Friday, November 18, 2022

Hospital Laboratory Excellence: Three Case Studies

Hospital Laboratories are undergoing unique operational and financial challenges. Here below is a slide show of three case studies of recent operational excellence. They all began with senior executives hiring consultants to use benchmarks to build new labor budgets,  cut positions and reduce cost. And all three did something quite different, but with much better results.

All three required detailed study and teamwork.  This required a willingness to ask the uncomfortable questions of "What happened to your volume? Where is it now? What are your service levels? What is your backlog? What is the satisfaction level of your colleagues, patients and providers? What and where is your leakage? What is your direct line workload and productivity? What is your QC, supervisory, cross-training and onboarding overhead? What is your experience level by bench, shift and day of week? " Questions that don't have easy answers. Questions without readily available data. These questions are not "out of scope" to Workforce projects. They are the scope.

Results improved the bottom line much faster than any labor cuts could have done with three-to-10 times the margin improvement of labor cuts. These projects also yielded a variety of service improvements, staffing stability, growing associate engagement, and rising patient and provider satisfaction scores.  

Making those cuts would have harmed the capacity of these departments to recover and further grow their volumes, pushing down service and satisfaction. A decent consultant knows all this. As do most hospital  executives. But only an excellent consultant says so, and acts on that knowledge.

These case studies are what happens when executives take the risk to engage all participants and trust the development of answers that run entirely opposite of their best but limited judgement. 

Hospitals need consultants who choose to do the right things, the difficult things, the unpopular things however controversial; the counter-intuitive things, not the expected things, not the easy things, when inconvenient facts no one else believes or understands,  lead that way. Facts that would never have come to light without the insight to get them first, before acting. 

Because we are all led by example, often the consultant, as the "expert", must therefore become that better example. They must be the first to say "I'm not really sure. Let's take a closer look at a few different things together." 

But for that we need executives willing to support that journey, to have their notions of how to get there overturned, and take the journey of seeing and learning anew side by side with their management and consultants.

Friday, September 23, 2022

Hospital Productivity Systems: The Good, The Bad and The Ugly Part II: Two Examples from Physical Medicine

In our last blog article we detailed all the good ingredients of a best - practice productivity management system. 

Link to Part I

In this article we provide two examples where decision-making based on an existing productivity system went off the rails, and where additional analytics made things right again.

Here below, for your viewing and sharing pleasure, is a slide deck detailing two examples of hospital management system-based decisions from Physical Medicine. These two examples are a compilation of detailed work analysis, creative engineering and collaboration primarily by the Physical Medicine and Rehabilitation Directors of these departments, their managers and therapists, Nursing colleagues, and their executive C-Suite Leadership. The work was conducted over three health systems in the Midwest and Northeast, representing five different hospitals and their clinics from 2020-2021.

Just click on the first slide to bring up the slide viewer, and remember to save as a favorite for future education in your own organization.

Spence Tepper and Dirk Pattee

If you would like to learn more about our collaborative approach to building management excellence, check us out at...  

Or Call us at (888) 661-4677

That's 888-No1-HOSP

Be the Number One Hospital.

Call Today. Outperform Tomorrow.

Friday, September 9, 2022

Hospital Workforce Productivity Systems: The Good, The Bad and The Ugly

The increased corporatization of healthcare has made investment in big data systems possible. The data has proven to be a powerful tool for public service, patient access and margin improvement. But the downside is using this information for remote supervision rather than local supervision. That means judging performance a few management layers away from the department management, in a corporate office, based purely on limited data reports and verbal hearsay. 

This is the first of two blog articles. Here, in the slide deck below, we will detail the "Good": robust systems of complete information used in a disciplined infrastructure designed for two-way communication, collaboration and understanding. We will show the positive results these have generated in two  hospital improvement project examples. 

Simply click on the first slide to bring up the full-screen slide viewer.

In the next article we will detail two examples of the "bad" and the "ugly". We will share how good but incomplete information was misunderstood, painting false conclusions and generating poor decisions. These generated illusory short-term financial gains that burdened staff, patients and margin. 

