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TOCICO Healthcare Annotated Bibliography - by James F. Cox III
Listed below is an annotated bibliography of the presentations on the use of TOC in healthcare made at the annual TOCICO International Conference (2003-2013) and TOCICO webinars (2010-2013).

 

Aoki, N. (2005). Using the TP for medical error reduction. TOCICO International Conference: 3rd Annual Worldwide Gathering of TOC Professionals, Barcelona, Spain, Goldratt Marketing Group.

                This presentation discusses the scope of medical errors and compares the number of deaths from medical errors (98,000) to traffic deaths (43,000), deaths from cancer (42,500), and deaths from AIDS (16,500).  Patient case studies are described illustrating the causes of medical errors.  The thinking processes (TP) are used to analyze this medical errors case; to develop a solution to prevent the errors; and to establish consensus among medical professionals.  Several undesirable effects (UDEs) were surfaced related to the medical errors; the three-cloud approach was used to build a generic core conflict cloud. This cloud was comprised of objective (A) To provide high quality (e.g. timely and safely) care for each patient; (B) Respect autonomy of each professional to maximize their activities; (D) Work independently and have the responsible physician manage patients; (C) Reduce risk of medical errors and check the status during the process; and (D’) Work as a team based on standardized processes.  The current reality tree was built connecting all UDEs.  The assumptions of the core conflict cloud were surfaced and injections identified.  The future reality tree was constructed to achieve the desirable effects based on the injections.

 

Aoki, N. (2006). Critical chain for inpatient management of patients with diabetes mellitis. TOCICO International Conference: 4th Annual Worldwide Gathering of TOC Professionals, Miami, FL, Goldratt Marketing Group.

                This presentation describes the application of the theory of constraints (TOC) critical chain project management (CCPM) application to design a resource allocation and scheduling system for healthcare professionals.  Diabetes is used as a case example as a project.  CCPM provides a good solution to create a concrete schedule for each professional which maximizes resource utilization and reduces extra waste.  Quality indicators were examined. A prototype information system is being implemented based on CCPM concepts.

 

Arai, H. (2009). Myths about product registration of medical devices in Japan. TOCICO International Conference: 7th Annual Worldwide Gathering of TOC Professionals, Tokyo, JP, Goldratt Marketing Group.

                Due to its rapidly aging population, Japan has been a very attractive market to medical device manufacturers. This presentation introduces organizational efforts for improve its performance with using the concepts of TOC, such as critical chain project management (CCPM) and the thinking processes (TP). Internal touch-time to register a product has been shortened by about 30-70% in a multiple projects environment with less people and without compromising compliance.

 

Cerveny, J. F. (2009). Managing back office healthcare operations. 1st Annual North American Regional TOCICO Conference, Tacoma, WA, Goldratt Marketing Group.

                The back office (billing) phase of hospitals is a source of challenge and of low hanging fruit. The volume of backlog to process charts accurately to ensure maximum reimbursement is vital to attaining throughput: the more errors, delays, etc. that occur exposes hospitals to possible fraud and contributes to uncollectable revenues. This session demonstrates how the five focusing steps (5FS) were applied to align the efforts of the back office for a Florida hospital.

 

Cox III, J. F. and T. M. Robinson (2012). The use of TOC in a medical appointment scheduling system for family practice. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

                The use of TOC in healthcare is an emerging field. This presentation describes the use of the five-focusing steps (5FS), throughput accounting (TA), drum-buffer-rope (DBR), buffer management (BM), the engines of harmony, and the thinking processes (TP) in a family practice organization. Many medical providers use a patient appointment scheduling system based on fixed appointment times to schedule patient flow; the use of TOC in this type of scheduling system is a new and significant area of study. The TOC tools (the TP) and BM were used to improve scheduling, execution, and patient flow by eliminating the major causes of interruptions, thus providing a smoother flow of patients to and from the provider. The attendee benefits from understanding: 1. The application of each TOC tool to the medical practice through various examples in an actual practice. 2. The use of BM to proactively improve appointment scheduling and execution systems. 3. The major causes of poor organizational performance across a medical practice.

 

de Kiewiet, M. (2012). Solid gains throughout an acute hospital. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

                This presentation provided a blended, holistic approach to operational excellence in an acute hospital - A case study. The hospital services a population of about 260,000 residents and 5 million tourists. The presentation goal and key learning points relate to sharing practical experience of what can be gained within a year by using the implementation of a blended approach to operational excellence of an acute hospital. The key learnings are: a two-pronged approach works, involve everyone, resistance to change has a lot to do with the mermaid syndrome (taking comfort in not changing), learning to see, pathway integration, the speed of implementation is important, project management and sustained results are vital.

 

Dinham, A. and R. Stratton (2011). Why assessment units are not a waste of time: A TOC perspective. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                This presentation describes three topics.  The first topic is how assessment units can significantly improve patient flow when configured and managed in line with TOC principles. The second topic is how assessment units buffer the inpatient / emergency care pathway, introduce a divergent point from which patients can be discharged after a reduced stay, and therefore off-load scarcer, slow-moving in-patient beds. The third topic is how this approach has been practically delivered together with an assessment of the current limitations and the relationship to alternative theory.

