Theory of Constraints Handbook - James Cox Iii [628]
This cloud reads:
In order to [A] provide the best care I can for my patients, I need to [B] complete patient X’s discharge, and in order to [B] complete patient X’s discharge, I want to [D] accompany him to his transportation when it arrives at 10 a.m.
On the other hand, in order to [A] provide the best care I can for my patients, I need to [C] support patient Y during the consultation with his doctor, and in order to [C] support patient Y during the consultation with his doctor, I want to [D’] be with patient Y during the consultation at 10 a.m.
Obviously, the nurse cannot be in two places at once.
Table 32-2 shows some of the assumptions between the nurses’ needs, B and C, and wants, D and D’.
TABLE 32-2 Assumptions for Attending to Patient X or Patient Y
By sharing this cloud, it became evident that this dilemma was a common occurrence at this particular facility. Most nurses said that they had resolved this cloud by challenging the assumption of “because the transportation is booked” between B and D by spending time rescheduling the booked transportation until after patient Y’s consultation with his doctor. That way they could fulfill all of their duties—meet all of their needs and take the best care they could of their two patients.
However, on hearing about this the patient transportation service was eager to share how this particular resolution affected them.
The Negative Branch
The Negative Branch will give them a predictive tool to:
Provide a process by which proposed solutions can be effectively critiqued.
Differentiate and address the weak parts of proposed plans, thereby removing the need to reject them completely and improving on the original idea.
Act as a communication tool for needed buy-in.
In Fig. 32-4, we see a simplified example of how the transportation service used the Negative Branch to communicate its perspective of the problem of rescheduling patient transport times on short notice.
When the nursing staff read this Negative Branch and realized why there had been recent price increases for the services, they challenged the transportation providers need to increase the number of crews (the point at which the NBR turned negative) and therefore their charges. When it was explained to the nursing staff that approximately 20 percent of all of the discharge bookings from that particular facility had to be rescheduled, the nurses began to realize that an occasional change request from each of them was costing the facility more than they had budgeted for.
The nurses revisited their dilemma and decided to see if it was possible to find an alternative solution to rescheduling transportation on the day of the patient’s discharge, especially as patients were usually disappointed when their return home was delayed.
The Ambitious Target Tool
The Ambitious Target Tool will provide a basic sequencing tool to:
Offer a means to investigate the reasoning behind proposed actions.
Bring a greater understanding of the need to sequence and protect the time to complete critical tasks.
Give the staff a basis with which to plan their personal contribution to large projects.
Table 32-3 is a simplified version of the Ambitious Target Tool that the nurses decided to use to take a closer look at the activities that take place during the discharge process.
They decided to challenge the assumption from the cloud of “accompanying patients off of the premises is part of my duties.”
When the nurses shared this information with the transportation managers, they were able to suggest that their crews were already qualified to bring patients into the hospital, which should mean that they were qualified to take them out.
Once this had been verified by the Legal Department, the transport crews collected patients from