Theory of Constraints Handbook - James Cox Iii [600]
Figures 31-1 and 31-2 give us a summary view of the medical practice system.
The model of the health care system in Fig. 31-1 points out that the improvements in healthcare must be done at the system level. Figure 31-1 shows that inputs affecting the disease rate (moving people from the healthy population state to the diseased population state) include the amount of preventative care, the environment of the populations, the genetics of the individuals, the lifestyle and psychosocial behavior of the individuals. The health care system provides inputs such as financial capability, system capability for quality/reliable care, system capability for rapid response to patient needs, and access to care to patients measured by the cure rate (defined as moving patients from the diseased population to the healthy population). The lower the cure rate, the higher the death rate. The model shows the significance of system capability to respond rapidly to patient needs and to provide quality and reliability of the disease management system in improving the cure rate. The goal of the health system as shown in Fig. 31-2 is to transform a patient from a diseased state to a healthy state as fast as possible. The system must be integrated with all of its parts functioning together and well to provide high quality, reliable treatment without unnecessary delays and to exceed patient expectations. The diagram further shows that all systems are made up of processes and subprocesses that can be broken down to the task or subtask levels of each stakeholder. The system must never be bogged down in the details of individual processes or lose sight of the main goal; that is, to serve the patient efficiently. The goal of aligned value chains is to satisfy patients’ wants and needs
FIGURE 31-1 Model of a health care system.
FIGURE 31-2 Process flow model of a health care system.
Improving Quality and Quantity of Patient Flow through Health Systems
Looking inside the systems pictured in Figs. 31-1 and 31-2, TOC’s basic premise is that even the most complex systems have one key constraint or weakest link. For a POOGI, the Five Focusing Steps8 (5FS) (Goldratt, 1990b, 7) are useful in identifying and managing the constraint within the system and improving flow. The 5FS are:
1. Identify the system’s constraint.
2. Decide how to exploit the system’s constraint.
3. Subordinate everything else to the above decision.
4. Elevate the system’s constraint.
5. If in the previous steps a constraint has been broken, go back to Step 1, but do not let inertia cause a system constraint.
Elaborating on the 5FS
The 5FS process assumes that there is a clear goal or vision of the system’s performance: the goal of making more money (Throughput) now and in the future in a for-profit business. Further, since a constraint is the weakest link in a system, it determines the Throughput of the entire system. One strategy to increasing Throughput is to be much better than your competitors are in meeting the customers’ needs.
The strategy of a small or large health care system or even the entire value chain should be to develop a decisive competitive edge (DCE) in providing a high quality, reliable delivery and health care system. The goals of each of the subsystems have to be consistent with the overall health care system in the larger context. Example: If the specialty hospital has cardiac surgery as the financial model, it should work within the umbrella of the epidemiology or disease management model. This hospital must work to improve the velocity of flow of diseased patients through the health care system but at the same time invest in research to prevent the cardiac disease; not encourage people to get sick so that the hospital can continuously make profits. The strategies of government, insurers,