Monday, June 30, 2014

Focus and Leverage Part 357


For the past year, I have been consulting in the healthcare field….not exclusively, but predominantly.  It makes me sad to hear about all of the problems within the VA, but truthfully, it doesn’t surprise me.  While working with some of these heathcare facilities, I heard comments like, “If we want to improve outputs, we must increase inputs, or if we want to increase patient volume in a clinic, we need more personnel, space, advertising, etc. and even, if we want to improve (decrease) waiting time for patients, we need more personnel and equipment.”  The fact of the matter is, it’s absolutely possible to do much more with what you have because the performance of the whole system depends on a few factors - - the system constraints.

The problem is, most hospitals strive to have every unit in their organization functioning optimally, and when this happens, the entire organization usually suffers.  By focusing on everything, you typically get very little improvement.  Approaching improvement in this way actually results in sub-optimization or local optimization when true improvement happens only when the system improves.  Thinking in terms of a system perspective is when improvement happens.  Let’s look at an example of what I’m talking about.  I know of a private hospital who tried to increase their Operating Room capacity.  They decided to create more operating rooms and time slots, but throughput did not increase.  Why not?  Because they failed to consider the impact of more surgeries on the recovery rooms.  The recovery rooms simply did not have sufficient capacity to house additional patients.  This hospital focused on local optimization and did not consider the impact on the rest of the system.  One more time, focusing on local optimization will not result in improvements to the system.

The key to having a sustainable improvement initiative is by management by constraints and looking at the impact of changes on the system.  Management by constraints, as I’ve written about many times on this blog, is truly an innovative and very effective approach which was developed by Goldratt and Cox in the mid-80’s.  And while many people believe that this is a five-step process, I believe it is a seven-step process as follows:
  • Determine the system’s goal
  • Establish global performance measures
  • Identify the system constraint
  • Decide how to exploit the constraint
  • Subordinate the rest of the system to the constraint
  • Elevate and break the constraint
  • If the constraint is broken, return to step 3

The goal of any organization should be foremost in everyone’s mind and should act as a guide for every decision and action taken.  In for-profit organizations the goal should be to increase the the shareholder’s value or net worth.  For not-for-profit organizations, like many hospitals, the goal is determined by the mission of the organization.  For example, the goal of a not-for-profit health care organization should be something like, maximizing the quality of healthcare services provided to patients, within the limits of the budget.

Determining the goal of an organization can be somewhat problematic for some organizations in the healthcare world and other industries because of the apparent death grip traditional cost accounting has on many organizations.  As I have written about many times on my blog, attempting to become profitable through cost cutting is simply not the right approach.  The right approach to improving profitability in healthcare organizations is by focusing on the revenue generating processes like surgery. clinics, and even the emergency departments while maintaining the same level of labor in these areas.  But improving these areas in isolation, such as the example I gave you earlier (i.e. surgical unit) without looking at the entire system (i.e. recovery room availability) will be a fruitless activity.

In the next several postings, we’ll talk more about healthcare organizations and how they might focus their improvement efforts.  I also want to re-visit the concept of being a satisficer versus being an optimizer as you approach improvement.

Bob Sproull

Saturday, June 28, 2014

Focus and Leverage Index Through Part 356


Post #                    Subject Discussed

Each of the following postings can be reached by searching for the number designation below.  For example:  1 is Focus and Leverage or 2 is Focus and Leverage Part 2 and so forth.  The link to the first blog posting is:  http://www.blogger.com/blogger.g?blogID=4654571158555106378#editor/target=post;postID=4464386559619829406

 

