Tag Archives: CEO

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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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Protected: the fungible anesthetist…


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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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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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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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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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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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