\n\t\t\t\t@danweissmann\t\t\t<\/a><\/p>\n\t\t\tHost and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.\t\t<\/p>\n
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\t\t\t\t\t\tTranscript: A Mathematical Solution for US Hospitals?<\/strong>\t\t\t\t<\/p>\nNote: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\nDan:<\/strong> Hey there. Mark Taylor is a reporter, and when he started covering health care in the 1990s, the beat wasn\u2019t his first choice.<\/p>\nMark Taylor:<\/strong> I thought it was a punishment. I thought, I don\u2019t know anything about healthcare. I was bad at science, I was bad at math. I didn\u2019t understand any of this stuff, but I just was determined not to fail at it. And I dove into it head first and my wife said, you know, you used to read novels in bed and now you\u2019re reading the CDCs mortality and morbidity report.<\/strong><\/p>\nDan:<\/strong> About twenty years in, he picked up some medical journals \u2014 like you do \u2014 and looked at some studies about work by a guy named Eugene Litvak.<\/p>\nMark Taylor:<\/strong> I started reading these and going, wow, that\u2019s a good story.<\/strong><\/p>\nDan:<\/strong> Litvak was a math PhD, with a background in operations management, systems engineering. He\u2019d spent the first chunk of his career making telecommunications networks more efficient and reliable.<\/p>\nMany years later, One hospital that had implemented Litvak\u2019s program had saved more than a hundred million dollars a year.<\/p>\n
But the results were about more than money. Mark Taylor kept reading\u2026<\/p>\n
Mark Taylor:<\/strong> Reduces mortality rates in-hospital. That\u2019s a good story.<\/strong> Improves nurse retention. We\u2019ve got a nursing shortage. Reduces waiting times in ER and patient boarding.<\/strong><\/p>\nDan:<\/strong> Patient boarding sounds nerdy, but: We talked about this a couple of episodes ago, when we looked at the new HBO\/Max medical drama \u201cThe Pitt.\u201d<\/p>\nWhen hospital ERs get crowded \u2014 and way less effective \u2014 it\u2019s generally because of crowding upstairs.<\/p>\n
ER patients who need a bed upstairs can\u2019t get one, so they wait in the ER. And clog it up. Wait times get longer. Medical mistakes happen. People die.\u00a0<\/p>\n
On \u201cThe Pitt,\u201d and in lots of hospitals, this gets treated as a fact of life.<\/p>\n
Hospital administrators say they can\u2019t afford to build the new wings or hire extra nurses to meet peak demands.<\/p>\n
But Litvak\u2019s work showed: They don\u2019t need to.<\/p>\n
Because \u2014 it turns out \u2014 random ER visits don\u2019t cause those peaks.<\/p>\n
Scheduled surgeries do. They get bunched up on certain days. Un-bunch them, and the peaks get smoother.<\/p>\n
Nurses and doctors get less burned out. Fewer patients die. Hospitals waste less money.<\/p>\n
In other words, Litvak\u2019s work addressed some of the biggest problems Mark Taylor had been writing about for decades.<\/p>\n
Mark Taylor:<\/strong> There\u2019s a solution here. It\u2019s been proven to work, and it\u2019s been validated in the best medical journals in the country and in the world. How come this isn\u2019t in every hospital?<\/strong><\/p>\nDan:<\/strong>\u00a0 That was ten years ago. It\u2019s still a good question.\u00a0<\/p>\nMark wrote some newspaper stories about Litvak\u2019s work, starting with one in the Chicago Tribune, and eventually started working on a book.<\/p>\n
It came out in 2024, and it\u2019s called \u201cHospital, Heal Thyself: One Brilliant Mathematician\u2019s Proven Plan for Saving Hospitals, Many Lives and Billions of Dollars.\u201d<\/p>\n
By the time Eugene Litvak started working with hospitals, he was in his mid-40s. He had grown up in the Soviet Union, where he earned a PhD in math and worked as a systems engineer.<\/p>\n
