue reading
Graphic Simulation Interactions of Constraint Theory and Lean
SHS2013 #107 “Clarifying and Using OR Turnover Time for Purpose and Advantage“ supports #161 “Clarifying the Definition, Purpose, and Effects of OR On-time Starts“ supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model“ also see: predicting scheduled starts for … Continue reading
Posted in anesthesiologist, ASC, Uncategorized
Tagged anesthesia, COO, CRNA, or sche, surgeon, theory of constraints, toc
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The effects of late surgeons on other surgeons, overtime, Pre-Op, PACU, and patient waiting…
SHS2013 poster presentations supported supports #161 “Clarifying the Definition, Purpose, and Effects of OR On-time Starts“ supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model“ also see Getting Dr. Able out of the OR before 4pm… | ORTimes … Continue reading
Posted in Ambulatory Surgical Center, anesthesiologist, ASC, scheduling, similation, surgeon
Tagged Ambulatory Surgical Center, ASC, OR scheduling, PACU, preOP, surgical case
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bad research…or bad reporting?
This is an example of the perils (morbidity, mortality, and financial) of mathematical manipulation of data by researchers in basing broad conclusions without more fully understanding the processes and externalities involved: Unnecessary anesthesia adds $1B to health spending – FierceHealthcare … Continue reading
Posted in Accounting, Ambulatory Surgical Center, anesthesiologist, ASC, board of directors, CEO, surgeon
Tagged anesthesia, OR scheduling, OR throughput, risk, risk management, scheduling
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accounting and scheduling come together…
It took a few days (alright… quite a few days), but now my accounting software (great company-versatile software) collects accounting data in the standard cost accounting manner, yet reports it in a Throughput Accounting or Activity-based Accounting way so that … Continue reading
Posted in Accounting, anesthesiologist, ASC, CEO, healthcare reform, scheduling
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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
Posted in Ambulatory Surgical Center, anesthesiologist, ASC, scheduling, surgeon
Tagged anesthesia, CEO, COO, OR scheduling, room flipping, scheduling, surgeon
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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
Posted in Ambulatory Surgical Center, anesthesiologist, CEO, healthcare reform, scheduling, surgeon, Uncategorized
Tagged anesthesiology, cfo, COO, cost accounting, FTE, full time employee
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‘risk vs return’ or ‘when the shit hits the fan’ in the OR
Taken from a Linkedin post of mine with the HFMA group: Sandra, The ‘general’ rule is that ASA 1-3 is ok for free standing facilities. That rule is effectively bent for rational reasons. The ASA classification has a lot of … Continue reading
OR scheduling concept map (concept diagram)…
A few years ago I diagrammed several concepts involved in scheduling an OR onto this graph. The intent was to take advantage (or nullify disadvantages) of characteristics of individual surgeons and anesthetists. The interplay of these concepts and individual factors … Continue reading
Posted in anesthesiologist, concept graph, concept map, healthcare reform, scheduling, surgeon
Tagged anesthesia, concept graph, concept map, COO, OR, scheduling, surgery
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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
Posted in anesthesiologist, CEO, healthcare reform, scheduling, Uncategorized
Tagged cfo, healthcare reform, healthcare systems analysis, OR, scheduling
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putting it all together…intra-case and inter-case….TOT and more
There are a thousand variations of the following examples, but I hope these four graphs will get across some ideas. For potential economic effects, see: Wasting $2.7 million dollars a year. Each of the following graphs has 5 bars. Each … Continue reading
Posted in anesthesiologist, board of directors, CEO, healthcare reform, scheduling, surgeon, Uncategorized
Tagged anesthesia, scheduling, surgeon, toc, TOT
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absolute loss of time…
In medicine, almost nothing is absolute. Absolutes are strictly enforced, unless the person who decided that it was an absolute changes his mind. In the narrow world of OR throughput, this is an important factor why surgeons (and anesthesiologists) should … Continue reading
Posted in anesthesiologist, scheduling, surgeon
Tagged decision algorithm, OR, surgeon
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clinical resolution of systems engineering scheduling in the OR…
No new graphs today… Let’s discuss the resolution of a systems engineer in improving turnover time (TOT). In the last few blogs I showed the difference in TOT due solely to who sees the patient in the pre-op holding area, … Continue reading
Posted in anesthesiologist, CEO, healthcare reform, scheduling, surgeon
Tagged anesthesiology, CEO, COO, healthcare systems analysis, nurses, scheduling, surgeon, surgery
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coffee and donuts…. time for a break
Oh what fun… This is just one of many factors affecting turnover time (TOT). For the sake of smaller graphs and clarity, I’m showing only the times till anesthesia induces the patient to show the comparison of … Continue reading
Posted in anesthesiologist, scheduling, surgeon
Tagged anesthesiology, OR, scheduling, theory of constraints
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difficulties with start times and TOT in the OR…
The following are excerpts from a discussion concerning Turn-Around-Time (TOT) in the OR. They relate to my recent posts on scheduling, and show the complexity/difficulty in defining the problems and solving them: ____ she: There are benchmarks out in the … Continue reading
Posted in anesthesiologist, scheduling, surgeon
Tagged anesthesia, decisio, OR, scheduling, surgical case
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micro real options in the OR…
One advantage of performing virtually identical cases—such as specialty ORs (cataract surgery would be an example) is that the room setup is virtually identical and a great deal of time can be saved (or avoided) by being able to put … Continue reading
Posted in anesthesiologist, healthcare reform, scheduling, surgeon
Tagged COO, finance, OR, schedule, scheduling