 

Ferguson, L. A. (2011). Achieving win-win-win in U.S. healthcare reform. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                This presentation provides the case for how to achieve win-win-win for all stakeholders of the U.S. healthcare system. Dr. Ferguson explains the key components of the analysis from a paper she wrote. The answers to the questions (What to change?, To what to change?, and How to cause the change?) are presented for each type of stakeholder, in addition to how to overcome resistance to change. Professor Ferguson also explains how to improve healthcare in the world as well as an analysis that addresses all of the stakeholders of the U.S. healthcare system. Each stakeholder is addressed with respect to the questions of 'What to change?' and  'To what to change?' in the paper. With respect to the second question, a summary of any known successes of implementing TOC in healthcare in the world is shared. The question of 'How to cause the change?' is answered as well to some extent. The full answer to the third question would need to be presented in a strategy and tactics (S&T) tree written specifically for how to implement the change in the U.S. A roadmap is described in this presentation as well.

 

Ferguson, L. A. and A. van Gelder (Sept. 8th, 2010). Strategy and Tactics for Hospitals. TOCICO Webinar Series. TOCICO, Theory of Constraints International Certification Organization.

                We present the generic Strategy and Tactics tree for hospitals for how to implement TOC to improve healthcare quality, provide a more rewarding environment and improve financial performance. Then, we share experiences of implementing TOC in both public and private hospitals. 

 

Halaby, D. (2009). Dealing with the nursing shortage. 1st Annual North American Regional TOCICO Conference, Tacoma, WA, Goldratt Marketing Group.

                In 2001, 10 area hospitals, four institutions of higher education plus 10 related NGO’s, agreed to work collaboratively to outline the process for training in nursing and allied health occupations in the Rio Grande Valley (RGV) and develop a strategic plan to increase the throughput of locally trained professionals. The effort led to the creation of the RGV Allied Health Training Alliance and the creation of the centralized clinical scheduling system.

 

Inozu, B. (2010). Injecting TOC with lean / six sigma into process improvement in healthcare. TOCICO International Conference: 8th Annual Worldwide Gathering of TOC Professionals, Las Vegas, NE, Goldratt Marketing Group.

                A new best-of-the-breed approach to combine TOC concepts and tools with lean and six sigma in healthcare is shared.  This approach is used when jump-starting a new continuous process improvement program or reenergizing an existing one. Strategies and tactics to overcome resistance are also presented when introducing TOC to lean and/or six sigma cultures. Examples are provided from interventional radiology, advanced cancer treatments, and laboratory turnaround times in emergency departments.

 

Inozu, B. (2011). Implementing constraints management with lean / six sigma: Lessons learned at Anadolu Medical Center. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                The first twelve months of deploying a continuous performance improvement program, called Super, at Anadolu Medical Center in Turkey is discussed. The 201-bed hospital has begun implementing lean and six sigma with constraints management in an integrated manner. Examples are provided from improvement project selection that incorporates the thinking processes (TP), addressing policy constraints in the outpatient appointment process, the magnetic resonance imaging (MRI) repair and maintenance preparing process, the  the operating room (OR) process, and the inpatient medication order process, as well as results of a pilot study on dynamic replenishment for medical supplies.

 

Kitabayashi, A. (2011). Operational excellence by a TOC armed IE. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                OMRON Healthcare is known around the world for its consumer-oriented medical devices, such as blood pressure monitors and thermometers, and its factories have been showcased as success stories for the Toyota Production System (TPS). In this presentation, Atsushi Kitabayashi shows how OMRON Healthcare is reaching new heights of performance. He also discusses how OMRON Healthcare used TOC to effectively manage itself in the aftermath of the recent earthquake in Japan.

 

Knight, A. (2009). Theory and practice. First European TOCICO Regional Conference, Amsterdam, The Netherlands, Goldratt Marketing Group.

                Alex Knight describes his first meeting with Dr. Eli Goldratt at a senior-level seminar.  He then describes the experiences he has had in different environments (healthcare, legal, universities).  TOC (Eli) is using the question, "Why?" very effectively.  Managing complex systems, such as the healthcare industry, involves managing health and social environment systems. What we did to improve the system: We took what the theory (related to production) said and did it!  The chain of activities in the health and social care system is explained.  The patients that stay the longest in any part of the system are not the sickest, but the patients who had the most delays in the process.  The healthcare evaporating cloud is presented and discussed.  The cloud is (A) Run an effective healthcare system; (B) Medics/managers are required to give the best (appropriate) medical treatment to those they are now treating; (D) Medics/ managers should act only upon medical considerations; (C) Medics/managers are required to treat all patients in a more timely manner; (D’) Medics/managers should act more and more within budget considerations.  Medical technology is improving rapidly and as it improves the costs of buying and operating the new equipment is increasing significantly.  The costs of running a hospital are defined and discussed. The truly variable cost is about 20%, while 60-70% of hospital costs are related to medical staffing.  If you try to save money, then you reduce Throughput.  Achieving a breakthrough in healthcare consists of five elements: achieving consensus, operational breakthroughs, finance and measures, market breakthroughs and sustainability.