Take your pick. Some learn best by good examples of good habits. Others are annoyed by it and need to see the negative results of bad habits. There are no bad habits, though. Simply habits that no longer function in this current environment. Here is our contribution to the journey forward.

If you would like to consider further assistance on your continuing path to hospital management excellence, you can find us here...

Or give Spence or I an email or call...

(888) 661-4677 (That's 888-No1-HOSP)

Dirk Pattee and Spence Tepper 

Call today. Outperform tomorrow. 

Friday, September 2, 2022

Rinse and Repeat: New Problems Can't Be Solved With Old Solutions

When hospital systems attempt to solve new problems with old solutions that don't work, the problems get worse

Today's financially challenged healthcare environment didn't just happen by itself, nor was it caused entirely by COVID. Executive decision-making had a little something to do with helping it along. But the good news is, there is a better way.

Here below is a quick slide show to consider and share, along with a list of recommendations. Just click on the first one to bring up the slide show viewer.

And if you would like to learn more about implementing Transformational Infrastructure, Engineered Staffing Pools and Synchronized Care Systems in your health system, reach out to Dirk or I :

or our email:

Or give us a call at 414-915-8577

Call Today! Outperform Tomorrow.

Spence Tepper and Dirk Pattee


Wednesday, July 27, 2022

Hospital Span-of-Control? 

Or Span-out-of-Control? 

Part II:  Span-of-Control Work

In our previous post we provided an essay on hospital system Span-of-Control and how it has changed over the decades...

Hospital Span-of-Control Part 1

Here we offer a more technical and practical approach on conducting Span-of-Control work.

Where there are quality, service, cost and productivity issues, Span-of-Control is a crucial foundational area for investigation and re-engineering. Building a better management team is a first step to actually getting things done right. Let's get woke to the work of management!

Here for your viewing and sharing pleasure are the fundamentals of Span-of-Control analysis work. Just click on the first slide to open the full screen slide presenter.

By Dirk Pattee and Spence Tepper
And remember that you can find out more and reach us at..


Hospital Span-of-Control? Or Span-out-of-Control?

Span-of-Control has been a hot topic for some time in healthcare, and it has undergone dramatic change over the years. 

There was a time when every nursing unit, regardless of size, on every shift, had a person designated as the Charge Nurse. Anyone, including patients, family members and MDs, at any hour of the day, whether weekday or weekend, could always ask to speak to the Charge Nurse on a unit.  

The Charge Nurse was empowered to address with knowledge, wisdom and compassion any questions or complaints about every patient under their care.  

In decades of cost cutting initiatives, head nurses are no more, and there are far fewer Charge RNs.  

Today's Charge RN often has responsibility over multiple nursing units, a greater range of specialists and hospitalists, each with their own span of authority to contend with.

Physicians are less available for each patient, expecting Charge RNs, RNs, extender mid - levels and hospitalists to fill the gaps. Eyes on patient has now been replaced with eyes on EMR. Critical judgement in real time has been replaced with critical paths and their flags. 

In theory these specialists and technology resources should provide better, more pro-active and preventative care than ever before. However, that still requires real-time teamwork. Each job has its own siloed priorities, so the work is arranged around volume not teamwork. Work is moved from one person's list to another person's list, creating batching, prompted only by EMR outlier flags. Now real-time live teamwork is an added separate task in its own box, limited to patient outliers, rather than a function of pro-active care for every patient. 

Years ago nurses were trained not to focus exclusively on tasks, but on the patient. Now with the advent of the EMR, tasks have won.

In the absence of functional supervision (and in the newer corporatization of healthcare, where supervision is now remote, where front-line management is being replaced by corporate functionaries netting zero margin improvement) supervisory hours are greatly reduced.  The system and its participants are disconnected from each other, the patient and their care, requiring care navigation among the layers and silos. 

