Theory of Constraints Handbook - James Cox Iii [627]
Constructing the CRT
Using rigorous cause-and-effect logic and the Categories of Legitimate Reservation (CLR),10 the UDEs are connected to reveal the core problem, which can then be expressed in the form of a Cloud to describe the core conflict 11 of the facility.
During this process, it is necessary to have ongoing contact with a champion at the facility who is used to verify the logic used to construct the CRT, the core problem, and the core conflict.
Sphere of Influence
Constructed correctly, the CRT will identify both internal and external constraints. During the reporting process, and after the CRT, the core problem and its underlying core conflict have been verified, it is necessary to make staff at the facility aware of the need to plan to work within its current sphere of influence, the recognized bounded areas of activity over which the staff, including the executives, have the authority to make autonomous changes. A facility may be suffering from a legislative or corporate constraint that its staff has no current ability to influence. To try to do so at this stage will be a waste of effort and time that is needed to treat patients.
However, the ability to address corporate constraints will improve once the facility’s executives are able to demonstrate that its ability to improve further is being blocked by corporate policies, by which time the head office will be keen to understand how the facility has been able to produce marked improvements in patient Throughput.
Most facility CRTs will expose many erroneous behavioral issues that are being driven by behaviors, policies, and procedures 12 that eventually will need to be addressed. The danger at this stage of the process is that the staff will want to address these issues in isolation—in effect, reverting back to addressing symptoms as opposed to the core problem.
How to Cause the Change
Training the Process Units
Once the core problem and its underlying conflict and their causal relationships to the numerous isolated UDEs have been identified and verified by the contacts (the champion and key staff) at the facility, it is time to begin to train the employees (managers, clinicians, and support personnel) to prepare them to overcome the facility’s core problem.
The training needs to include an overview of TOC and how it addresses problems. The people who need to be trained are those working at the facility who will be needed to introduce the changes necessary to overcome the systemic conflict. Often this will require people from all levels of the facility to be trained as the CRT will clearly show the far-reaching effects of the deep-rooted core problem.
To this end, the training needs to offer trainees opportunities to work on existing problems through guided practice using the three basic behavioral TOC tools:13
1. The Evaporating Cloud14
2. The Negative Branch15
3. The Ambitious Target16—a derivative of the Prerequisite Tree17 developed by TOC for Education
The repeated use of these three tools will increase the ability of the staff to overcome many of the nonsystemic and interpersonal problems they encounter during their working day.
The Process of Ongoing Improvement
Providing a Knowledge Base for Achieving the Goal Now
The Cloud
The Cloud will give them the critical thinking skills they need to:
Make effective win-win decisions.
Understand and facilitate their own and other people’s understanding of situations.
FIGURE 32-3 A nurse’s dilemma.
Resolve dilemmas and conflicts on many levels—personal, departmental, etc.
Be receptive and willing participants in other people’s or department’s problems.
In Fig. 32-3, we see an example of a typical problem in large-scale healthcare systems that many nurses experience.
When nurses are allocated patients, they are responsible