Theory of Constraints Handbook - James Cox Iii [631]
By producing a factual, system-wide analysis of how the prevailing problems are affecting the system as a whole and how these interactions produce ripple effects throughout the system, it is easy for the staff to recognize why certain difficulties arise out of the interactions between departments, divisions, and personnel. With this level of analysis, it is a simple task, often for the first time ever in the life of a facility, to demonstrate the way internal systems, policies, and procedures have evolved and why some of them are outdated or inappropriate for current needs, forcing people to behave in ways that are often counterintuitive and sometimes badly. Furthermore, this analysis can begin to open new lines of communication and repair those that are failing or have broken down. The provision of this platform and mechanism at the outset of a TOC improvement program in a large-scale healthcare system provides a very powerful demonstration25 of how the TOC tools provide a mechanism to begin to effectively address UDEs experienced by the staff.
With such a high dependency on the behavior of people, the initial core problems of individual facilities are highly unlikely to be operational issues, but rather they will be behavioral. Of course, operational issues will exist in every facility, but addressing the deepest problem of a lack of platform and mechanism by which negatives can be raised and effectively addressed will yield far greater benefits when the constraint becomes an operational issue.
In partnership with the system-wide CRT, training the people in the three basic TOC tools provides the staff with the mindset they need to be receptive, decisive, and willing to participate in the development of new solutions to longstanding problems. Practicing these tools on small everyday issues clears much of the “noise” out of the system to reveal the “skeleton” of operational issues residing in the original CRT analysis that need to be addressed.
By cycling through the 5FS and training trainers to disseminate the knowledge of the three tools within the facility, it is possible to rapidly achieve exponential improvements in all of the necessary measures that are desirable in large-scale healthcare systems—Throughput, cost, quality, and waiting times to be able to treat more patients, better, sooner, now and in the future.
Proof of Concept
The author of this chapter was able to apply these principals to a large not-for-profit health-care system that was able to:
Triple patient Throughput with:
Only a 5 percent increase in resources
A sustained increase in service quality to over 96 percent
A sustained increase in patient satisfaction to over 96 percent
And achieved:
Third-year operating profit (margin) equal to first year revenue
The organization had no difficulty in recruiting clinical staff and establishing a waiting list of professionals ready to work for the organization. It continues to provide the margin needed to achieve its mission today.
References
Goldratt, E. M. 1990. The Haystack Syndrome: Sifting Information out of the Data Ocean. Crotonon-Hudson, NY: North River Press.
Goldratt, E. M. 1999. Goldratt Satellite Program Session 6: Achieving Buy-in and Sales. (Video series: 8 DVDs) Broadcast from Brummen, The Netherlands: Goldratt Satellite Program.
Sullivan, T. T., Reid, R. A., and Cartier, B. 2007. TOCICO Dictionary. http://www.tocico.org/resource/resmgr/files-public/toc-ico_dictonary_first_edit.pdf