His career there came to a halt when he asked for an exit visa \u2014 and his request was refused for almost a decade. There was a word for people in that predicament, lots of them, like Litvak, Soviet Jews: refuseniks.\u00a0<\/p>\n
Eventually he got to the U.S. \u2014 where he\u2019s now spent decades trying to get hospitals to try his methods.<\/p>\n
Eugene Litvak:<\/strong> I recently started telling people that I am a double refusenik, for 10 years refusing for the exit visa in Soviet Union, and now for 25 years in healthcare decision makers.<\/strong><\/p>\nDan:<\/strong> He\u2019s not giving up any time soon. And he thinks eventually hospitals will come around. He thinks they\u2019re gonna have to.<\/p>\nThis is An Arm and a Leg\u2013 a show about why health care costs so freaking much, and what we can maybe do about it. I\u2019m Dan Weissmann. I\u2019m a reporter, and I like a challenge, so the job we\u2019ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life, and bring you something entertaining, empowering and useful.<\/p>\n
Eugene Litvak was born in Kiev in 1949. Mark Taylor reports in his book that Eugene Litvak\u2019s work in engineering and math attracted international attention in the 1970s.<\/p>\n
Litvak also faced frustrating obstacles. A controlling boss. Semi-official antisemitism.<\/p>\n
But what finally spurred him to try to leave the Soviet Union was an offer. From the secret police\u2013 the KGB.\u00a0<\/p>\n
Eugene Litvak:<\/strong> And they were so nice, you know, like you\u2019re talking to your long lost brother. They said, you have a lot of friends. You communicate with many people. How about you work for us?<\/strong><\/p>\nDan:<\/strong> Eugene says the offer terrified him. Because he knew immediately he couldn\u2019t accept it.<\/p>\nEugene Litvak:<\/strong> I would not be any longer in peace with myself. In addition to that,\u00a0 I can tell you my father probably would stop talking to me if he would learn that I did something like that. So, these two factors \u2013\u00a0 look,\u00a0 I didn\u2019t think whether I should accept it or not. I didn\u2019t think about that. The only thing that was immediately in my mind\u2013\u00a0 how can I avoid it to minimize the consequence for myself?<\/strong><\/p>\nDan:<\/strong> As he told Mark Taylor, he didn\u2019t face immediate consequences for declining, but he knew he\u2019d always be at risk. He and his wife decided to leave.<\/p>\nAs they expected, they got fired from their jobs the day they applied for exit visas.<\/p>\n
He says they were prepared to wait out a process that they figured would take months, maybe a year.<\/p>\n
But their timing was bad. While they were waiting, in December 1979, the Soviet Union invaded Afghanistan. The Cold War got hotter, and exit visas basically stopped getting approved.\u00a0<\/p>\n
Eugene Litvak:<\/strong> So we, and many thousands of others, became victims of that.<\/strong><\/p>\nDan:<\/strong> Eugene says for most of the next decade, police and the KGB called him in, searched his house, threatened him with prison \u2014 while he and his wife worked basic jobs: she washed floors in a factory. He delivered telegrams.<\/p>\nWhen they finally got to the U.S., in 1988, with Eugene\u2019s parents in tow, Eugene\u2019s job prospects weren\u2019t much better.<\/p>\n
He says he had contacts with well-known scientists, but not great English. He worked in a hotel gift shop, then behind the desk.<\/p>\n
And practiced his English by cold-calling stores from the Yellow Pages.<\/p>\n
