Tag Archives: surgeon

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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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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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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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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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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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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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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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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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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Protected: theory, tools, and techniques… abstract


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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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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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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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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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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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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 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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