 
1. Introduction to TOC – Lean – Six Sigma

2. Why Improvement Initiatives Fail

3. The Basic Concepts of TOC

4. Throughput Accounting

5. The Process of On-Going Improvement (POOGI)

6. The 3 Cycles of Improvement

7. Combining TOC, Lean and Six Sigma Graphically

8. Step 1a Performance Metrics

9. Planning Steps 1b and 1c Reducing Waste and Variation

10. Developing a Constraint’s Improvement Plan

11. This number was skipped

12. Steps 1b and 1c Reducing Waste and Variation plus an intro to DBR

13. Drum-Buffer-Rope

14. The Final Steps of UIC

15. How do I start the UIC?

16. The 10 Prerequisite Beliefs

17. Comparing Lean, Six Sigma and TOC

18. Types of Constraints

19. The Logical Thinking Processes

20. Undesirable Effects (UDE’s)

21. Categories of Legitimate Reservation

22. Current Reality Trees

23. Constructing Current Reality Trees

24. Conflict Diagrams Basic Principles

25. Constructing Conflict Diagrams

26. Intro to Future Reality Trees

27. Constructing Future Reality Trees

28. Prerequisite Trees

29. Constructing Prerequisite Trees

30. Transition Trees

31. Constructing Transition Trees

32. Book Announcement

33. Project Management Failures

34. Project Management Negative Behaviors

35. Critical Path Management (CPM)

36. Critical Chain Project Management (CCPM)

37. Tracking Projects In CCPM

38. Final Posting on CCPM

39. Intro to the TOC Parts Replenishment Model versus the Min/Max System

40. The TOC Parts Replenishment Model

41. Interview with Joe Dager from Business901

42. Deming, Ohno and Goldratt Commonality

43. Dedication to Dr. Eliyahu Goldratt

44. How processing time, cycle time, throughput and WIP are interrelated

45. Little’s Law

46. Batch and queue production system and the fallacy of a balanced line

47. Why an unbalanced line is better.

48. What prevents me from making more money now and more money in the future?

49. More on the 10 Prerequisite Beliefs

50. Motivating a work force to actively participate in improvement initiatives

51. Re-Introducing the Intermediate Objectives Map

52. Introducing Be Fast or Be Gone: Racing the Clock with CCPM

53. Parkinson’s Law, The Student Syndrome, Cherry Picking and Multi-Tasking

54. Overcoming the four negative behaviors in Project Management

55. Intro to combining the Interference Diagram (ID) and the IO Map

56. The Simplified Strategy

57. The Interference Diagram

58. Interference Diagram for Strategy

59. The ID/IO Simplified Strategy

60. Preface Part 1 for Epiphanized©

61. Preface Part 2 for Epiphanized©

62. CHAPTER 1 Part 1 for Epiphanized©

63. CHAPTER 1 Parts 2 and 3 for Epiphanized©

64. CHAPTER 1 Part 4 for Epiphanized©

65. CHAPTER 1 Part 5 for Epiphanized©

66. Focused Operations Management For Health Service Organizations by Boaz Ronen, Joseph Pliskin and Shimeon Pass

67. Marketplace Constraints

68. A Discussion on Variability

69. More Discussion on Variability

70. Still More Discussion on Variability

71. Paper from the International Journal of Integrated Care

72. Value Stream Mapping

73. Paths of Variation

74. Step 3, Subordination

75. The Key to Profitability: Making Money Versus Saving Money

76. My First Experience With TOC

77. TOC in Non-Manufacturing Environments

78. Deborah Smith’s Excellent Chapter in the TOC Handbook (i.e. Chapter 14)

79. More on Performance Metrics

80. Efficiency, Productivity, and Utilization (EPU) ©

81. Productivity as a Performance Metric

82. Utilization as a Performance Metric

83. What the Dog Saw –Malcolm Gladwell

84. Speaking at the CPI Symposium – Cal State, Northridge

85. NOVACES– A Great Young Company

86. NOVACES’SystemCPI©

87. Problems With My Publisher

88. The Why? – Why? Diagram

89. Experience With the Integrated Methodology

90. A New Piping Diagram

91. The Healthcare Industry

92. More Bad News From the Publisher

93. A Message from the CPI Symposium

94. Multiple Drum-Buffer-Rope

95. Problem Solving Roadmap

96. Problem Prevention Roadmap

97. Improving Profitability

98. More on Throughput Accounting

99. More on Parts Replenishment

100. TLS

101. Engaging the "Money Makers" in Your Company

102. A Conversation on the Theory of Constraints

103. The Key to Successful Consulting Engagements

104. The Three Basic Questions to Answer

105. A Problem With the Airlines

106. A Better Way to Improve Processes and Systems

107. The Problem With Project Management

108. Critical Path Project Management Revisited

109. Critical Chain Project Management Revisited

110. The Fever Chart

111. Comparing CPM and CCPM

112. Performance Improvement for Healthcare – Leading Change with Lean, Six Sigma and Constraints Management

113. More on Performance Improvement for Healthcare

114. Even more on Performance Improvement for Healthcare

115. Still One More on Performance Improvement for Healthcare

116. The Final One on Performance Improvement for Healthcare

117. The Real Final One on Performance Improvement for Healthcare

118. Focused Operation's Management for Health Services Organizations.

119. Focused Management Methodology

120. The Clogged Drain

121. The “Soft” Tools of Improvement

122. More on TOC’s Distribution/Replenishment solution

123. Still More on TOC’s Distribution/Replenishment solution

124. Amir Schragenheim’s Chapter 11 entry in the TOC Handbook

125. Comparison of Lean, Six Sigma and TOC

126. A Simple Lesson on Applying TLS to Your Processes

127. A Historical Index of Blog Postings

128. Mafia Offer Part 1

129. Mafia Offer Part 2

130. Mafia Offer Part 3

131. Airline Problems

132. A YouTube Interview with Bob Sproull and Mike Hannan

133. Active Listening

134. Viable Vision

135. Throughput Accounting

136.  Performance Metrics

137.  On-the-Line Charting

138.  Comment on Epiphanized from a reader in the US Marines

139.  Active Listening

140.  Healthcare Case Study

141.  Change

142.  Getting buy-in for Change

143.  Aviation Maintenance, Repair and Overhaul Client Part 1

144.  Aviation Maintenance, Repair and Overhaul Client Part 2

145.  Continuous Improvement in Healthcare

146.  Using Your Senses in Continuous Improvement

147.  A Video by Phillip Marris on CI