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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 … Continue reading
Posted in anesthesiologist, scheduling, surgeon
Tagged anesthesia, anesthesiologist, COO, risk management, surgery, theory of constraints, toc
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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
Posted in anesthesiologist, board of directors, CEO, healthcare reform, scheduling, surgeon
Tagged anesthesia, COO, finance, healthcare reform, healthcare systems analysis, OR, surgery, surgical case
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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
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
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
Posted in anesthesiologist, board of directors, CEO, healthcare reform, scheduling, surgeon
Tagged anesthesia, CEO, COO, healthcare reform, healthcare systems analysis, scheduling, surgery
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So much data…so little time
Posted in anesthesiologist, CEO, healthcare reform, scheduling, surgeon
Tagged COO, healthcare reform, healthcare systems analysis, surgery, surgical case
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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
Posted in anesthesiologist, scheduling, surgeon
Tagged anesthesia, COO, OR, surgeon, surgery, surgical case
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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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Tagged anesthesia, CEO, COO, scheduling, surgery
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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
Posted in anesthesiologist, CEO, healthcare reform, surgeon
Tagged anesthesia, CEO, COO, CRNA, decision algorithm, surgeon
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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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Tagged anesthesia, COO, scheduling, surgery
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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
Posted in anesthesiologist, scheduling, surgeon
Tagged anesthesia, COO, finance, schedule, scheduling, surge, throughput
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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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Tagged anesthesia, COO, scheduling, surgeon
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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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Tagged CEO, COO, healthcare reform
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Protected: theory, tools, and techniques… abstract
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Posted in anesthesiologist, CEO, scheduling, surgeon
Tagged anesthesiologist, CEO, COO, finance, surgeon, throughput
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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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Tagged anesthesia, COO, healthcare reform, risk management
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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
Posted in anesthesiologist, CEO, healthcare reform, scheduling
Tagged anesthesia, CEO, cfo, COO, legal risk, risk, risk management
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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
Posted in anesthesiologist, scheduling, surgeon
Tagged anesthesia, COO, scheduling, surgeon
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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
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
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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Tagged anesthesiologist, CEO, COO, surgeon
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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
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
Posted in anesthesiologist, CEO, scheduling, surgeon
Tagged anesthesia, CEO, linkedin, risk management, schedule, scheduling, surgeon
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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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Tagged anesthesia, anesthesiologist, schedule, scheduling, surgeon
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the fungible anesthetist…
See also: staffing anesthesiologists…the law of unintended consequences I’m emphasizing anesthetists as the fungible commodity (since they can be more readily fungible, and expensive), however it could be anything such as nurses, surgeons, equipment, OR rooms, etc. The existence of similar … Continue reading
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Tagged anesthesiologist, CEO, COO, schedule, scheduling, surgeon
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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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Tagged anesthesiologist, CRNA, schedule, scheduling
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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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Tagged anesthesiologist, CEO, COO, CRNA, schedule, scheduling
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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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Tagged administration, anesthesiologist, CEO, finance, surgeon
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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
Posted in anesthesiologist, scheduling
Tagged anesthesiologist, CRNA, schedule, scheduling
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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
Posted in anesthesiologist, CEO, scheduling, surgeon
Tagged anesthesiologist, CEO, COO, linkedin, schedule, scheduling, surgeon
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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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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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Tagged anesthesiologist, CEO, finance, linkedin, schedule, scheduling, surgeon
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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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Tagged anesthesiologist, COO, CRNA, finance, schedule, scheduling
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ORTimes 