Theory of Constraints Handbook - James Cox Iii [629]
FIGURE 32-4 The problem of scheduling patient transport.
TABLE 32-3 PRT Results Challenge the Assumption from the Cloud of “Accompanying Patients Off of the Premises is Part of My Duties”
The overall results were:
A reduction in the cost of patient discharge transport.
Extra time for the nurses to take care of their patients.
Far fewer delays in planned patient discharges due to transportation.
Far fewer patients and relatives being disappointed by unnecessary delays in discharges.
An improved working relationship between the nurses and transportation crews.
Earlier and more predictable bed availability.
Providing the Knowledge Base for Achieving the Goal in the Future
Each TOC student needs to use these three tools a sufficient number of times to integrate them into their everyday thinking skills to become comfortable with their use and for the tools to become each student’s preferred tool of choice when they encounter problems.
Once this has been achieved, they will be ready to participate in the construction of the systemic plan that will address the core problem of the facility. The students will be ready to assist in the production of desirable effects (DE) 18—the antithesis of the original UDEs used to construct the CRT—which will be used to build the lower, facility-specific levels of the Strategy and Tactic Tree (S&T). 19
Addressing the New Core Problem
By using some of the problems included in the CRT as worked examples in the workshops, the students will have become very familiar with both the CRT and their own facility’s core conflict.
In order to move the facility as a whole, it is necessary to produce a systemic S&T using this knowledge to populate the lower levels of the tree, the actions of which will address the systemic core conflict and move the facility into a position where the champion and the staff will be ready to address the facility’s higher aims of the tree including:
Recognizing the need to protect the time of the staff that will be used effectively to improve patient Throughput.
How the facility will be able to identify and release latent capacity.
How to support the staff to introduce productive behaviors.
How the application of scientific thinking can be applied successfully to soft systems.
The facility specific S&T will also include, in the higher levels, the identification and incorporation within the facility of the knowledge of the higher level TOC applications that will be needed to bring about systemic Throughput improvements.
Five Focusing Steps
The Five Focusing Steps(5FS) (Goldratt 1990, Chapter 11(is a systematic five-step approach used to improve a system’s ability continually to obtain goal units. The steps are as listed in the following:
1. IDENTIFY the system’s constraints.
2. Decide how to EXPLOIT the system’s constraints.
3. SUBORDINATE everything else to the above decision.
4. ELEVATE the system’s constraints.
5. WARNING!!!! If in the previous steps a constraint has been broken, go back to Step 1, but do not allow INERTIA to cause a system’s constraint.
Critical Chain Project Management (CCPM)20
CCPM is the TOC solution for planning, scheduling, and managing performance in a project environment. It is applied in two very different environments—single project environments and multi-project environments where resources are shared across several different projects concurrently.
TOC Synchronized Supply Chain Application21
The TOC Distribution/Replenishment solution is a pull distribution method that involves setting stock buffer sizes and then monitoring and replenishing inventory within a supply chain based on the actual consumption of the end user, rather than a forecast. Each link in the supply chain holds the maximum expected demand within the average replenishment time, factored by the level of unreliability in replenishment time. Each link generally receives