Superior Productivity in healthcare Organizations, 2nd Edition

The only book on healthcare productivity

From Health Professions Press, 2016

Loaded with practical, enduring solutions, this book will help hospitals and health systems achieve increased productivity in a  surprisingly short time and at low cost. This revised second edition not  only supports current financial and workforce trends in healthcare  services, but also introduces new measurement methods. In a supportive, conversational style, the author takes you step by  step through a simple, logical, and powerfully effective approach that  moves from analysis to implementation of productivity standards, and  then beyond. Drawing upon his successful experience with more than 70  hospitals, Paul Fogel provides dozens of incisive illustrations, tables,  financial models, and case studies to illuminate the text’s core  concepts of measurement, accountability, simplicity, and fairness. Whether you want to increase current work output or reclaim lost productivity, you will learn how to:  

  • Develop and implement realistic and understandable labor standards
  • Resolve core productivity concepts and management problems
  • Avoid falling back on stopgap measures, such as layoffs
  • Institute effective, customized monitoring systems and management protocols
  • Formulate new procedures to capture and build on what has been accomplished

One of the most valuable additions to this revised edition is an all-new chapter on developing workload measures to accurately reflect both volume and patient or service mix. If you are a hospital administrator, physician, corporate health system staff, financial executive, or hospital or health plan  administrator, you will find here the tools to invigorate the  productivity of your organization with long-lasting success. 

Available at:

Also available through: Chegg, Baker and Taylor, OverDrive, Gardners, and Follett. 

Chapter 1: The State of the Union  

  • Been There, Done That
  • Do Layoffs Really Work?
  • Skill Mix Strategy
  • Benchmarking
  • The Problem of Overtime and Registry
  • Hospital Mergers
  • Planning versus Reality
  • Summary

Chapter 2: How to Develop Realistic Productivity Standards  

  • Learn from History
  • Assign Performance Measures
  • Do the Math
  • After the Analysis
  • Do You Need Outside Help
  • Comparing Apples and Oranges
  • Summary

Chapter 3: Developing Better Units of Service  

  • Workload Templates
  • Patient Accounting
  • Work That Is Usually Not Captured
  • Benchmarking Considerations
  • Summary

Chapter 4: Implementation  

  • Fixed and Variable: Fact or Fiction?
  • The New Deal
  • Implementation Strategy
  • Summary

Chapter 5: Monitoring and Reporting  

  • Seduced by Technology
  • Technology and Good Management
  • Complex Systems Don’t Work
  • Timing of Reviews
  • The New Productivity Report
  • How to Create Your Own Report
  • Make the Master Schedule Work
  • Summary

Chapter 6: Incentives and Consequences  

  • Laying the Foundation
  • Incentives
  • Consequences
  • Summary

Chapter 7: The Politics of Productivity  

  • Medical Staff
  • Labor Unions
  • Executives
  • Department Managers
  • The Board
  • Productivity for the Long Term
  • Summary

Attend a seminar

We have live seminars hosted by ACHE and HFMA, as well as online seminars. We can also come onsite for an engaging, customized presentation. Check the Seminars page for a calendar of events.


"Paul Fogel’s ability to capture the obvious and explain the treadmill effect  many healthcare executives face in managing their largest expense is  astonishing. If executives are tired of fleeting efforts on productivity  management and want a pathway to effectiveness, then Superior Productivity in Healthcare Organizations is a must-read. I had looked for most of my career for a solution that  tied cultural relevance to outcomes without a one-size-fits-all  approach. This methodology answers that longing to find a solution that  is tailored to our uniqueness.”
Steven D. Febus, MBA, CFO, Pullman Regional Hospital    

"Hospital leaders: This book serves as support for high level  strategic, intentional, mission-oriented labor management, and is a  detailed blueprint for: 

  1. Establishing appropriate, achievable staffing standards
  2. Effectively monitoring and reporting progress toward those goals
  3. Implementing accountability for performance

"All three are the core elements of a successful Culture of Productivity. If I had a nickel for every copy of Superior Productivity in Healthcare Organizations that I’ve recommended or gifted to senior healthcare managers…"
Keith Gott, Senior Director, Health Solutions at FTI Consulting, author of A Productivity Practicum


"This is a must-read for hospital system executives; buy a copy for every  manager at your hospital—you won’t regret it. Paul Fogel gives you the  knowledge and, most importantly, the exact plan on how to implement an  effective productivity system that works, backed up by his proven  experience with dozens of hospitals.”
Megan Foster, CEO of Foster Health Consulting, creator of Fostering the Journey: Empowering Programs for Dementia Caregivers

"This book is exceptional.

"Productivity  in healthcare is a true challenge; if you really want to do it. Sure, maybe your organization uses some kind of system that compares everyone to some kind of industry standard benchmark - or maybe you're looking at  some software that will save the day. Most approaches tend to pit the  clinical department leaders against the financial/analyst/operations teams. The clinicians state that they need "X" to provide quality care  and the administrators cite "Y" standard and demand they try and meet  it. And the back and forth continues - the clinicians feeling like the  standards don't reflect reality and the administrators frustrated that  their departments need so many caregivers to provide quality care. Is  this type of approach working for you? It sure didn't work for me...and  it hasn't worked for the industry in general.

"Paul takes this  reality and crafts a clear, concise, and effective user guide to  building a labor productivity system that works for everyone in a  healthcare organization. Paul takes a true reality-based approach to  this challenging topic and provides step-by-step guidance on building  and optimizing a labor/productivity system in your organization.

"He tackles the myth that software or complex labor algorithms will solve  the labor productivity challenge. There is no need to invest thousands  of dollars in those types of solutions. Start with this book - start  with simple collaborative dialogues and develop collective agreements  and then hold each other accountable to those agreements using basic and  simple tools. And then evolve that approach over time to include better  measures of productivity such as including acuity factors.

"Paul also recommends a strong policy and reward system to motivate appropriate management. I found that to be really refreshing. In healthcare, it's odd that many department leaders are unable to truly "own" their departments - have both the responsibility and  accountability for its performance. If department leaders truly owned their departments there would be no need for centralized positional approval committees. These archaic assemblies could move into a comfortable retirement as department leaders step into managing their departments, their staff, and their productivity based on  collaboratively developed expectations. Paul also discusses the power of good old fashioned management and the power of holding people accountable to standards - a critical component of any successful  productivity system.

"Paul  teaches an online course through the American College of Healthcare Executives. I was able to attend it and  would recommend it as enthusiastically as his book. As an instructor he is incredibly engaged, providing insight, analysis, pointers and guidance on every assignment. I've taken my fair share of online courses - and the instructor is typically phoning it in - giving the same  feedback to every student - providing canned responses, etc. But Paul is  clearly treating each attendee as an individual! It's a true functional course that applies everything in the book. It's a course that will  make you work and learn and grow - and frankly there aren't a lot of courses like that. And if you've read the book and would like expert  guidance in the actual HOW of doing it - this is the course for you. You will leave the course with a complete draft of quarterly reports, monthly reports, policies, procedures, and most everything you would need to begin the journey of establishing a truly superior productivity system in your organization.

"If you're a healthcare leader you should buy this book.

"If you really want to implement the tools - you should take Paul's course."

Jed Rudd, Chief Operating Officer, Gila Regional Medical Center