Theory of Constraints Handbook - James Cox Iii [616]
c. Since every patient is different, he or she could take different amounts of time to complete treatment. This environment is similar to the multiple projects environment. We must prioritize and have some computer calculate the staff utilization. The flow manager directs staff to different workstations as the need changes. Such software is not available at this time for health care applications; however, it is being developed.
d. Buffer Management helps us identify where and why the delays occur. If most of the delays are due to doctors not starting on time, we can figure out how to influence the behavior of doctors. If the patients always arrive late, we can start reminding them to come 15 minutes earlier.
6. Elevate the constraint: Once the company has fully exploited the doctor time and has subordinated everything else to doctor time, it is time to elevate the constraint to the market by hiring another doctor. The market becomes the key constraint. We can start the same focusing principles to determine how to exploit the market.
7. The last step is to ensure that inertia does not set in that could otherwise become a constraint. Once the practice is doing well, everyone becomes relaxed and happy with his or her achievements. The processes and systems start to slip and they start to go out of control, which results in a downward spiral. Be aware of this tendency.
CHAPTER 32
TOC for Large-Scale Healthcare Systems
Julie Wright
A patient opens a consultation with a doctor by saying “Doctor, it hurts when I do this.”
The doctor asks “Why do you have to do ‘this’?” mimicking the patient.
“Because I have to achieve that,” replies the patient moving around the room.
“OK, but what if you could achieve ‘that’ by doing ‘this’ differently?”
“That would work,” said the patient excitedly.
“So you agree.... If ‘this’ hurts it’s best to stop doing it? You’ll have time to heal and you will still get the results you need?”
“Of course.... Thanks doc!”
Introduction
Unlike the practice of medicine by individual physicians, the practice of medicine within large-scale healthcare systems is a relatively new phenomenon. As industrialization concentrated populations in urban areas, medicine followed suit and began to be practiced by groups of physicians. As the collective provision of medical services flourished, exponential advances in the diagnosis and treatment of patients caused the medical profession to divide into specialties. Now it is often the case that a patient’s care episode is dependent on the services of more than one specialist to reach a successful conclusion. Because of the division of specialties, patients are often forced to interact with many different people and services to secure the holistic treatment their conditions dictate.
While the delivery of healthcare is moving toward a more holistic model, the infrastructures within which is it delivered is still, for the most part, segmented with patients often being required to tolerate unnecessary waiting times between the receipt of separate services.
This chapter aims to show what needs to be changed, what the systems need to strive to achieve, and how to begin to identify the causes of these delays and to eradicate them, eventually redesigning the delivery of services to fit the ability of patients to absorb treatments, not their tolerance to waiting.
By successfully melding the many diverse services with a systemic approach, it is possible to increase the capacity of existing systems, reduce