Category Archives: Uncategorized

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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Is it all about Control?


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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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Value Added rationale….Lean Six Sigma group from Linkedin


Follow Mike How do determine which steps are non-value added and which add? I specialize in precision cleaning prior to final assembly, an operation traditionally described as “non-value added.” The operation is obviously critical to the final product quality, yet … Continue reading

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TA vs GAAP (from a LinkedIn conversation)


Similar benefits for TA also apply to Lean Accounting and Marginal Costing.–me From Tony Rizzo: “Constraints-Accounting, that to which you refer as TA, is useful when one’s questions are designed to enable one to MAKE more money. The corresponding calculations … 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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big-data, gut-feelings, intuition


The argument comparing the usefulness of big data vs intuition needs some clarification of definitions and thought experiments. A thought experiment: “One picture is worth a thousand words”. Let’s suppose that the word is a an entry into a field … Continue reading

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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

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OR Policy Comparative Results and PreOP Congestion


See also: “SHS2013 Resolving Resistance to OR Scheduling” “SHS2013 Clarifying OR Turnover Time Concept Graph” “SHS2013 Clarifying OR On Time Starts” Many PreOp holding areas have a large variance in their usage.  To keep PreOp from being a constraint (bottleneck) for surgery (surgeons … Continue reading

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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

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


 The necessary clinical experience and scheduling backend to implement these strategies is assumed. For comparison, two surgeons doing similar cases are used: Dr. Schlicter is flipping between two rooms which for visualization purposes are grouped together into the blue horizontal band … Continue reading

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Linkedin Medical Tourism excerpt: Major Diagnostic Category flaws


Medical Tourism for Group Health: Using Major Diagnostic Categories (MDCs) to Predict Medical Tourism Utilization – A Flawed Strategy that Can Lead to Unrealistic Expectations The MDC is a very commonly used term, and widely misunderstood. All diagnoses or illnesses … Continue reading

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Lawyer discussing complicated fine print (tax laws?)…


A few months ago, law professor Evan McKenzie wrote a short blog post called “The Fine Print Society” (December 2011): Quote: As I go over all the bills and statements and announcements and changes to this or that plan or … Continue reading

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Is Healthcare’s Insular Culture a Liability or Benefit? Linkedin thread started by Peter Hadras…


Is Healthcare’s Insular Culture a Liability or Benefit? Working recently in the healthcare industry, I keep being struck by the deep-seated culture that unless the solution or practitioner is from healthcare, then it cannot be applied to a solve a … Continue reading

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Canadian healthcare analyzed by Robert Gordon…


Robert Gordon • Alan P obliges me to comment on drug availability in Canada and on recourse to the US private sector for healthcare services. I comment first on DRUGS. In Canada, healthcare (“The Establishment, Maintenance, and Management of Hospitals, Asylums, Charities”) … Continue reading

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constraint theory and pareto optimals linkedin…


Constraint theory and Pareto optimals… We’ve been using Constraint theory (TOC) as a way to derive Pareto optimal solutions in the OR for a couple of years now, and briefly mentioned the approach at a recent Academy of Business Research … 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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book recommendation: Models.Behaving.Badly by Emanuel Derman (Why Confusing Illusion With Reality Can Lead To Disaster, On Wall Street And In Life)


It’s nice to see one’s thoughts echoed by others who are much better known and established— even to the point of the same words and phrases used to categorize and clarify a universal problem and possible approaches to understanding and … Continue reading

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Healthcare Administrator-Physician divide


The following is an excerpt from an ongoing discussion in the Linkedin group ‘Healthcare Executives Network’. It broaches several problems and approaches that are necessary to understand before finding workable solutions, and could be taken as a preface for a … 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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unfounded confidence…anesthesiologists excluded :)


Don’t Blink! The Hazards of Confidence – NYTimes.com    

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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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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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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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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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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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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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