Category Archives: scheduling

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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LinkedIn conversation…transparency discussion SCO (Surgery Center of Oklahoma)


Follow Mary Pat Oklahoma City hospital posts surgery prices online; creates bidding war kfor.com OKLAHOMA CITY – An Oklahoma City surgery center is offering a new kind of price transparency, posting guaranteed all-inclusive surgery… 9 days ago Unlike Comment Unfollow Flag … Continue reading

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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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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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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

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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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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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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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flipping rooms…get started


If you’re in charge of the OR, whether nursing or an anesthesia or surgical group, and want to decrease turnover time, risks, and costs while increasing revenue — you could greatly benefit from flipping rooms. With internet connectivity in your … 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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a little data goes a long ways…


Although the expression –‘it’s not what you have, but how you use it’– is not entirely true, knowing how to massage whatever data you have can be very productive.  The data needed for this display is easily available from the … 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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not your father’s OR scheduler…


Want to know who’s doing what, when: With what?  What’s starting when? Who’s got to be there? How many whos? Can you let a few people off early?  Can you start a few people late?  How many people need to … Continue reading

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labor analysis of CRNA from collectible time data…


6:00 Labor Analysis 482 230 280 0.5809 150 102 14:02 The above shows information about the work of a CRNA during the day. The CRNA clocked in at 6:00 am and out at 14:02 for total Time-on-the-Clock wage minutes of … Continue reading

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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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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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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

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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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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

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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

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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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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

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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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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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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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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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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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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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Protected: Scheduling Abstractions…


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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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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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Geek humor…


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

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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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“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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