148.  An article about a Construction Company Using the TOC Thinking Processes

149.  Using TOC in Healthcare Part 1

150.  Using TOC in Healthcare Part 2

151.  Using TOC in Healthcare Part 3 Supply Replenishment

152.  Using TOC in Healthcare Part 4 Supply Replenishment (con’t)

153.  Using TOC in Healthcare Part 5 Supply Replenishment (final)

154.  The Sock Maker

155.  The Negative Effects of Using Efficiency

156.  Cost Accounting Part 1

157.  A Political Voting Story

158.  Cost Accounting Part 2

159.  Cost Accounting Part 3

160.  Using TLS for the Affordable Care Act

161.  The System Constraint in Hospitals Part 1

162.  Wait Times in Hospitals

163.  The Oncology Clinic Case Study Part 1

164.  The Oncology Clinic Case Study Part 2

165.  Article: Emergency Department Throughput, Crowding, and Financial Outcomes for Hospitals

166.  Goldratt’s 5 Focusing Steps in Healthcare

167.  My First Experience With TOC Part 1

168.  My First Experience With TOC Part 2

169.  My First Experience With TOC Part 3

170.  My First Experience With TOC Part 4

171.  My First Experience With TOC Part 5

172.  My First Experience With TOC Part 6

173.  Healthcare Case Study Part 1

174.  Healthcare Case Study Part 2

175.  Healthcare Case Study Part 3

176.  TOC in Healthcare

177.  Healthcare Case Study Part 4

178.  My Transition From Aviation Maintenance to Healthcare

179.  Door to Doc Time Case Study Part 1

180.  Door to Doc Time Case Study Part 2

181.  Door to Doc Time Case Study Part 3

182.  Door to Doc Time Case Study Part 4

183.  My White Paper in Quality Forum Part 1

184.  My White Paper in Quality Forum Part 2

185.  My White Paper in Quality Forum Part 3

186.  A Meeting on Epiphanized at the Pittsburgh Airport

187.  Billing for Immunizations Case Study Part 1

188.  Some Thoughts on Performance Improvement Part 1

189.  Some Thoughts on Performance Improvement Part 2

190.  Case Study on Using TOC in Healthcare

191.  IO Map

192.  TOC Thinking Process Tools Part 1

192B.  TOC Thinking Process Tools Part 2

193.  Case Study on How to Use TOC’s Thinking Processes Part 1

194.  Case Study on How to Use TOC’s Thinking Processes Part 2

195.  Case Study on How to Use TOC’s Thinking Processes Part 3

196.  Synchronized and Non-synchronized Production

197.  Competitive Edge Factors

198.  Case Study on How to Use TOC’s Thinking Processes Part 4

199.  Case Study on How to Use TOC’s Thinking Processes Part 5

200.  Case Study on How to Use TOC’s Thinking Processes Part 6

201.  Case Study on How to Use TOC’s Thinking Processes Part 7

202.  Case Study on How to Use TOC’s Thinking Processes Part 8

203.  Case Study on How to Use TOC’s Thinking Processes Part 9

204.  Case Study on How to Use TOC’s Thinking Processes Part 10

205.  Case Study on How to Use TOC’s Thinking Processes Part 11

206.  Case Study on How to Use TOC’s Thinking Processes Part 12

207.  Case Study on How to Use TOC’s Thinking Processes Part 13

208.  Case Study on How to Use TOC’s Thinking Processes Part 14

209.  Case Study on How to Use TOC’s Thinking Processes Part 15

210.  Case Study on How to Use TOC’s Thinking Processes Part 16

211.  The IO Map Revisited Part 1

212.  The IO Map Revisited Part 2

213.  The IO Map Revisited Part 3

214.  The IO Map Revisited Part 4

215.  An Interview About The Ultimate Improvement Cycle by Joe Dager

216.  Healthcare Case Study:  Door to Balloon Time Part 1

217.  More On My First Experience With TOC Part 1

218.  More On My First Experience With TOC Part 2

219.  More On My First Experience With TOC Part 3

220.  More On My First Experience With TOC Part 3

221.  More On My First Experience With TOC Part 4

222.  A Discussion on Constraints Management Part 1

223.  A Discussion on Constraints Management Part 2

224.  A Discussion on Constraints Management Part 3

225.  A Discussion on Constraints Management Part 4

226.  A Discussion on Constraints Management Part 6

227.  How I Present TOC Basics to Students & Teams Part 1 (Most viewed of all posts)

228.  How I Present TOC Basics to Students & Teams Part 2

229.  YouTube Video on Improving Flow Through a Bottleneck

230.  YouTube Video on Throughput Accounting

231.  YouTube Video on What to Change

232.  YouTube Video on What to Change To

233.  YouTube Video on How to Cause the Change to Happen

234.  A Meeting With an Executive of a Larger Corporation

235.  The Missing Link

236.  You Tube Video by Goldratt on Henry Ford and Taichi Ohno

237.  Prevention Versus Detection – The Bug Guy

238.  An Article by Anna Gorman of the LA Times

239.  TOC’s Solution to Supply Chain Problems

240.  The Nun and the Bureaucrat Part 1

241.  The Nun and the Bureaucrat Part 2

242.  The Nun and the Bureaucrat Part 3

243.  The Nun and the Bureaucrat Part 4

244.  The Nun and the Bureaucrat Part 5

245.  The Nun and the Bureaucrat Part 6

246.  A Healthcare Clinic Case Study Part 1

246B.  An Update to Focus and Leverage Part 246

247,  Drum Buffer Rope in Manufacturing

248.  The Sock Maker Revisited Part 1

249.  The Sock Maker Revisited Part 2

250.  Throughput Accounting Part 1

251.  Throughput Accounting Part 2

252.  Throughput Accounting Part 3

253.  How to Use and Integrated TOC, Lean & Six Sigma Methodology Part 1

254.  How to Use and Integrated TOC, Lean & Six Sigma Methodology Part 2

255.  How to Use and Integrated TOC, Lean & Six Sigma Methodology Part 3

256.  How to Use and Integrated TOC, Lean & Six Sigma Methodology Part 4

257.  How to Use and Integrated TOC, Lean & Six Sigma Methodology Part 5

258.  Critical Path Project Management Versus Critical Chain PM Part 1

259.  Critical Path Project Management Versus Critical Chain PM Part 2

260.  Critical Path Project Management Versus Critical Chain PM Part 3

261.  Critical Path Project Management Versus Critical Chain PM Part 4

262.  Critical Path Project Management Versus Critical Chain PM Part 5

263.  Critical Path Project Management Versus Critical Chain PM Part 6

264.  The Cabinet Maker – A TOC Case Study Part 1

265.  The Cabinet Maker – A TOC Case Study Part 2

266.  The Cabinet Maker – A TOC Case Study Part 3

267.  The Cabinet Maker – A TOC Case Study Part 4

