Theory of Constraints Handbook - James Cox Iii [624]
To collect sufficient verbalized UDEs to be able to deduce the core problem of a facility, there needs to be a safe environment for the people suffering from the UDEs to voice their concerns. They need guidelines to help them give accurate descriptions of the UDEs, ones that do not place blame onto colleagues, but rather give a clear description of the result of errant actions and processes, and which will not result in future recriminations.
Once a safe platform has been established, it is necessary to make sure that the concerns being raised are addressed in an effective manner.
If both a safe platform and an effective mechanism were in place to understand and address systemic negatives, then far less “interpersonal noise” and fewer operational problems would exist. Therefore, the underlying core problem of healthcare facilities is the lack of platform and mechanism by which negatives can be effectively raised and addressed (Wright and King, 2006).
Both a platform and a mechanism are needed because a platform without an effective mechanism to identify and rectify the causes of the UDEs will be ineffective, as is a mechanism that does not address the majority of negatives at a systemic level.
If both an effective platform and mechanism were present in a facility, the UDEs or symptoms being experienced would be of minimal concern and the facility would be able to improve with the following results:
A minimum amount of disruption to patient care.
A cooperative workforce.
The facility working at optimum capacity, generating or securing the maximum possible income.
Clinical staff would be able to devote almost all of their workday to the treatment of patients.
Administrative services would be subordinate to clinical services, causing minimal disruption and waiting times for patient/clinician interaction.
A greatly reduced need for clinicians to participate in administrative improvement programs.
What to Change to
Where Should the Constraint Reside in Healthcare?
In an ideal healthcare system, there would be nothing to stop the constrained resource of clinicians from maximizing the time they spend with patients. In fact, the clinicians need to be the constraint.
This constraint will never be broken until there is enough clinical capacity to treat all of the community’s patients, with the best available methods, as soon as they need it.
If a facility does have sufficient clinical staff, the constraint needs to be the recovery rate of the patients. Under these circumstances, the only factor that should impede a patient’s progress through the caregivers’ services should be the patient’s ability to heal or recover, with no system or clinician imposed wait times.
These ambitious constraints are far from being onerous; they are the constraints health-care providers and their managers should be striving to establish within their individual facilities.
However, before these ambitious targets can be reached, it is necessary to address the underlying core problem.
Starting an Organization on a Process of Ongoing Improvement
In healthcare, the deepest problem of a lack of platform and mechanism by which negatives can be effectively raised and addressed is easier to understand in the form of the personal conflict or dilemma being experienced by the people who suffer from it. They are caught in the personal dilemma described in the following Evaporating Cloud6 in Fig. 32-2.
This Cloud reads:
In order to [A] treat more patients better, sooner, now and in the future, I need to [B] contribute my expertise to the improvement of our facility; and in order to [B] contribute my expertise to the improvement of our facility, I want