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Tag Archives: COO
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
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
Posted in CEO, experts, healthcare reform, Uncategorized
Tagged CEO, COO, healthcares systems engineering, systems engineering
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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
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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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
Posted in concept graph, orthopedics, simulation, surgeon, Uncategorized
Tagged CEO, COO, healthcare systems engineering, OR throughput, othopedics, throughput
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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
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
Posted in Accounting, CEO, healthcare reform
Tagged accounting, cfo, COO, cost accounting, toc
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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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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
Posted in board of directors, CEO, healthcare reform
Tagged CEO, constraints, COO, healthcare reform
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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
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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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
Posted in board of directors, healthcare reform, scheduling, Uncategorized
Tagged constraints, COO, hospital patient flow, theory of constraints, toc
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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
Posted in board of directors, CEO, healthcare reform, scheduling, surgeon
Tagged CEO, cfo, COO, hospital patient flow
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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
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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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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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
Posted in healthcare reform, scheduling, surgeon
Tagged constraints, COO, healthcare reform, healthcare systems analysis, scheduling, surgeon
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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
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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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
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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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
Posted in board of directors, CEO, healthcare reform
Tagged board of directors, CEO, cfo, COO, healthcare reform, healthcare systems analysis
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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
Posted in board of directors, CEO, healthcare reform
Tagged CEO, cfo, COO, healthcare reform, healthcare systems analysis, systems 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
Posted in board of directors, CEO, healthcare reform
Tagged board of directors, CEO, cfo, COO, healthcare reform, healthcare systems analysis
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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
Posted in anesthesiologist, CEO, healthcare reform, scheduling, surgeon
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
Posted in anesthesiologist, scheduling, surgeon
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
Posted in anesthesiologist, CEO, healthcare reform, scheduling, surgeon
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
Posted in anesthesiologist, CEO, healthcare reform, scheduling, surgeon
Tagged CEO, COO, healthcare reform
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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
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
Posted in anesthesiologist, healthcare reform
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
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
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
Posted in anesthesiologist, healthcare reform, surgeon
Tagged anesthesiologist, CEO, COO, surgeon
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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
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
‘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
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
Protected: the fungible anesthetist…
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Posted in anesthesiologist, CEO, scheduling, surgeon
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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
Posted in anesthesiologist, CEO, scheduling
Tagged anesthesiologist, CEO, COO, 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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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
Posted in anesthesiologist, scheduling
Tagged anesthesiologist, COO, CRNA, finance, schedule, scheduling
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ORTimes 