Eugene Litvak:<\/strong> Like Home Depot. Asking may I buy, you know, the air conditioner? And then the supermarket. The CVS. I was doing that on a regular basis until people started understanding what I want from them.<\/strong><\/p>\nDan:<\/strong> He eventually got some consulting work. And he found his calling \u2014 his obsession \u2014 bringing his training as an operations engineer to U.S. hospitals \u2014 when his father\u2019s health went downhill.<\/p>\nEugene Litvak:<\/strong> I saw the failures in operations at the hospital by spending a lot of time with my father.<\/strong><\/p>\nDan:<\/strong> And his chutzpah \u2014 and his persistence \u2014 all of that, really shows itself in what he did next:<\/p>\nEugene Litvak:<\/strong> I sent a letter actually to every hospital president in Massachusetts, offering my services to help.<\/strong>\u00a0<\/p>\nDan:<\/strong> No takers. No responses. But in 1995, the vice president of a big local hospital, Mass General, gave a lecture about how new market conditions meant hospitals would need to get more efficient.<\/p>\nAfterwards, Litvak stepped up, introduced himself\u2013 and got an invitation to drop by for a chat. In that meeting, his new pal the Vice President gave him a small assignment \u2014 one that Eugene didn\u2019t get to finish.\u00a0<\/p>\n
Eugene Litvak:<\/strong> He interrupted me before even implementation. He said, we have a more important project and that is operating room.<\/strong><\/p>\nDan:<\/strong> Operating room. Surgeries.<\/p>\nEugene Litvak:<\/strong> So that\u2019s how it started.<\/strong><\/p>\nDan:<\/strong> A doctor named Mike Long, who ran logistics for the hospitals surgeries, had been pushing to get things more efficient.<\/p>\nSome days, surgical patients crowded the hospital, so doctors and nurses sweated through expensive overtime. Others, the place was quiet and the hospital lost money staffing empty beds. Nobody could figure out why.\u00a0<\/p>\n
Long and Litvak became a team, with two big strengths: One, they were kindred spirits.<\/p>\n
Eugene Litvak:<\/strong> As he described it, you know, long lost twins.<\/strong><\/p>\nDan:<\/strong> And two, they had complimentary expertise:<\/p>\nEugene Litvak:<\/strong> He knew healthcare very well, which I didn\u2019t, and I knew operations management, that he didn\u2019t know.<\/strong><\/p>\nDan:<\/strong> They dove in together, pulling data, talking to people, and observing. The two of them worked and worked. For months, Litvak watched the weekly 6am meetings where surgeons would set their schedules.<\/p>\nThey had a hypothesis: Sometimes more people just showed up in the ER: More broken legs, more burst appendixes. The ER got crowded, and so did the rest of the hospital.<\/p>\n
So they searched their data for ways to predict or manage that problem.<\/p>\n
And then one day, a totally different answer literally showed itself to them.<\/p>\n
This was the 1990s, before PowerPoint. To share their data, they printed charts onto transparencies \u2014 plastic sheets for an overhead projector.<\/p>\n
One day, in Mike Long\u2019s office, they noticed a couple of these sheets sitting one on top of the other.<\/p>\n
One had a line showing scheduled surgeries \u2014 more this day, fewer that day. The other had a line showing, day by day, how many hospital beds were full.\u00a0<\/p>\n
Eugene Litvak:<\/strong> And we look. Wow, it\u2019s almost the same. We put it against the light in the window and they almost coincided. That was an aha moment.<\/strong>\u00a0<\/p>\nDan: <\/strong>When the line showing scheduled surgeries went up, so did\u00a0 the line showing full beds \u2014 crowding. They went down together too.\u00a0<\/p>\nEugene Litvak:<\/strong> It was clear message.<\/strong><\/p>\nDan:<\/strong> The question they\u2019d been working on\u2013 why does the hospital get so jammed sometimes?<\/p>\nThe answer wasn\u2019t random at all. It had nothing to do with random surges in patients showing up in the ER.<\/p>\n
The hospital got jammed \u2014 and the ER got backed up with patients waiting for a bed upstairs \u2014 when there were more surgeries scheduled.<\/p>\n