268.  How I Run Improvement Events

269.  Using The Goal Tree vs. the Full Thinking Process Analysis Part 1

270.  Using The Goal Tree vs. the Full Thinking Process Analysis Part 2

271.  Using The Goal Tree vs. the Full Thinking Process Analysis Part 3

272.  Using The Goal Tree vs. the Full Thinking Process Analysis Part 4

273.  Using The Goal Tree vs. the Full Thinking Process Analysis Part 5

274.  Using The Goal Tree vs. the Full Thinking Process Analysis Part 6

275.  An Analysis of Focus and Leverage’s Top Page View Postings

276.  An Index of All Focus and Leverage Blog Posts

277.  Using the Thinking Processes in Healthcare Part 1

278.  Using the Thinking Processes in Healthcare Part 2

279.  Using the Thinking Processes in Healthcare Part 3

280.  The Four Disciplines of Execution Part 1

281.  The Four Disciplines of Execution Part 2

282.  The Four Disciplines of Execution Part 3

283.  The Four Disciplines of Execution Part 4

284.  The Four Disciplines of Execution Part 5

285.  The Goal Tree – A New Way to Make it and Use It Part 1

286.  The Goal Tree – A New Way to Make it and Use It Part 2

287.  The Goal Tree – A New Way to Make it and Use It Part 3

288.  Operation Excellence by Jim Covington

289.  The Saw Mill Assessment

290.  How I present the Theory of Constraints to People Not Familiar With it

291.  David and Goliath – Malcolm Gladwell’s Latest Book

292.  The Basics of TOC

293.  TOC’s Replenishment Model Part 1

294.  TOC’s Replenishment Model Part 2

295.  Blog Posting Index

296.  Overcoming Natural Resistance to Change

297.  Integrating TOC, Lean and Six Sigma Part 1

298.  Appendix 1 from Epiphanized Part 1

299.  The Winter Storm in Atlanta

300.  Appendix 1 from Epiphanized Part 2

301.  Appendix 1 from Epiphanized Part 3

302.  Appendix 1 from Epiphanized Part 4 Final

303.  Bill Dettmer videos on TOC’s Thinking Processes

304.  Queuing Theory Part 1

305.  Queuing Theory Part 2

306.  Delta Airlines Lack of Customer Focus

307.  Bill Dettmer’s Book Strategic Navigation

308.  Excerpts from The Ultimate Improvement Cycle – My second book Part 1

309.  Excerpts from The Ultimate Improvement Cycle – My second book Part 2

310.  Excerpts from The Ultimate Improvement Cycle – My second book Part 3

311.  Excerpts from The Ultimate Improvement Cycle – My second book Part 4

312.  Excerpts from The Ultimate Improvement Cycle – My second book Part 5

313.  The Ultimate Improvement Cycle – Step 1:  Identify - My second book Part 6

314.  The Ultimate Improvement Cycle – Step 2:  Define, Measure and Analyze - My second book Part 7

315.  The Ultimate Improvement Cycle – Step 3:  Improve - My second book Part 8

316.  The Ultimate Improvement Cycle – Step 3:  Control - My second book Part 9

317.  Throughput Accounting Part 1

318.  Throughput Accounting Part 2

319.  Throughput Accounting Part 3

320.  Throughput Accounting Part 4

321.  Throughput Accounting Part 5

322.  Throughput Accounting Part 6

323.  Throughput Accounting Part 7 Final

324.  Optimium Health’s Amazing New Software for Healthcare

325.  Personal experiences using Throughput Accounting

326.  MRO Project Management Case Study Part 1

327.  MRO Project Management Case Study Part 2

328.  MRO Project Management Case Study Part 3

329.  MRO Project Management Case Study Part 4

330.  MRO Project Management Case Study Part 5

331.  MRO Project Management Case Study Part 6

332.  MRO Project Management Case Study Part 7 (Finale)

333.  Part’s Replenishment Systems Part 1

334.  Part’s Replenishment Systems Part 2

335.  Part’s Replenishment Systems Part 3

336.  Part’s Replenishment Systems Part 4

337.  Part’s Replenishment Systems Part 5

338.  Part’s Replenishment Systems Part 6 (Finale)

339.  My Most Rewarding Experience

340.  Operation Excellence by Jim Covington

341.  Epiphanized sequel update

342.  The intent of Focus and Leverage Part 1

343.  The intent of Focus and Leverage Part 2

344.  The intent of Focus and Leverage Part 3

345.  The intent of Focus and Leverage Part 4

346.  The intent of Focus and Leverage Part 5

347.  My Most Profound Learning

348.  An update to our sequel to Epiphanized

349.  TOC and the VA Problem

350.  Reasons for Failing Improvement Initiatives

351.  Appendix 1 from Epiphanized Part 1

352.  Appendix 1 from Epiphanized Part 2

353.  Appendix 1 from Epiphanized Part 3

354.  Link to a presentation on TLS

355.  Article on 91 Hospitals laying-off Employees

356.  How Cost Accounting is Hurting Hospitals

Wednesday, June 25, 2014

Focus and Leverage Part 356

In my last posting I talked about 91 hospitals who have gone through lay-offs as a way to improve their margins.  In this posting I am presenting a link to an article entitled Fewer hospitals have positive margins as they face financial squeeze written by  Beth Kutscher reporting in Modern Healthcare.  As you read this article, I want you to notice how many times the author talks about cost cutting as a way to become more profitable.


As I have written about many times in my postings, the key to profitability is not achieved by cutting costs and attempting to save money.  The true pathway to profitability is through making money.  And how do we do that?  We do that by focusing on increasing the throughput of your revenue generating processes such as surgical units, out-patient clinics, the Emergency Departments, etc,


The real problem here is that healthcare, like so many other industries, is firmly in the grasp of cost accounting with all of its performance metrics and the belief that profitability is best accomplished through saving money.  Throughput Accounting, on the other hand, teaches us to increase revenue while either reducing or maintaining our operating expenses.  One of the major differences between cost accounting and throughput accounting is how labor is treated.  Cost accounting treats labor as a variable cost while throughput accounting treats labor as a fixed cost, which it is.  Way back when cost accounting came into existence, labor was a variable cost, back when labor was paid based upon piece rates.  But this is no longer how labor is paid.


