Theory of Constraints Handbook - James Cox Iii [622]
The effect of any improvement initiatives, on both of the project management based work streams, should be to generate an overall increase in effectiveness to achieve one or ideally more of the following objectives:
Generate more income, which will provide a facility with more resources to enable it to
Take care of more patients.
Offer improved services.
Reduce patients’ waiting times.
Continually improve.
When people who spend the majority of their time involved with direct patient care are charged with tasks from the operational improvement projects, they are often being asked to perform what can loosely be described as “extracurricular” activities as often they have to carve time out of their patient care commitments to perform them. When individuals are charged with participating in both types of “project,” they are often placed under tremendous pressure. They feel a loyalty to their patients at the same time as recognizing the need to improve the system that will eventually help them to deliver better or quicker services to their future patients.
Unlike the production environment, the service sector is far more dependent on the people to deliver the desired outcomes needed to succeed. In services like banking, insurance, leisure, and the like, it is possible to standardize many of the processes along the lines of a production environment, a trait that many departments in healthcare facilities mimic. However, the resulting finished “product” is, say, an insurance policy or a vacation; there are inherent mechanisms that can be tweaked or adjusted to meet the consumers’ needs. However, in healthcare the finished product is far less predictable and the producers are far less able to gauge the effectiveness of their efforts as they are often as dependent on the emotive and experiential issues of their patients’ care episode as the science and technology used to satisfy the health needs of their “clients.” It is this human element of both the “production units” and the “raw material” that introduces huge amounts of potential variation into the management of healthcare and which generate core problems3 that can be difficult to predict and even more difficult to generalize without the use of effective analytical tools.
In order to understand fully the generic core problem of healthcare as an industry, it is necessary to dig deep enough to find a common cause that will take into account all of the wide range of variations presented by a service that delivers very personal care to people.
The core problem of healthcare has to encompass fully the problems experienced by the people as well as the operational processes used within the system.
To verify this statement, one only has to look at the improvement programs that are adopted by seemingly homogonous large-scale healthcare systems represented by countrywide socialized systems.
It is common for overarching socialized healthcare management entities to insist upon the adoption of certain management practices that have brought benefits to a few of their facilities, often through pilot projects.
What these projects almost inevitably overlook is the real current core problem of each facility4 and in doing so assumes that because project X worked so well on one facility, its repetition will yield the same results in all of their locations.
What is not established before these projects are initiated is the core problem of each facility and whether the proposed project will eliminate the core problem by rectifying the underlying conflict, or if it will only address lesser problems and symptoms (undesirable effects) being generated by the conflict.
Current Problem Solving Techniques
“Not everything that can be counted counts and not everything that counts