And there was a definite pattern: There were a LOT more scheduled surgeries early in the week, on Mondays and Tuesdays.<\/p>\n
He\u2019s taken to calling it \u201cweekday-related disease\u201d<\/p>\n
Eugene Litvak:<\/strong> Weekday related disease that manifests on a particular week days.\u00a0<\/strong><\/p>\nDan:<\/strong> On those days, there was no give in the operating-room schedule, a lot fewer open beds on the wards. When a normal day\u2019s batch of emergency cases showed up\u2013 wham. Things got jammed.<\/p>\nI told Eugene: Hearing all this after the fact, it just seems \u2014 obvious. You schedule a bunch of surgeries, you\u2019re gonna fill up the hospital, right? He was like, well, yeah.<\/p>\n
Eugene Litvak:<\/strong> As one of the hospital\u2019s chief medical officers said, Eugene pointed us to absolutely unexpected event that during the winter we have snow.<\/strong><\/p>\nDan:<\/strong> Right, but this hadn\u2019t kind of occurred to anybody before.<\/strong><\/p>\nEugene Litvak:<\/strong> No. And the first people reaction was practically calling me names.<\/strong><\/p>\nDan:<\/strong> People in the hospital did not want to believe what Eugene\u2019s data showed.\u00a0<\/p>\nWhich is easier to understand given what Eugene had seen when he observed the surgeons doing their 6 a.m. scheduling meetings for those six months.<\/p>\n
Each surgeon basically called dibs on a block of time for each week. And certain blocks were highly coveted:\u00a0<\/p>\n
Eugene Litvak:<\/strong> Every surgeon wanted to do the surgery Monday morning.<\/strong><\/p>\nDan:<\/strong> The intensity of the scramble for those times had puzzled Eugene. He asked his partner Mike Long about it.<\/p>\nEugene Litvak:<\/strong> I said, Mike, I hear they\u2019re fighting for this morning, block times as they would fight for their spouses. And he said, Eugene, you don\u2019t get it. He said they would rather give up their spouses than the morning, Monday, block time.\u00a0<\/strong><\/p>\nDan:<\/strong> Would rather give up their spouses than Monday morning block times. There were reasons\u2013 beyond just wanting the rest of the week clear.<\/p>\nLike: Surgeons wanted to come in and do their best work when they were fresh from the weekend.<\/p>\n
They wanted the early-morning slot for the same reason frequent travelers want early flights: Later in the day, your schedule could get delayed because of some problems that happened earlier.<\/p>\n
And if you operated on somebody later in the week, they might have to spend the weekend in the hospital. When, yeah, you might get called in to check on them.<\/p>\n
But also: hospitals operate with skeleton crews on weekends. Fewer nurses, less staff around for services like physical therapy.\u00a0<\/p>\n
Surgeons may have been looking out for themselves, Eugene says, but they were also trying to look out for their patients. And failing on both counts.<\/p>\n
Eugene Litvak:<\/strong> They\u2019re the first and foremost victim along with their patients of this mismanaged operation. They\u2019re trying to do their best, but, but the system is screwed up.<\/strong><\/p>\nDan:<\/strong> And they did NOT want to hear some engineer telling them when they should operate.<\/p>\nEugene Litvak:<\/strong> I talked to one of the prominent cardiac surgeon, really talented person. And, he told me, Eugene, how dare you are to teach me when I supposed to operate on my patients. Even my patients do not know when they should be operated on. How can you do that? And I said, okay, uh, your point is well taken. May look at your data, talk to your data people. He said, sure. So I talked to the data people. I came back and I said, look, I would like to be your student. As such, I would like to learn what kind of a disease your patients have that manifests itself every Tuesday\u00a0<\/strong><\/p>\nDan:<\/strong> And how did he respond?<\/strong><\/p>\nEugene Litvak:<\/strong> From that point, he avoided talking with me.<\/strong><\/p>\nDan:<\/strong> In his book, Mark Taylor reports that resistance like this from surgeons prevented Mass General from actually implementing Eugene Litvak and Mike Long\u2019s recommendations.<\/p>\nMike Long retired from Mass General in 2000, and Litvak\u2019s consulting contract ended.<\/p>\n
