Theory of Constraints Handbook - James Cox Iii [630]
Drum-Buffer Rope (DBR)22
DBR is the TOC method for scheduling and managing sequential process steps.
Buffer Management (BM)23
BM is the TOC method of identifying the current status of items with respect to arriving at the bottleneck and causes of lateness in items of arriving at the bottleneck. This tool is used to focus both expediting and local improvement efforts, which results in global improvement.
The TOC Thinking Processes (TP)24
The TP is a set of logic tools that can be used independently or in combination to address the three questions in the change sequence, namely, What to change? What to change to? and How to cause the change?
Leaving a TOC Legacy
The aim of this program is for the TOC experts to leave each participating facility with the knowledge to be able to maintain the process of ongoing improvement, through repeated application of the 5FS and the in-house knowledge and confidence to use the TOC applications until they are able to position and manage their constraint in such a way that it maximizes their ability to strive for the goal of treating more patients, better, sooner, now and in the future.
Summary
Contrary to common belief, the quality and cost of healthcare delivery is far more dependent on the people delivering the service than the infrastructures in which they operate. Excellent medical prevention and treatment can take place in the most basic of settings if the people delivering it are well trained, knowledgeable, and have access to the supplies they need. However, expensive and well-designed large-scale healthcare facilities, infrastructures, and buildings can fail in their purpose to deliver good quality, affordable, and timely care if the people working within it are hampered by the way the internal systems operate. By failing to meet the needs of their patients and their staff, these organizations can stagnate and lose the ability to make effective improvements.
All too often improvement projects in large-scale healthcare systems fail to yield the expected results. More often than not this is not due to a lack of efficacy on the part of the methodology used, or a lack of the intent by the people trying to improve matters, but rather a lack of understanding of the underlying issues that need to be addressed to unlock the stalemate generated by so many failed attempts to progress matters. In addition to breaking the “improvement stalemate,” there is the added obstacle of the day-to-day business of the hospitals and clinics, which cannot and should not be interrupted. Unlike a production line, it is not possible to shut down a clinic for a refit if the demand for its services cannot be satisfied elsewhere. Healthcare is a continually traveling carousel of activity onto which improvement programs have to leap and be successful without disrupting the daily business of providing care.
In order to provide the improved levels of care their patients need, operational health-care improvement efforts need to be subordinate to the day jobs of caregivers. The people working in healthcare have to be able to integrate changes that will bring about real gains with a minimum of disruption to patients and services. However, even before changes are attempted, the people expected to implement them need to be able to voice any concerns they have and contribute their own expertise and experiences about any proposed changes in the processes they perform each day. All too often, the operational knowledge and intuition of the staff is not sought or offered. However, giving people the opportunity to participate in the planning of improvement projects is insufficient.
In any Emergency Room, a team of well-trained, experienced medical and nonmedical support staff can treat multiple patients with incredible speed, accuracy, and high quality of care. Charge the same team with improving patient Throughput management in the Emergency Room and they will likely suggest