Theory of Constraints Handbook - James Cox Iii [625]
On the other hand, in order to [A] treat more patients better, sooner, now and in the future, I need [C] not to waste my time (use my time as productively as possible) and in order to [C] use my time as productively as possible, I [D’] don’t want to raise reservations about proposed changes.
FIGURE 32-2 Contributing expertise.
Obviously, D and D’ are in direct conflict, a simple “do or don’t do” dilemma.
Some of the assumptions behind some of the arrows of this cloud are as in Table 32-1.
Because this dilemma is so prevalent in healthcare, the people working in it are often unable to prioritize effectively between the demands on their time and they resolve this perpetual dilemma by accepting an ever-increasing administrative workload. This is a practice that, as it becomes more and more common among the workforce, is accepted as being a fact of life in healthcare.
As people feel obligated to accept this fact of life, they try to complete all of the work expected of them and are frequently forced into accepting a compromise solution by working more hours, and taking on more unrecognized and often unpaid tasks and responsibilities than they are contracted for, all too regularly to the detriment of their personal lives.
Conversely, the people who refuse to be put upon are often thought of as being obstructive and uncooperative.
In either case, the inability or unwillingness of these people to raise objections to the proposed change or to suggest alternate solutions is prevalent, and without the ability to resolve this dilemma in a way that does not compromise the essential needs of both B and C, it is not possible to effectively achieve the goal of healthcare to treat more patients, better, sooner, now and in the future.
TABLE 32-1 Assumptions for Raising or Not Raising Reservations about Proposed Change Initiative
This dilemma is generated by the fact that staff is often unable to resolve many of the problems generated by any or a combination of the following:
Interpersonal conflicts
Conflicting schedules
Insufficient resources
Ineffective operational processes
Erroneous policies
These problems exist because of the deeper underlying problem of a lack of platform and mechanism by which negatives can be effectively raised and addressed.
Providing a Safe Platform and an Effective Mechanism
TOC offers a number of different ways to identify the core problem of a system, all of which can achieve the same result of arriving at a core problem that, on further analysis, can be expressed as a core conflict.
While it is possible to identify an organizational core conflict through one of the more direct TOC analytical process, such as the Three Cloud7 analysis, this process may not provide the breadth of analysis needed to fulfill the need of a system-wide platform to air problems. It is necessary to provide the staff with a broad-brush relational map to show from where their own experiences emanate and how the subsequent behaviors they are forced to exhibit are the result of the way the system is structured and operating.
When the system being analyzed is more heavily dependent on people as opposed to mechanical processes and process units, it is necessary to take a more detailed approach to finding the core problem.
At this stage of the process, the staff has neither the time nor the skills to identify their own facility’s core problem; therefore, it is necessary to provide both the platform and mechanism for them.
Each facility’s personnel must understand what it needs to change8 before plans can be made to facilitate change. Few people, if any, in any given facility have a clear picture of how their current activities generate problems and what magnitude of impact these problems have throughout the system. Therefore, it is necessary to find a way to gather evidence of the problems in the most effective way possible, with the least detrimental impact possible on the treatment of patients.
The problems need to be stated in such a way as