But by then they had compiled enough evidence to start publishing their findings in medical journals. And attracting allies in the field.<\/p>\n
At Boston University, Litvak set up a tiny research center with big names in medicine on the advisory committee: Like the CEO of the organization that accredits most U.S. hospitals.<\/p>\n
Hospitals brought Litvak in to consult \u2014 including the Mayo Clinic and Johns Hopkins. Mark Taylor\u2019s book says they undertook limited projects that achieved impressive results \u2013but never expanded.<\/p>\n
And then in 2004 a couple of doctors from Cincinnati Children\u2019s Hospital went to one of Litvak\u2019s talks, and came away\u2026 impressed. Litvak ended up talking with the hospital\u2019s CEO, Jim Anderson.<\/p>\n
Jim Anderson CCH:<\/strong> And I thought this would be a fun adventure to pursue.<\/strong><\/p>\nDan:<\/strong> So he did. The adventure they undertook at Cincinnati Children\u2019s remains Eugene Litvak\u2019s biggest success to date. That\u2019s next.<\/p>\nThis episode of An Arm and a Leg is produced in partnership with KFF Health News\u2013 that\u2019s a nonprofit newsroom covering health issues in America. Their reporters do amazing work and win all kinds of awards every year. We\u2019re honored to work with them.<\/p>\n
As a first step, Cincinnati Children\u2019s Hospital had Eugene Litvak do an evaluation and present recommendations to the lead medical staff.<\/p>\n
Eugene Litvak:<\/strong> Vice president, chief of surgery, chief of anesthesia, et cetera, et cetera.<\/strong><\/p>\nDan:<\/strong> Eugene\u2019s prescription: Change how you schedule surgeries, spread them out across the week. As he recalls, everybody seemed agreeable, and the CEO Jim Anderson made a proposal on the spot.<\/p>\nEugene Litvak:<\/strong> So he asked me, Eugene, okay, would you do that for us now to implement what you are preaching for? And I said, no. And he said, how come? I said, because these very people who smile at me would create roadblocks, and I\u2019m not sure I would overcome it. So he look around the room and said, okay, if you face any resistance, you call me directly. He looked at me again and said, would you do it now? I said, absolutely.<\/strong><\/p>\nDan:<\/strong> Jim Anderson recalls that part of the exchange a little differently.<\/p>\nJim Anderson CCH:<\/strong> I remember telling them and said, look, we\u2019re gonna do this anyway. We\u2019d love to have you involved if you\u2019re not. That\u2019s fine. Go away. But, uh, we\u2019re committed.<\/strong><\/p>\nDan:<\/strong> However that exchange went, the follow up was real.<\/p>\nWith Litvak\u2019s guidance, the hospital reorganized the way it scheduled surgeries\u2013 and saved a hundred thirty-seven million dollars a year. They\u2019d been planning to build a hundred-million dollar new tower to increase capacity, but with their new systems, they decided they didn\u2019t need to.<\/p>\n
Actually, Jim Anderson told another interviewer: without adding a single bed, the hospital took on more cases, AND wait times for patients went down by 28 percent. Nurses, surgeons, and anesthesiologists reported they were able to take better care of patients.<\/p>\n
Jim Anderson says the hospital was making other changes too, but he gives Litvak lots of credit.\u00a0<\/p>\n
