Who is Eugene Litvak? Eugene Litvak, Ph.D. is a Professor of Health Care and Operations
Management and Director of the "Program for the Management of
Variability in Health Care Delivery"
at Boston University Health Policy
Institute. His primary research interest is, as the foregoing would
suggest, identifying and managing natural and artificial variability.
(Select publications here.)
Hospital care will never be a "just in time" operation. Patients and
their health are not a raw material to be scheduled and metered out at
a precisely controlled rate. In the overall delivery of care however,
variability comes in two flavors: "natural" variability which cannot be
controlled, and "artificial" variability which can be controlled. Queuing theory
can be used to manage natural variability. Artificial variability comes
from batching, blocking and other techniques that are commonly used to
The following are some key papers on managing variability to improve patient flow:
Managing Unnecessary Variability in Patient Demand to Reduce Nursing Stress and Improve Patient Safety, Joint Commission Journal on Quality and Patient Safety, June 2005, vol. 31, no. 6, pp. 330-338(9) (full text $20)
Root Cause Analysis of Emergency Department Crowding and Ambulance Diversion in Massachusetts,
A report submitted by the Boston University Program for the Management
of Variability in Health Care Delivery under a grant from the
Massachusetts Department of Public Health, October, 2002 (full text)
Emergency Department Diversion: Causes and Solutions, Academic Emergency Medicine, November 2001, Volume 8, Number 11, pp. 1108-1110, (full text)
Hospital Emergency Departments: Crowded Conditions Vary among Hospitals and Communities, Report to the Ranking Minority Member, Committee on Finance, U.S. Senate, March 2003, GAO-03-460 (full text)
You can also view an archived webinar (slides and audio) at Urgent Matters titled "Maximizing Throughput: Smoothing the Elective Surgical Schedule". This presentation describes how Boston Medical Center reduced artificial variability in their surgical schedule.
[Hat tip: Premier Safety Share]