Tag Archives: scheduling

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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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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bad research…or bad reporting?


This is an example of the perils (morbidity, mortality, and financial) of mathematical manipulation of data by researchers in basing broad conclusions without more fully understanding the processes and externalities involved: Unnecessary anesthesia adds $1B to health spending – FierceHealthcare … 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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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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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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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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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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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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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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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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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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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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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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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…


There is no excerpt because this is a protected post.

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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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Graph of CRNA usage for optimized Surgeon Schedule


also see: FTE vs cost accounting … when PUNs equal CUEs also see: Wasting surgeons’ time This is a graph of the CRNA usage for the Optimized Surgeon schedule from the blog post dated Jan 20, 2010.   Compare this graph to … 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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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

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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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