Theory of Constraints Handbook - James Cox Iii [620]
Deciding to improve the ability of an operating room (OR) suite to process more patients in a facility that does not have sufficient ICU staff to take care of the patients postoperatively. This results in unsafe staffing levels and additional staff being called in to work at short notice, at additional expenses to the facility.
Deciding to improve Throughput in the emergency room while ignoring the needs of the discharge process. This in turn results in extended boarding (patients waiting on gurneys) in the department because there are no vacant beds to move them into.
The decision by an entire board to adopt a method to manage waiting lists that proved effective in reducing waiting times in a facility that was operating at 65 percent capacity and in a facility that was already working at 95 percent of its capacity. The result was a very costly program that was unable to deliver the improvements needed because of a lack of capacity, and a group of disgruntled staff who had to find alternate work when the unit downsized.
This propensity to adopt improvement programs with little or no understanding of the systemic effects is not uncommon. However, when systemic improvements that are able to incorporate the differentiated needs of individual facilities are adopted they can produce astounding results; improvements such as increased patient Throughput at levels that far exceed expectations, with little or no increase in resources.
By working at the facility level with the TOC suite of tools, it is possible to differentiate between the core problems of each individual facility, align the staff to be ready to take an active role in systemic improvements and take full advantage of the industry’s inherent propensity to spread best practices to other facilities.
The Organic Nature of Healthcare Facilities
Healthcare facilities grow, and sometimes contract, over time in response to local needs and the availability of clinicians.2 As facilities secure the services of medical specialists, their infrastructures develop to accommodate the specialists’ and their patients’ needs. These needs can also change over time as treatment regimes develop and morph clinical offerings to patients.
A good way to demonstrate the organic nature of large healthcare systems is to view them from above the facilities. Hospitals, even new ones, undergo ongoing physical development with wings, towers, and additional buildings being added to house evolving services. Unlike production plants, few hospitals can afford the luxury of suspending services while these additions or renovations are constructed because of the need to provide around-the-clock care.
The need to work in a constantly changing environment poses problems for the staff and patients alike. As the physical plant of hospitals change over time, their operational systems also need to adapt and change to support the changing mix of clinical specialists and new treatment regimens. All too often the number of changes taking place in a single facility at any one time are too numerous to track effectively. This is especially true in facilities that possess a strong silo management culture; one where the predominant mode of management is departmental, vertical, and hierarchical. This form of management has evolved in most healthcare facilities and it is widely accepted that these organizations are too big to manage systemically.
The Human “Engine of Healthcare”
Over the years, industry has been able to automate many processes and, in doing so, increase the accuracy and therefore the constancy and quality of the products it produces. We can now enjoy the exact same products on every continent of the world safe in the knowledge that they will not vary in quality.