Anyway, I thought you might be interested in this article.


http://www.modernhealthcare.com/article/20140621/MAGAZINE/306219968&utm_source=AltURL&utm_medium=email&utm_campaign=am?AllowView=VXQ0UnpwZTVEUGFmL1I3TkErT1lBajNja0U4VURPUmNFQk1HREE9PQ==&mh


Bob Sproull

Monday, June 23, 2014

Focus and Leverage Part 355


A client of mine sent me a very disturbing article about so many hospitals laying off parts of their work force. For me, this is a sad state of affairs in healthcare and is probably being driven by cost accounting that I have written about negatively many times on this blog.   Below, I have listed links to all 91 of the hospitals throughout the country who are laying their employees off.  And to think that by just applying an integrated TOC, LSS to the revenue generating areas within the hospital, they would no doubt, be able to keep these employees to generate much more revenue and therefore much more profits than they would ever get a la cost cutting..  But as long as cost accounting believes that the pathway to profitability is through cost cutting, rather than revenue/throughput improvement, layoffs will continue.  It’s just all so unnecessary! 

Bob Sproull

The following hospital and health system layoffs and workforce reductions were covered by Becker's Hospital Review since January 2014. They are listed below with the number of employees and/or positions affected.

 1. St. Mary's Hospital in Illinois to Cut Services, Lay Off 25
St. Mary's Hospital in Streator, Ill., plans to close its maternity unit and end home health services this summer. The maternity unit closure is tied to the lack of practicing physicians in the region who deliver babies.

2. Beth Israel Deaconess Hospital – Plymouth to Lay Off 15
Beth Israel Deaconess Hospital – Plymouth (Mass.) is planning to lay off approximately 1 percent of its workforce, or about 15 people. A BID-Plymouth spokesperson said the majority of positions affected were part-time and the majority of full-time positions that were reduced were non-union positions.

3. Kindred Healthcare to Close 2 Texas Hospitals, Trim 246 Jobs
Louisville, Ky.-based Kindred Healthcare is closing two Texas hospitals and eliminating 246 jobs. The transitional and extended-stay hospital operator will close its 83-bed location in Channelview, which will eliminate 139 jobs, and its 86-bed facility Houston, which will cut 107 jobs.

4. Mercy to Lay Off 300 Across 4 States
Chesterfield, Mo.-based Mercy is planning to lay off up to 300 people across four states this month, and the health system is attributing the workforce reduction to a lack of Medicaid expansion in most of the states it serves. Cuts are not planned for those positions involved in direct patient care.

5. Mayo Clinic Eliminates 14 Nursing Positions
Mayo Clinic has eliminated 14 nursing positions at its headquarter site in Rochester, Minn.

6. Abington Health to Lay Off 95
Abington (Pa.) Health will lay off 95 employees and cut the hours of others before July 1. Eighty-five of the affected employees are full-time workers.

7. Ellwood City Hospital Lays Off 67
Ellwood City (Pa.) Hospital has laid off 67 employees, eliminating the equivalent of 44 full-time positions. Seven of the layoffs were voluntary, with employees retiring or relocating.

8. St. John's Hospital in Illinois to Lay Off 43 Managers
St. John's Hospital in Springfield, Ill., is eliminating 43 management positions. The 43 positions are about 1 percent of the 3,100 employees at the Catholic, 439-bed St. John's.

9. Hilo Medical Center Cuts Clinical, Administrative Staff
Hilo (Hawaii) Medical Center has eliminated one physician, five administrative and 25 temporary nurse and technician positions. The physician was one of the hospital's two urologists.

10. WellStar Health Trims 29 Corporate Jobs
Marietta, Ga.-based WellStar Health System has cut 29 corporate positions, including the complete elimination of 11 "team member roles." Another 18 team members' positions were displaced Tuesday, meaning WellStar will try to place them in another open position within the system.

11. Hartford HealthCare to Eliminate 350 Jobs
Hartford (Conn.) HealthCare plans to eliminate 350 jobs through layoffs and attrition. About 230 employees will be laid off or leave through buyouts and retirement, while the rest of the positions are vacant.

12. Kern Medical Center Plans Layoffs, Department Closures
Kern Medical Center in Bakersfield, Calif., may close two departments and lay off employees soon. KMC is on its way to a $30 million loss for this fiscal year.

13. MaineGeneral Health to Eliminate 128 Jobs
MaineGeneral Health in Augusta, Maine, plans to lay off 16 workers and cut 112 empty full-time positions this summer. Two of the positions are directly involved in patient care and several manager positions will be eliminated.

14. High Point Regional Health to Cut 115 Jobs
High Point (N.C.) Regional Health, part of Chapel Hill-based UNC Health Care, is eliminating 115 jobs, or 5 percent of its workforce. Both clinical and nonclinical employees are included in the workforce reduction.

15. Queen of the Valley Medical Center to Lay Off 10% of Staff
Queen of the Valley Medical Center in Napa, Calif., plans to eliminate 111 positions, or roughly 10 percent of its staff, and reduce the hours of five employees in the next 90 days. The 191-bed hospital plans to close four outpatient units as well.

16. St. Clare's Health System to Eliminate 59 Jobs
St. Clare's Health System, with locations in Morris and Sussex counties in New Jersey, plans to eliminate 59 positions through layoffs and attrition. Forty-eight employees will be laid off across the system.

17. Pickens County Medical Center Lays Off, Furloughs Employees
Pickens County Medical Center in Carrollton, Ala., laid off 14 employees and furloughed 13 managers. The furloughed managers will take one unpaid day each pay period.

18. Yukon-Kushokwim Health to Eliminate 160 Jobs
Bethel, Alaska-based Yukon-Kushokwim Health Corp., a system that includes one regional hospital and several community clinics that serves 58 rural communities in southwest Alaska, announced plans to lay off 110 employees and leave 50 positions empty.

19. Mercy Medical Center-Des Moines Eliminates 136 Positions
Mercy Medical Center-Des Moines (Iowa) laid off 29 employees and will leave 107 positions vacant in a move orchestrated to cut $15 million.

20. St. Francis Healthcare of Hawaii to Lay Off 110
Honolulu-based St. Francis Healthcare System of Hawaii plans to lay off 110 employees and slash its hospice and home health services. The system plans to close one of its hospice units in Ewa Oahu by Sept. 30 and cease offering a home health program that served patients on Oahu and Kauai by June 30.

