January 13, 2020

Mastering predictive modeling to improve patient care

By: Elizabeth Wood

The Best in OR Business Award is presented annually at the OR Business Management Conference to recognize an outstanding leader who has saved on costs, increased OR utilization, improved patient safety, or otherwise streamlined the surgical services department.

Vikram Tiwari, PhD

The 2020 award will be presented to Vikram Tiwari, PhD, associate professor of anesthesiology, biomedical informatics, and management at Vanderbilt University School of Medicine and Vanderbilt University, as well as director, surgical analytics, at Vanderbilt University Hospital. Since joining Vanderbilt in 2012, he has demonstrated skills in leadership and innovation that meet the criteria for the award.

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“My interest in healthcare developed during my doctoral studies and led to my thesis on coordination and capacity management in hospitals,” Tiwari says. With a doctorate in operations management and decisions sciences from Indiana University Bloomington, as well as engineering and MBA degrees, Tiwari has helped OR leaders at Vanderbilt better understand how to use data to inform decision making and increase efficiency.


Power of predictive analytics

“Thanks in large part to his expertise in predictive analytics and passion for serving patients, we can much more efficiently tailor our operating room staffing levels to our case volume,” notes C. Wright Pinson, MD, deputy chief executive officer (CEO) at Vanderbilt University Medical Center (VUMC) and CEO of Vanderbilt Health System. “This has made a significant difference in our organization and serves as a best practice for hospitals throughout the country.”

Cindy Kildgore, MSHA, RN, CNOR, perioperative services director at VUMC, echoes that praise. She told OR Manager that Tiwari built and maintains data sets within Tableau, such as first case on-time starts, turnover times (by hour of the day, as well as the components of turnover time), and financial cost per case/per surgeon. “He has significantly impacted our ability to increase our volume with sufficient knowledge of future needs,” she says.

“At VUMC, we thrive on innovation, and leaders encourage and support new ideas,” Tiwari says. Having that culture helped ease the way for adoption of advanced analytical methods.

“The predictive modeling we have done to predict our daily surgical volume has helped many different departments in our hospital,” he says. The model, constructed in 2013, has recently been updated to reflect the surgical volume that is now higher than when the model was first used. “We are also now able to predict case volume very accurately up to 30 days out,” he adds. “We have separate models for each day of the week, as well as for each of the 30 days into the future.”

Tiwari’s predictive analytics, Kildgore says, have been used to help shift outpatient volume off site. Tiwari used simulation modeling to determine how many ORs could be accommodated in this new ambulatory surgery center without compromising the holding room (HR) and postanesthesia care unit (PACU). “That work proved that we can have one additional OR in lieu of fewer HR/PACU beds,” he says.

Tiwari notes that implementing any process change requires demonstrating that the new process will create less, not more, manual work, and that it won’t inadvertently overload some other part of the system. “Seeing through the lens of systems thinking when crafting changes helps get better buy-in from the affected stakeholders,” he explains. “We also rely on validated data metrics and measurements for effective monitoring of improvements in performance.”

In addition to his data analytics work, Tiwari is a researcher who has published extensively, and he teaches courses in healthcare operations management and healthcare analytics to MBA students. “The inspiration for my research and teaching comes from real issues of capacity management planning and process efficiencies faced by our hospital that I work on intricately,” he notes.

He sees analytics as a way to achieve better care for patients. “The most rewarding accomplishments are those where some aspect of my analysis helps these people,” he says.

“We have just started to scratch the surface of the analytics toolkit,” Tiwari adds. “Most of what we still do will be described as ‘descriptive analytics,’ that is, reporting data retrospectively. I want to develop tools for predicting future states to help decision makers proactively improve resource usage. I also want to leverage organizations like OR Manager to help spread the word on the potential of using scientific techniques to better manage an organization’s capacities and capabilities.”

He believes that continuously learning and staying curious are important for success. His advice for aspiring leaders? “Those who show a positive attitude, are team players, take the initiative, and are ready to challenge themselves tend to stand out,” he says.

These characteristics are reflected in Tiwari’s many accomplishments and have earned him the admiration and respect of colleagues and leaders at Vanderbilt. True to form, Tiwari not only is a past presenter at both the annual OR Manager Conference and the OR Business Management Conference, he also is presenting “The Power and Perils of Data Analytics” on January 29—the same day he will receive the Best in OR Business Award.

To learn more, visit www.ormanager.com/managementconference. ✥

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