Health Policy - New York State

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April 28, 2004

Comments

Steven Davidson

Yes, actually it can. The ambulance industry uses "unit hour distribution" distributing ambulances differently geographically by time of year (8760 hours). We started staffing differently by time of year in our ER, first with docs, later with clerks and nurses. Managed a 50% increase in patient volume with reduced throughput and no change in the number of doctors. But the models are proprietary and unpublished. Even so, at a certain saturation point of the physicial plant (patients per sq. ft.) chaos increases non-linearly and throughput craters correspondingly.

John

Steven's is a very useful comment. Three responses:

1. Why are the models proprietary? I'm assuming the hospital owns them. Is that correct?

2. Even if the owner is unwilling to but the models into the public domain, why not sell them?

3. The references to reaching a saturation point and having everything spin out of control is evidence of some serious analysis and deep thinking about the nature of systems generally and this one in particular. Most view systems like this in a strictly linear manner and most of them aren't even aware of the potential consequences. Thus, they're not aware of the risks and when they do reach the tipping point they are almost invariably confused and their responses are wrong, often exactly the opposite of what they should do. Thus, the awareness of what happens here is evidence of sophisticated thinking.

Thanks for an excellent comment!

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