21. Genesis Health to Cut Jobs, Benefits
Genesis Health System in Davenport, Iowa, is eliminating 30 management positions — affecting its COO and a senior vice president — and 50 staff-level positions. The system's CEO, Doug Cropper, and the rest of the C-suite are all taking pay cuts, and Genesis Health is also reducing employee benefits.

22. Morehead Memorial Hospital Cuts Positions, Hours
Eden, N.C.-based Morehead Memorial Hospital eliminated 22 positions and cut the hours of 25 other employees as it faces financial hardships.

23. Ozarks Medical Center Eliminates 11 Jobs
Ozarks Medical Center in West Plains, Mo., laid off 11 employees in primarily nonclinical areas. OMC eliminated the positions as a response to declining reimbursements and inpatient volumes, according to the report.

24. Wake Forest Baptist to Cut 350 Positions
Winston-Salem, N.C.-based Wake Forest Baptist Medical Center plans to eliminate 350 jobs across all of its locations.

25. West Tennessee Healthcare Cuts 10 Jobs, Offers Early Retirement
Jackson-based West Tennessee Healthcare eliminated 10 positions in the last two months and offered 220 employees early retirement packages.

26. University Medical Center Lays Off 105
Las Vegas-based University Medical Center laid off 105 employees, including nurses, as it plans to close four care centers.

27. Barton Hospital Offers Voluntary Separation Packages
Forty-two employees from Barton Hospital in South Lake Tahoe, Calif., accepted a voluntary separation program that includes a severance package.

28. Hayes Green Beach Memorial Hospital to Cut 25 Jobs
Hayes Green Beach Memorial Hospital in Charlotte, Mich., plans to eliminate 25 jobs, or about 6 percent of its workforce.

29. Alabama's Baptist Health System Lays Off 23
Birmingham, Ala.-based Baptist Health System laid off 23 employees across its four hospitals and its headquarters. Baptist Health is in the midst of reorganizing support services and nonclinical functions, which in part led to the layoffs.

30. Lourdes Health System to Lay Off 23
Camden, N.J.-based Lourdes Health System is laying off 23 employees at Our Lady of Lourdes Medical Center in Camden and its corporate headquarters.

31. HealthAlliance Hospital to Cut Nursing Positions
Roughly seven full-time nursing positions will be eliminated at HealthAlliance Hospital locations in Fitchburg, Mass., and Leominster, Mass.

32. McCready Memorial Hospital Initiates Layoffs
The McCready Foundation, the parent of McCready Memorial Hospital in Crisfield, Md., started laying off employees due to decreases in patient volume and reimbursements. There was no word on how many employees will be affected by the current round of layoffs, as some employees were offered other positions and are weighing their options.

33. Kaiser to Lay Off 101 in Hawaii
Oakland, Calif.-based Kaiser Permanente issued layoff notices to 101 employees of Kaiser Permanente Hawaii, which operates one hospital and 20 clinics on three Hawaiian islands. The affected employees include 66 security guards and 16 patient transporters, among other positions.

34. Beacham Memorial Hospital Closes Outpatient Clinic
Beacham Memorial Hospital in Magnolia, Miss., closed its outpatient clinic in Osyka, Miss., resulting in three layoffs. In addition to closing the clinic, about 100 of the hospital's employees will see a reduction in hours.

35. Calais Regional Hospital Lays Off, Reduces Hours of 30% of Workers
Calais (Maine) Regional Hospital laid off or reduced the hours of 30 percent of its workforce due to financial issues. The cuts affected 86 employees, including 12 members of the Maine State Nurses Association. Four of those employees were laid off permanently.

36. TJ Samson Community Hospital to Cut Jobs
T.J. Samson Community Hospital, a 196-bed hospital in Glasgow, Ky., plans to cut between 39 and 49 jobs. In addition to the layoffs, management and salaried physicians will see their pay cut by 10 percent, and hourly workers who make more than $10 an hour will also see pay cuts after Sept. 24.

37. Providence Health & Services to Eliminate 42 Alaska Jobs
As Renton, Wash.-based Providence Health & Services works to streamline its billing processes, 42 jobs in Anchorage are being eliminated. Providence is moving most of its billing positions to Washington and Oregon.

38. Pearl River County Hospital Cuts 19 Jobs
Pearl River County Hospital and Nursing Home in Poplarville, Miss., eliminated 19 positions and cut the hours of other employees.

39. Peconic Bay Medical Center to Lay Off 12
Facing declining admissions, Peconic Bay Medical Center in Riverhead, N.Y., is laying off 12 employees. Administrative staff will be affected by the cuts. Peconic Bay Medical Center employs roughly 1,200 people.

40. St. Francis Hospital to Slash Pediatric Staff
Hartford, Conn.-based St. Francis Hospital and Medical Center is cutting the staff at its pediatric and adolescent clinic. Five part-time pediatricians will lose their jobs by June 30. Additionally, two physicians and a nurse practitioner have left the clinic since October, and their positions are still vacant.

41. Northern Berkshire Healthcare to End Operations, Lay Off 530
Northern Berkshire Healthcare in North Adams, Mass., closed North Adams Regional Hospital, its home health facility and its three hospital-owned physician practices. About 530 full- and part-time employees were affected.

42. Newman Regional Health Reduces Workforce
Emporia, Kan.-based Newman Regional Health plans to lay off 10 full-time and five part-time employees in a move to cut labor costs by 5 percent. In addition, the 53-bed hospital will leave five full-time and seven part-time positions vacant, and 29 Newman Medical Partners employees will have their hours reduced.

43. Palm Drive Hospital Braces for More Layoffs
Management at financially beleaguered Palm Drive Hospital in Sebastopol, Calif., held meetings notifying employees of possible layoffs. The layoff warnings come roughly two months after a round of layoffs at the hospital that affected 40 employees. This round will affect at least 50 employees.