Jim Anderson CCH:<\/strong> Eugene was a wonderful stimulus, to helping us, think outside the box and reorganize and really, uh, be more effective at what we did.\u00a0<\/strong><\/p>\nDan:<\/strong> And yet, almost twenty years later, he\u2019s had clients here and there. But few institutions have gone as far as Cincinnati Children\u2019s in following Litvak\u2019s advice.<\/p>\nJim Anderson CCH:<\/strong> It\u2019s been a mystery to me for decades now. I\u2019m astonished by the lack of response.\u00a0<\/strong><\/p>\nDan:<\/strong> That\u2019s the mystery Mark Taylor stumbled across when he started reading about Eugene Litvak\u2019s work years later. He started calling sources for a reality check.\u200b<\/p>\nMark Taylor:<\/strong> Most people in the hospital business knew nothing of him, hadn\u2019t heard of him at all. But some of my best sources as a healthcare journalist, told me, you know, this guy is really onto something. and it was like, Jesus, this guy\u2019s right. How come nobody else knows this?<\/strong><\/p>\nDan:<\/strong> He started reporting his first story on Litvak for the Chicago Tribune and basically asked Litvak himself: Who are your opponents?<\/p>\nEugene Litvak:<\/strong> He said, Eugene, I\u2019m health care reporter. I should be objective. You have the names of supporters and coauthors. I would like to know the names of naysayers so I can interview them, and I said, here is what I can do. If you find the one, I owe you a dinner.<\/strong><\/p>\nDan:<\/strong> He\u2019s had a lot of time since then. Since that was like what, seven, eight years ago?<\/strong><\/p>\nEugene Litvak:<\/strong> Yeah.<\/strong><\/p>\nMark Taylor:<\/strong> I talked to well over a hundred sources and I called all kinds of hospital executives, consulting firms, and I couldn\u2019t find anyone who said, a, this doesn\u2019t work. B, his, algorithms are wrong. C this is a fraud. They\u2019re making up details in that.<\/strong><\/p>\nDan:<\/strong> So what\u2019s the holdup? In my first conversation with Eugene Litvak, we talked about why more hospitals don\u2019t go with his recommendations\u2013 even after they hear about successes at institutions like Cincinnati Children\u2019s.<\/p>\nEugene Litvak:<\/strong> I\u2019ve been told by other hospital leadership, those are special hospitals. Our hospital is different. Our patients are sicker. Uh, at one hospital, they asked me, it was in South Carolina. They asked me whether I ever implemented that in South Carolina.<\/strong><\/p>\nDan:<\/strong> Implemented his idea that by reorganizing surgeries, hospitals can save money and take better care of patients.\u00a0<\/p>\nEugene Litvak:<\/strong> And I said, that\u2019s a management law has nothing to do with the state. And they said, no, no, no, it does. Uh, and I said, then let, let me, I\u2019m curious whether gravitation law works in South Carolina.<\/strong><\/p>\nDan:<\/strong> How did they respond to that?\u00a0<\/strong><\/p>\nEugene Litvak:<\/strong> Uh, people just get angry from some of my comments.\u00a0<\/strong><\/p>\nDan:<\/strong> Political maneuvering, may not be your strong suit, not to tell you anything you may not have heard before.\u00a0<\/strong><\/p>\nEugene Litvak:<\/strong> Yeah.<\/strong><\/p>\nDan:<\/strong> So I left that conversation with a hypothesis: Maybe this guy just doesn\u2019t have the diplomatic skills for this kind of work.<\/p>\nBut when I ran that hypothesis by Mark Taylor, he had a counter-example from Litvak\u2019s work at Cincinnati Children\u2019s Hospital.<\/p>\n
The administration was backing him, but they said eventually the various department heads would vote his specific plan up or down\u2013 so he needed to secure *yes* votes.<\/p>\n
