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2015 TOCICO International Conference

Transforming Healthcare Track

Roy Stratton
Nottingham Business School
Nottingham Trent University

Teaching TOC in Context
September 8, 2015

The presentation begins by asking the question why TOC is given such little attention compared to other breakthrough developments in operations management. A comparison of the space provided in operations management text books shows stark comparison, with TOC typically being covered in 2-3 pages and other developments being embraced within full chapters (strategy, quality management / six sigma, lean management and supply chain management).

One of the most popular Operations Management (OM) text books in Europe devotes just 2 pages to TOC (Slack et al., 2012) and in others the coverage is also often very outdated (Hill and Hill, 2012).

However, on closer inspection this is shown to not be a valid comparison as the chapter content rarely conveys the paradigm shift associated with the originators innovation. This is reflected in the emphasis placed on cost reduction when referring to lean and TQM and viewing lean as a trade-off between flow and resource efficiency (Modig and Ahlstrom, 2012).

This cost rather than systems focus is also evident in the inertia associated with the content of operations text books that still promote the use of EBQ and quality cost models (Slack et al., 2012). As a consequence these innovative systems developments continue to be viewed discretely, emphasising the associated techniques rather than identifying the common underlying assumptions at a more abstract level.

These wider breakthrough developments are shown to centre on a shift in thinking from cost and efficiency to variability and flow involving structural and infrastructural mechanisms - flow lines (Ford, 1926); statistical process control (Shewart, 1931); focused factories (Skinner, 1974; 1986); kanban (Ohno, 1988) and buffer management (Goldratt, 1990).

To help clarify the common origins as well as the distinctions, the presentation identifies key construct relationships linking variability, uncertainty, buffering mechanisms and trade-offs which are selectively used to explain the above developments - this involves the use of cloud analysis and the 5 steps. The TOC perspective is also linked to that of others (Hopp and Spearman, 1995; Schmenner and Swink, 1997; Hopp, 2008) in defining these 7 laws.

Law of variability
Law of variability buffering
Law of bottlenecks
Law of variability pooling
Law of flexibility buffering
Law of trade-offs
Law of focus

These laws are shown to help explain how the approaches relate to each other as well as identifying the main distinctions. This includes the importance of the laws of variability pooling and bottlenecks to TOC and buffer management.

The presentation concludes by using case examples to illustrate the need to consider environmental fit in the selection and integration with specific reference to health care applications (Radnor et al., 2012; Stratton and Knight, 2010).


Ford, H. (1926), Henry Ford – Today and Tomorrow, Portland, OR: Productivity.
Goldratt, E.M. (1990), Theory of Constraints, North River Press, Great Barrington, MA.
Hill, A., Hill, T. (2012), Operations Management 3rd Ed., London: Palgrave Macmillan
Hopp W.J., and Spearman, M.L. (1995), Factory Physics., Singapore: McGraw Hill.
Hopp, W. J. (2008), Supply Chain Science, Waveland Pr Inc.
Mentzer, J.T., Dewitt, W., Keebler, J.S., Min, S., Nix, N.W., Smith, C.D. Zacharia, Z.G. (2001), "Defining Supply Chain Management”. Journal of Business Logistics, Vol. 22, No 2, pp.1-25.
Ohno, T. (1988), The Toyota Production System; Beyond Large-Scale Production. Productivity, Portland, OR.
Radnor, Z.J., Holweg, M. and Waring, J. (2012), "Lean in healthcare: The unfulfilled promise?”. Social Science & Medicine, Vol.74, pp. 364-371.
School of the Department of Agriculture, Washington, DC.
Schmenner, R.W., and Swink, M.L. (1998), "On theory in operations management”, Journal of Operations Management, Vo.17, pp.97-113.
Shewhart, W.A. (1931), Economic Control of Quality of Manufactured Product. New York, NY: Van Nostrand.
Skinner, W. (1986), "The Productivity Paradox”, Harvard Business Review, Jul-Aug, pp. 55-59.
Slack, N., Brandon-Jones, A., Johnson, R and Betts, A., (2013), Operations and Process Management, 3rd Ed., London: Pearson.
Stratton, R. and Knight, A. (2010), "Managing patient flow using time buffers", Journal of Manufacturing Technology Management, Vol. 21 No 4, pp.484 – 498.

DR. ROY STRATTON is based in the UK and is a Reader in Operations and Supply Chain Management at Nottingham Business School, Nottingham Trent University, where he is actively involved in TOC related teaching, research and consultancy. He is the Director of studies of a number of TOC based doctoral students and the Programme Manager of a portfolio of part time TOC based MSc courses delivered in collaboration with QFI Consulting. Previously, Roy worked for Rolls Royce Aero Engines in an internal consultancy role and has since been actively involved in a wide range of industry-based and government funded knowledge transfer research projects. He has published widely in both professional and academic journals and has co-authored two educational books.

Roy is a chartered Engineer (F.I.Mech.E.) and has been awarded a BSc in Mechanical Engineering (Nottingham), an MSc in Manufacturing System Engineering (Warwick), and a PhD in Supply Chain Management (Nottingham Trent). He is certified in all TOC ICO fields and joint Chair of the TOC ICO healthcare SIG.

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