44. Vista Health System to Shrink Billing Staff
Waukegan, Ill.-based Vista Health System is consolidating some of its business office functions, which could affect as many as 33 employees.

45. Layoffs Occur at St. Mary's Hospital Prior to Prime Takeover
Passaic, N.J.-based St. Mary's Hospital laid off or cut the hours of 30 employees. The workforce reduction comes as the hospital waits for state approval to be sold to Ontario, Calif.-based Prime Healthcare Services.

46. Beleaguered Lake Whitney Medical Center Shuts Down
Lake Whitney (Texas) Medical Center decided to close its doors after roughly a year of financial troubles and botched takeovers. The Whitney Hospital Authority board of directors voted to shutter the hospital, laying off the remaining 30 employees who were still there.

47. Cambridge Health Alliance to Lay Off 30
Cambridge (Mass.) Health Alliance plans to lay off 30 employees, including some managers. The layoffs are expected to improve efficiency and improve the safety-net system's financial position.

48. Mackinac Straits Health Lays Off 15
Mackinac Straits Health System in St. Ignace, Mich., laid off 15 employees and reduced the hours of eight others, effective April 1. The system is also leaving four positions empty and cutting the salaries of top managers by 5 percent. Employee benefits will also be restructured.

49. SUNY to Lay Off 300+ Long Island College Hospital Workers
State University of New York plans to lay off 300 to 350 Long Island College Hospital employees. More than 1,400 employees are currently on LICH's payroll, even though the hospital is serving a dwindling patient base.

50. Coshocton County Memorial Hospital to Cut 47 Positions
Coshocton (Ohio) County Memorial Hospital plans to lay off 25 employees and leave an additional 22 positions vacant.

51. Mercy Hospital Grayling Cuts 24 Jobs
Mercy Hospital Grayling (Mich.) eliminated 24 full-time positions and will leave an additional 11 positions vacant.

52. Wetzel County Hospital Eliminates Jobs, Cuts Hours
Wetzel County Hospital in New Martinsville, W.Va., is cutting eight jobs, reducing the hours of 15 employees and leaving some empty positions vacant.

53. Monroe Hospital Lays Off 17
Bloomington, Ind.-based Monroe Hospital cut 17 employees from its 300-person staff. One of the affected employees held a nursing position, while the rest of the 17 workers were in administrative or support roles.

54. Columbus Regional Health to Cut Jobs
Whiteville, N.C.-based Columbus Regional Health System, part of Carolinas HealthCare System, plans to lay off employees in the next two months. No details have been released as to how many employees will be affected by the cuts.

55. Highmark Lays Off 100 More Employees
Pittsburgh-based health insurer and hospital manager Highmark has laid off 100 health plan employees, bringing the company's total job losses to 520 within the past eight months.

56. KentuckyOne Health Confirms 500 Layoffs
Five-hundred employees at Louisville-based KentuckyOne Health were recently laid off, and 200 additional vacant positions were eliminated. In addition to the workforce reduction, the system is closing the emergency room at Medical Center Jewish Northeast in Louisville.

57. Crozer-Keystone to Lay Off 250, Including Physicians
Financially beleaguered Crozer-Keystone Health System in Springfield, Pa., announced it will eliminate 250 positions. The job cuts will affect physicians and several managers.

58. St. Joseph Hospital Lays Off 152
St. Joseph Hospital in Orange, Calif., laid off 152 employees and is leaving 18 positions vacant as part of a cost-cutting initiative. The hospital has experienced low patient volumes and reimbursement cuts, and is cutting 5 percent of its budget for the current fiscal year.

59. McLaren Northern Michigan Cuts 43 Jobs
McLaren Northern Michigan in Petoskey is eliminating 43 positions and cutting the hours of 100 more employees. McLaren officials said the workforce reduction will put it "on par with industry standards."

60. Temple University Health System Eliminates 75 Jobs
Philadelphia-based Temple University Health System is eliminating 75 full- and part-time jobs from its Jeanes Hospital.

61. Kimball Medical Center to Lay Off 73, Including Nurses
Kimball Medical Center in Lakewood, N.J., part of West Orange, N.J.-based Barnabas Health, plans to lay off 73 employees by the end of April, including 62 nurses.

62. Oroville Hospital to Lay Off 50
Oroville (Calif.) Hospital is reducing its staffing by 3.5 percent, meaning about 50 employees will be let go. The reduction does not only involve layoffs: some positions will be combined, and some full-time employees will become part-time or per diem workers.

63. Good Shepherd Health System Lays Off 24
As part of a series of cost-cutting moves, Longview, Texas-based Good Shepherd Health System eliminated 24 jobs. The layoffs announcement came just a week after the system announced plans to close Good Shepherd Medical Center Linden (Texas) and two health centers, affecting 100 employees.

64. Barrett Hospital to Cut 14 Jobs
Barrett Hospital & HealthCare in Dillon, Mont., is eliminating 14 full-time positions from its workforce. The workforce reduction does not mean 14 people will lose their jobs, as some reductions are being achieved through reduced hours or attrition.

65. Northern Arizona Healthcare Trims 9 Administrative Jobs
Flagstaff-based Northern Arizona Healthcare eliminated nine administrative positions in an attempt to increase efficiency and cut costs. Eliminating the positions will help the system better combine services provided at two of its hospitals, Flagstaff Medical Center and Verde Valley Medical Center.

66. New London Hospital to Cut Jobs, Benefits
New London (N.H.) Hospital plans to trim its 600-person staff and cut employee benefits to stay financially viable. Hospital officials plan to reduce benefits, change staffing levels at the nursing home, delay implementing an electronic medical record system in its outpatient practices, freeze spending on capital projects and stop paying for travel and education for workers.

67. South Haven Health System to Cut Jobs, Services
South Haven (Mich.) Health System will eliminate its obstetrics services in May, laying off 19 employees.System officials pointed to fewer births and decreasing Medicaid reimbursements as reasons why the services needed to be cut.

