Theory of Constraints Handbook - James Cox Iii [626]
Twenty- to thirty-minute interviews should be conducted in a safe, private environment and the interviewees should be assured that their contributing statements will not be attributed to them personally and that the final analysis will not include the names of the contributors.
Prior to the interviews, the participants should be told that their contribution is not forming a witch hunt, that it is not a process intended to place blame on them or their colleagues. This obstacle can be addressed effectively by giving the interviewee a brief description of three of the basic assumptions of TOC.
1. All systems are simple, if understood correctly.
2. There are no conflicts in reality, just different perspectives of reality.
3. People want to do good; this is especially true in healthcare and it is often the system or people’s perspective of the system that forces them to behave in ways that are counterintuitive.
By briefly explaining that these are the assumptions of the process in which they are participating and that their contribution will be confidential, most participants readily agree to participate. They intuitively know that the system should and can be improved, and when that is done, they will be able to provide better, quicker services to more patients. Furthermore, the participants also agree that in order to change the system they recognize their need to participate and support the proposed process.
The participants are then asked to tell the interviewers about the problems (UDEs) they experience in their work lives. These statements are noted by the interviewers.
At this stage of the analysis, time is the current constraint of the interviewees. Therefore, it is necessary for the TOC practitioners to subordinate the interview schedule to the needs of the facility.
It is also necessary to interview a range of staff from executives and physicians, to nurses, technicians, and administrative and service support staff. As well as capturing statements from the vertical structure, it is also necessary to collect statements across disciplines. Many of the interviewees will represent both aspects of a facility.
Building the Current Reality Tree 9 (CRT) of a Facility
The purpose of the CRT is to determine the core problem of a specific system, which in this case is a single facility. A facility-wide CRT offers a comprehensive and very detailed “snapshot in time,” clearly showing the interconnectedness of the problems that are being experienced by the staff and patients.
Because words are used as the primary source of “data,” a CRT easily incorporates details of behaviors, operational issues, policies, and protocols. Numbers can be included if they are needed to substantiate certain points, but the product of a CRT is written explanation of the existence of everyday problems and their source.
The process of building a CRT starts with writing the cause-and-effect logical relationship between closely related UDEs. Continuing to incorporate all UDEs in this way offers the readers a unique, revealing overview of their organization and a chance to recognize systemic patterns of behavior being exhibited by the staff, and understand why they exist.
Converting the Interviewees’ Statements into UDEs
Many of the statements collected during the interview process will be duplicates. These are easily collated and represented as a single UDE. Some statements appear to be standalone comments. Often, these take the form of a direct quote from a participant and, whenever possible, should not be generalized.
No statements should be dismissed at this stage, as they may be critical to the analysis, no matter how far-fetched