Newer employees no longer have the live mentoring that experienced Charge RNs once provided on all shifts. The result is not simply greater delay orienting new colleagues. It is the absence of real-time on-the-floor oversight and knowledge of a patient's condition and progress by more than just the lone RN given primary care responsibility. Now that RN is truly alone. And so the work environment's safety and support for patient and care-giver through transparency and collaboration has become a more singular and lonely experience for both.

Care Navigation is its own art, but can never replace the top-of-license pro-active synergies generated by real-time supervision. 

The various professionals involved in care are like several pieces of cloth held together at the seams to cover parts of the patient's care.  The garment is no longer the patient, but the standardized protocol and critical path. The seams are often stretched, an effort to take an off-the-rack garment of perpetually wrong size.

 But these same threads can be interwoven into a single bespoke cloth of care that also includes the patient's own threads. The patient can become their own garment. In truth, the patient IS the garment, and all care-givers, at best,  are not working to cover up the patient with diagnoses and tasks. They are part of the patient.

The case of Radonda Vaught illustrates the reactive and blind blame-placing that takes place when a system of real-time visibility, accountability and  management is not functionally in place. Yet if ever there were a true justification for such management, it must surely be patient care.

True frontline supervision is fully empowered  with the responsibility, time and authority to inspect and intervene with anyone and everyone at any and every hour of the day. 

Supervision isn't only reacting immediately when asked for help. It is seeing pro-actively where help is needed before anyone asks and offering it first.  It is seeing the stress on the face of the nurse and having time to partner with them before even they realize they are becoming stressed.  

Supervision is taking the time to watch others work with patients. It is investing in that time in the design of the management structure.  

Hospitals used to be the employer of  choice. Not so much today. Progress in technology and staff specialization represent incredible untapped resources for synergy. Hospitals can become the employers of choice once again. To sustain they must.

On our next post,  for your viewing and sharing pleasure, is a slide show  providing a general overview of Span-of-Control work. 

Or you can click below to go there...

Hospital Span-of-Control II

Where there are quality, service, cost and productivity issues, Span-of-Control is a  crucial foundational area for investigation and re-engineering. Because blame is so last-century, reactive and dysfunctional. But building a better health system actually gets things done right. Let's get woke to the work of management!

And remember you can always reach out to Dirk and I at..

By Spence Tepper and Dirk Pattee

Tuesday, June 21, 2022

The School for Hospital Staffing Pools That Rule!

 Workforce has become the number one challenge for many hospitals, and there appear to be limited options for recovery:

  1. By January 2020 US Hospitals averaged 90% occupancy or about 36,242 admissions

  2. This represented a 5.8% growth over 2000   

  3. But by September 2020 hospital occupancy had dropped to 60%

  4. And the projection for June of this year, 2022, is still only 60%       

  5. Two thirds of the employees lost due to the pandemic haven't returned to the hospital workforce

  6. The current workforce includes a 37% increase in Travelers

  7. The nation is no healthier than it was. As a result of COVID the population is more vulnerable. While the COVID death toll has dropped dramatically, now a higher percentage of vaccinated adults are getting COVID, and the long term effects of COVID are beginning to emerge.

  8. Given the impact from COVID and the aging population, the demand for services including inpatient admissions should be going up.

  9. Is it possible the inability to staff reliably and cost-effectively is affecting the return to 90% occupancy?

  10. A new model of resource management and performance excellence is needed to assure safe and reliable patient access: A collaborative model that uses all the best skills of the hospital’s highest achievers.

And what is the basic foundation of that new model? 

It's your service line's ESP! 

Engineered Staffing Pool......

So, for your viewing and sharing pleasure scroll all the way down below the text and click on the first slide to start the slide viewer.

...And enter the School for Hospital Staffing Pools that Rule!

By Spence Tepper and Dirk Pattee


We are HS4HS, a Co-Op of the nations’ best hospital consultants. 

Find out more about our unique approach at

Check our latest news and blog articles on our linkedin page at

 And if you found the above data as compelling as we did, read more from their sources here.








The School for Staffing Pools that Rule!