68. Meritus Health Eliminates 120 Jobs
Hagerstown, Md.-based Meritus Health laid of 60 employees and eliminated 60 other vacant positions. The 120 positions represent a 4 percent cut to Meritus Health's overall workforce.

69. CHS Affiliate Commonwealth Health to Cut 80 Jobs
Commonwealth Health, an affiliate of Franklin, Tenn.-based Community Health Systems in Northeastern Pennsylvania, is eliminating 80 business office positions.

70. Cleveland Regional Medical Center Loses Staff Through Layoffs, Walk-Outs
Cleveland (Texas) Regional Medical Center laid off roughly 20 employees and about 50 more walked off the job. The hospital owes $268,000 in unpaid taxes and has been losing millions.

71. Pekin Hospital Lays Off Employees
Nine full-time employees were recently laid off at Pekin (Ill.) Hospital. The hospital cut hours for 22 other employees as well.

72. ValleyCare Health System Lays Off 24
Livermore, Calif.-based ValleyCare Health System laid off 24 employees in Livermore and Pleasanton. Some of the affected employees were part of a cardiac rehabilitation program, which closed.

73. Lower Oconee Community Hospital Closes
Lower Oconee Community Hospital in Glenwood, Ga., closed its doors, laying off some of its 100 employees. The hospital may restructure into an urgent care center.

74. Highmark Lays Off 132
Pittsburgh-based Highmark has laid off 132 information technology and sales employees. About half of the affected employees were based in Pittsburgh, while the rest were in Camp Hill, Pa. The healthcare company cut employees to increase efficiencies.

75. Nearly 700 Cleveland Clinic Workers Accept Early Retirement Offers
Cleveland Clinic cut several hundred open positions, and about 700 workers took early retirement offers as part of the system's plan to cut $330 million.

76. Carthage Area Hospital to Lay Off 90
Carthage (N.Y.) Area Hospital plans to lay off 90 workers, or 20 percent of its staff. This is the second round of layoffs at the hospital in the last year,

77. Palm Drive Hospital Eliminates 20 Full-Time Positions
Palm Drive Hospital in Sebastopol, Calif., laid off or reduced work hours for 40 employees. The workforce changes will equate to the loss of 20 full-time positions, including eight nurses. 

78. Mercy General in Sacramento Initiates Layoffs
Sacramento-based Mercy General Hospital laid off an unspecified number of employees, including 14 union members. The 14 unionized employees are members of SEIU-United Healthcare Workers West.

79. Hamilton Memorial Hospital Lays Off 11
Hamilton Memorial Hospital in McLeansboro, Ill., laid off 11 full- and part-time employees. The layoffs affected five employees from the hospital's nursing floor as well as two respiratory therapy and two housekeeping employees. Hamilton Memorial employs roughly 150 workers.

80. Walla Walla General Hospital Lays Off Managers
Walla Walla (Wash.) General Hospital eliminated seven of roughly 30 leadership positions in a reorganization move. As a result, some directors have taken on additional responsibilities.

81. Alta Bates Summit Medical Center Trims 358 Jobs
Berkeley, Calf.-based Alta Bates Summit Medical Center, a Sutter Health affiliate, eliminated 358 jobs. The cuts affected the equivalent of 175 full-time positions.

82. Mountain States Health Alliance to Eliminate 161 Jobs
Johnson City, Tenn.-based Mountain States Health Alliance announced plans to eliminate 116 filled positions and cut 45 vacant positions in a cost-cutting move. The system said direct patient care areas will not be affected.

83. UMass Memorial Medical Center Cuts 99 Positions
Worcester, Mass.-based UMass Memorial Medical Center eliminated 99 positions, including clinical staff and employees at the vice president level. One-third of the affected positions were empty. In addition to vice presidents, managers and directors were also affected by the cuts.

84. Pomona Valley Hospital to Lay Off 76
Pomona (Calif.) Valley Hospital Medical Center plans to lay off 76 employees and cut the hours of 111 others. The layoffs represent about 3 percent of the hospital's staff.

85. Valley Health Lays Off 33, Eliminates Other Positions
Winchester, Va.-based Valley Health laid off 33 employees and eliminated 25 vacant positions. Nine management positions were included in the layoffs.

86. Baylor Medical Center at Garland to Lay Off 47
Baylor Medical Center at Garland (Texas) is closing its labor and delivery unit, which will lead to 47 layoffs.

87. Wiregrass Medical Center Announces Layoffs, Salary Cuts
Wiregrass Medical Center, a 67-bed hospital in Geneva, Ala., laid off 26 full-time employees and other part-time workers and also cut salaries of staff members making at least $10 per hour. The layoffs and salary reductions are expected to cut $1.3 million from Wiregrass' expenses.

88. Texas Health Presbyterian Hospital-WNJ Announces Layoffs
Sherman-based Texas Health Presbyterian Hospital-WNJ announced plans to cut 18 positions. Layoffs at the facility, which has more than 240 beds, will affect support jobs.

89. Washington Health System Layoffs Stem From Outsourcing
Washington (Pa.) Health System outsourced its medical transcription services to Clear Choice Transcriptions, affecting nine employees.  Two of the employees took jobs in other areas of WHS, one retired, and the other six staff members declined positions with Clear Choice and were laid off.

90. Mineral Community Hospital Lays Off 6
Mineral Community Hospital in Superior, Mont., laid off six employees in management and support positions. The layoffs represent a nearly 10 percent reduction in the hospital's workforce, as Mineral Community Hospital only employs 65 people.

91. Bryan W. Whitfield Memorial to Close Delivery Unit, Lay Off Employees
Bryan W. Whitfield Memorial Hospital in Demopolis, Ala., is closing its labor and delivery unit and laying off employees to cut costs. Five to 10 percent of the hospital's staff could be laid off.