Case Questions: Managing Orthepedics at Rittenhouse Medical Center

1. 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.

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  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 minutes

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 Operating Room 1
Patient in Operation Start Operation End Patient Out Room Ready
7:00 7:30 7:50 7:55 8:05
8:05 8:35 8:55 9:00 9:10
9:10 9:40 10:00 10:05 10:15
10:15 10:45 11:05 11:10 11:20
Operating Room 2
Patient in Operation Start Operation End Patient Out Room Ready
7:25 7:55 8:15 8:20 8:30
8:30 9:00 9:20 9:25 9:35
9:35 10:05 10:25 10:30 10:40
10:40 11:10 11:30 11:35 11:45

Hence, Booth could perform 8 operations during an operating block lasting from 7:00 AM to 12:00 PM

Booth is utilized for 25 minutes per operation

Hence, Booth’s utilization rate= (8*25)/300= 0.6667= 66.67%

Each Operating Room is utilized for 65 minutes per operation

Hence, utilization rate for the 2 operating rooms= (8*65)/ (300*2)= 0.8667= 86.67%

Case 2: When Patient Preparation Time is 45 minutes

Operating Room 1
Patient in Operation Start Operation End Patient Out Room Ready
7:00 7:45 8:05 8:10 8:20
8:20 9:05 9:25 9:30 9:40
9:40 10:25 10:45 10:50 11:00
Operating Room 2
Patient in Operation Start Operation End Patient Out Room Ready
7:25 8:10 8:30 8:35 8:45
8:45 9:30 9:50 9:55 10:05
10:05 10:50 11:10 11:15 11:25

Hence, Booth could perform 6 operations during an operating block lasting from 7:00 AM to 12:00 PM

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 Booth is utilized for 25 minutes per operation

Hence, Booth’s utilization rate= (6*25)/300= 0.5= 50%

Each Operating Room is utilized for 80 minutes per operation

Hence, utilization rate for the 2 operating rooms= (6*80)/(300*2)= 0.8= 80%

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