Managing Orthopedics at Rmc
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Case Questions: Managing Orthepedics at Rittenhouse Medical Center What is your assessment of the 3B Orthopedics model relative to that used for typical procedures performed by the faculty practice surgeons? Which is better? What are the key criteria for your assessment?In my opinion, the 3B Orthopedics model is far more superior than the typical procedures performed by the faculty practice surgeons, both in terms of operational efficiency and in terms of variability and risk due to streamlined and standardized processes. 3B Orthopedics model employs the principle of “Lean Hospital” and implements this philosophy quite successfully. In a lot of ways, I see parallels between the 3B Orthopedics Model and the Toyota Production System (TPS). TPS is mainly concerned with reducing waste, cutting down the lead times and standardizing the quality of the final product. It also emphasizes on healthy supplier relationships. Surgeons, nurses and technicians at 3B Orthopedics do exactly this, the only difference being that the final product here is a satisfied and cured patient.The key criteria for my assessment are as follows:3B surgeons performed a high volume of procedures, using highly standardized practices, serving the best interests of patients. Routine knee replacement surgeries were completed in less than 30 minutes as compared to one-to-two hours taken by typical orthopedic surgeons. This was achieved by cutting out all the time in between steps.3B orthopedics model focused on making the entire continuum of care- from first office visit to follow-up care, and especially the surgery itself- as efficient as possible. 3B surgeons were highly specialized in their practice. The senior surgeons were further more focused in their practice and their ability to sub-specialize was due to the reputation they had established over several decades.In the operating room, parts were standardized, problems were anticipated in advance, instrumentation was simplified, procedure was distilled to its essence, each step was performed singly and completely and each phase was evaluated quickly and incisively.From the patients’ standpoint, a through screening, pre-procedure and post-procedure follow-ups ensures that few complications arise unexpectedly.Each nurse and technician knew precisely what role they were expected to play during a surgery and they stuck to their role without any variation. To use manufacturing terminology, the 3B Orthopedic facility was akin to a low-cost, high volume, high efficiency and high output factory, churning out satisfied patients at a consistent rate.However, the typical procedures performed by the faculty practice surgeons is also an indispensable part of the operations at Rittenhouse Medical Center. This is because, these medical professionals were responsible for teaching at the medical school, research, as well as patient care.
2. Assume the specific process times noted on p. 10 of the case: 30 minutes to prepare patient in the operating room, 20 minutes for Booth to complete the procedure, 15 minutes for suturing and room turnover, and 5 minutes for Booth to perform interoperative activities such as calling the family and scrubbing for his next procedure. How many joint replacements could Booth perform during an operating block lasting from 7:00 AM to 12:00 PM? What is Booths utilization rate during this period? Over the same period, what is the utilization rate for his two operating rooms? How do these figures change if the time required to prepare a patient in the operating room increases from 30 to 45 minutes? For all calculations, assume that: (1) Booth only performs unilateral procedures, (2) the first patient cannot enter the operating room until 7:00 AM, and (3) the entire procedure for the final patient must be complete by 12:00 PM. Also, note that an operating room is considered non-idle when it is either occupied by a patient or being cleaned between procedures.Case 1: When Patient Preparation Time is 30 minutesOperating Room 1Patient in Operation Start Operation End Patient OutRoom Ready7:007:307:507:558:058:058:358:559:009:109:109:4010:0010:0510:1510:1510:4511:0511:1011:20Operating Room 2Patient in Operation Start Operation EndPatient OutRoom Ready7:257:558:158:208:308:309:009:209:259:359:3510:0510:2510:3010:4010:4011:1011:3011:3511:45Hence, Booth could perform 8 operations during an operating block lasting from 7:00 AM to 12:00 PMBooth is utilized for 25 minutes per operation