Mark Taylor:<\/strong> He said, Mark, I, I lied a little bit. I would meet with these different constituencies, the orthopedic surgeons, the anesthesiologists, the nurses, the administration, and each one I would go to, I would tell now don\u2019t tell anyone else, but your group is gonna benefit disproportionately from this<\/strong><\/p>\nDan:<\/strong> And then \u2014 as Eugene told me \u2014 the leaders met to vote on his plan.<\/p>\nEugene Litvak:<\/strong>\u00a0 So everybody raise his or her hand and look at his peers around with a slight smile. Say, oh guys, I know something you don\u2019t, you know, I benefit more than you.<\/strong><\/p>\nDan:<\/strong> Eugene Litvak\u2019s diplomatic skils \u2014 or lack thereof \u2014 maybe aren\u2019t the whole issue.\u00a0<\/p>\nHe and his supporters have another hypothesis.\u00a0<\/p>\n
Namely: It\u2019s hard to change institutions.\u00a0<\/p>\n
Surgeons are trained to fight for those Monday morning block times\u2013 and in hospitals, they have a lot of clout. They bring in patients, and administrators are afraid to cross them.<\/p>\n
Here\u2019s one of Eugene Litvak\u2019s most vocal allies<\/p>\n
Peter Viccellio:<\/strong> My name is Peter Viccellio. I work at Stony Brook on Long Island, and I\u2019m an. Emergency physician<\/strong><\/p>\nPeter Viccellio:<\/strong>\u00a0 and I am in my 48th year of practicing emergency medicine<\/strong><\/p>\nDan:<\/strong> Peter\u2019s published big studies with Litvak, goes on conference panels with him.<\/p>\nAnd he\u2019s got a very long view on medicine and hospitals. Not only has Peter himself been practicing for decades, his dad was a doctor.\u00a0 Peter used to go with him on house calls when he was a kid. He says in those days<\/p>\n
Peter Viccellio:<\/strong> If you had a stroke, you stayed at home. If you had heart attack, you stayed at home. \u2019cause the hospitals had nothing to offer you. So it made sense to have a hospital nine to five, Monday through Friday with a skeleton crew on evenings, nights, and weekends.<\/strong><\/p>\nDan:<\/strong> He\u2019s seen the role of medicine and hospitals change dramatically<\/p>\nPeter Viccellio:<\/strong> When I was in medical school, if you had lupus, you died when you were 18 years old. Now I see 70 year olds with lupus. It\u2019s amazing what I\u2019ve seen. I think when I graduated from medical school, the only cancer that you could really cure was Hodgkin\u2019s Lymphoma. That was it. And there are so many cancers now that can be cured, or at least can be substantially slowed down and contained. So it\u2019s just a dramatic change.<\/strong><\/p>\nDan:<\/strong> But even though hospitals do so much more now, they haven\u2019t changed their basic schedule.<\/p>\nPeter Viccellio:<\/strong> We have a seven day a week problem, and we\u2019re still trying to solve it with a five day a week. Solution. And when I say five days a week, I mean eight hours each day of those five days a week. So that\u2019s 24% of the week that we are running full fledged.<\/strong>\u00a0<\/p>\nDan:<\/strong>\u200aAnd just changing the schedules for surgeons wouldn\u2019t be enough\u2013 as Peter says a surgeon would tell you.<\/p>\nPeter Viccellio:<\/strong>If you wanna do a hip case on a Thursday or Friday, is there enough physical therapy present on weekends to get the patient up and walking around? Do you have the needed ancillary services and whatnot to get stuff done?<\/strong><\/p>\nDan: <\/strong>And he says hiring extra staff for weekends may sound expensive. But\u2026<\/p>\nPeter Viccellio: <\/strong>if you\u2019re doing more stuff on the weekends. But you have the same volume. It means you\u2019re doing less somewhere else. So it\u2019s called redistributing the load.<\/strong><\/p>\nDan:<\/strong>And people\u2019s lives get more predictable \u2014 less emergency overtime. And according to Eugene Litvak\u2019s modeling, you don\u2019t necessarily need to go twenty-four seven.\u00a0<\/p>\nPeter Viccellio:<\/strong> if you went at this for six days a week, so that a Saturday was just like a Tuesday, then you\u2019d get a huge gain.<\/strong><\/p>\n