Category Archives: healthcare reform

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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Can engineers and physicians mix…from LinkedIn conversation


Follow David Can engineers and physicians mix? When doing and hearing about healthcare performance improvement it seems much is dependent on doctors and engineers collaborating. Yet this is difficult. Sometimes impossible when implementing. Are they too different to succeed? 7 … Continue reading

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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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TA (throughput accounting) and TDABC (time driven activity based costing)….the fabric, the ‘warp and woof’ of healthcare accounting?


also see: throughput accounting…a natural for hospitals? Linkedin thread also see: throughput accounting (TA) vs activity based costing (ABC) also see: FTE vs cost accounting… when PUNs equal CUEs also see: When you’re lost, use a map… also see: Graphic Simulation … Continue reading

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Artificial Intelligence (AI), Simulations, and Experts…from Linkedin conversation


Artificial Intelligence, Simulations, and Experts I’m trying to get my head around how these all go together. For the sake of conversation, I’m posting a few statements (which may or may not be true) to get the conversation going. Any … Continue reading

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Linkedin converstion: “How will medical tourism insert itself into mainstream of US healthcare reform?”


MariaUnfollow How will medical tourism insert itself into the mainstream of U.S. healthcare reform? Under healthcare reform, employers are beginning to express interest in concepts and reform measures which have variously been labeled ―value-based, ―results-based, ―performance-based, or ―outcomes-based purchasing and … Continue reading

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throughput accounting…a natural for hospitals? Linkedin thread.


see also: TA (throughput accounting) and TDABC (time driven activity based costing)…the fabric, the ‘warp and woof’ of healthcare accounting?   Throughput Accounting— a natural for Hospitals? In my work with increasing OR productivity, throughput accounting quickly shows the benefits of … Continue reading

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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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throughput accounting (TA) vs activity based costing (abc)…


see also: TA (throughput accounting) and TDABC (time driven activity based costing)…the fabric, the ‘warp and woof’ of healthcare accounting? from a Linkedin topic: Just thought I’d expand on some thoughts about Acitivity Based Costing (ABC) vs Thoughput Accounting (TPA): … Continue reading

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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

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the art of flipping rooms…


– There are two main parts to flipping rooms: intra-case and inter-case. They are complementary and work together iteratively. – An analogy of this iterative type of scheduling –adjusting individual cases(intra-case) and schedule (inter-case) to make a good fit– is … Continue reading

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Foldit….human pattern recognition trumps algorithms…


One of my tenets is that creating tools that help people recognize patterns can create better results than creating an algorithm than cannot take into account all the parameters of a situation.  Just like the saying “One picture is worth … Continue reading

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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

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conundrum…


After trying to modify the simulation part of my OR scheduler, and encountering various conundrums, I decided to try to formally clarify the source of the conundrums which led me to other realizations: To wit: The important parts of decision … Continue reading

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a box lunch to go…


It looks as though healthcare funding will be cut shortly.  Medicare will be on the chopping block soon, reimbursements for hospitals will be down.  Those who don’t think outside the box–who never saw the lid of  the box closing–will be … Continue reading

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Do Doctors run Hospitals better?


internet: http://ftp.iza.org/dp5830.pdf local: Who Needs an MBA   So which is better, an MD, MBA, or MD / MBA?

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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

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the dark side of hospital patient flow…Part 2


I received this email last week. Have you ever seen the drawings with the title ‘Where’s Waldo?’ Let’s play “Where’s the constraint?’ Think in terms of the discussion from my prior post ‘the dark side of hospital flow…Part 1’. Start … Continue reading

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the dark side of hospital patient flow… Part 1


Flow is defined as the quantity of some item (units of an item) passing by, leaving, or arriving at some point in a designated unit of time.  So, flow is defined by four parameters: units(1) of an item(1) , a … Continue reading

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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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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

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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

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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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predicting scheduled starts for surgery…


also see: Graphic Simulation Interactions of Constraint Theory and Lean 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 … Continue reading

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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

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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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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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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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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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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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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…


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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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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‘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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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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