 

Knight, A. (2011). Fifteen year progress report on achieving breakthroughs in health and social care using the theory of constraints. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                This presentation reviews progress to date in the application of the TOC to achieving a breakthrough in performance in health and social care systems. These developments address how to improve emergency care, discharge management, out-patient management, elective surgery management and how to turn improvements in the operations into a decisive competitive edge. The presentation assesses progress to date, current limitations, together with future opportunities and challenges. Alex Knight also reflects on lessons learned in applying TOC to a new industry.

 

Knight, A. (2012). TOC in healthcare: Broadening the shoulders of our giant. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

                Healthcare is accelerating towards a crisis of affordability. The likely outcome is deterioration in both access and quality of care. It is time to make explicit how and why a TOC-focused approach is the only option. This presentation establishes: 1.  The conceptual similarities and differences between what was so dramatically improved by TOC production and project management approaches and the impact of these approaches on the healthcare environment. 2. The broader conditions under which TOC has been successful in healthcare, its applications and the boundaries of its applicability. 3. New knowledge to accelerate the impact of TOC in healthcare around the world is the core of the presentation.

 

Knight, A. (2013). The Development of TOC Applications for the Service Sector. TOCICO International Conference: 11th Annual Worldwide Gathering of TOC Professionals, Bad Nauheim, Germany, Theory of Constraints International Certification Organization.

                This presentation highlights some of the core developments over the last thirty years and in particular focuses on areas where modification of the standard applications was not sufficient and a different approach was required (one that remains firmly rooted in the underpinning theory). In each instance Alex Knight demonstrates that the breakthrough has come purely from the derivation of the underlying theory and has never required the addition or integration with other theories. In particular, Alex highlights the following points: 1. There are many examples where the assumptions upon which the generic TOC applications for manufacturing were built are not valid in the service environment. As an example, the concept of choking the release to help identify the constraint is a core first step in all of the operations, project and distribution / supply chain environments and yet this is often simply not a valid option in most services. The implications of this are far reaching and require a rethink in the development and adaptation of the TOC applications for the service sector. 2. The distinction between an operations and project environment are also not always valid in a service environment. Alex exposes a number of examples where ‘both and neither’ of the conditions can exist. As a result, this basis of distinction is no longer really very helpful. Alternative criteria for establishing the position and size of buffers are required.  3. The whole concept of developing a schedule for resources to follow is often redundant.  Demand emerges alongside frequent and major changes in both mix and volumes in extremely short timescales.  Creating sufficient protective capacity at very short notice becomes a key issue. Establishing the processes for this require a different perspective to the traditional applications. Some of the lessons learned in this environment may have implications for changing the way schedules are developed for other environments. 4. It is inferred from standard TOC processes and the transformational strategy and tactics (S&T) trees that initiating the analysis and eradication of underlying causes of delay should be embarked upon once the system is being guided by buffer management.  In many of these service environments, it is more appropriate to initiate this analysis and supporting actions before any attempt to introduce buffer management. The process of on-going improvement (POOGI) is more of a driving force than DBR (the TOC production/operations application) or CCPM (the TOC project management application).  5. In many service environments, the un-desirable effect (UDE) of ‘too early’ is just as valid as ‘too late’. As a result, there has been a need to invent a new buffer system and associated algorithms.  6. Exposing excess capacity can often happen in a matter of hours, days or weeks. This means that the synchronization of sales efforts to increase sales is very important.  With staffing as a major part of the operating expense (OE) of many service industries, it is very tempting to cut OE the moment excess capacity has been revealed. In some industries, the very first steps have to be to plan and start the processes to increase sales even before the decisive competitive edge (DCE) has been achieved.  7. Many service industries have high levels of front-line professional staff who must be bought in to the approach.  The number of people who can threaten the implementation's success if they do not believe in it is typically a magnitude of order higher. Many are very skeptical about anything to do with management.  This has major implications for the approach and intensity of the buy-in that is required.  8. The customer is often an active participant in the delivery of the service and cannot be treated like a piece of work-in-progress. Also, exploitation of the constraint to maximize throughput per constraint minute may be inappropriate.  We cannot reduce the lead time for someone to die to free up capacity.   9. Changing the mind-set of a TOC professional to work in the service industry has often taken significantly longer than starting with new recruits who have no knowledge of TOC.

 

Knight, A., et al. (2003). Making TOC the main way of managing the health system. TOCICO International Conference: 1st Annual Worldwide Gathering of TOC Professionals, Cambridge, England, Goldratt Marketing Group.

                This presentation provided the health context: UK healthcare is the largest employer in Europe with a workforce of over 1.3 million people, many of whom operate as highly qualified front line staff (doctors and nurses); the largest London teaching hospital employs more staff than, for example, the whole of Hewlett Packard Europe;  in a typical teaching hospital, there are more than 400,000 visits to outpatient clinics per year; 60,000 inpatients; 25,000 operations and 75,000 attendances to the accident and emergency department; the 'Number One' pledge of the UK government at the last election was to deliver a breakthrough in performance in healthcare; in the last three years, the national budget has been increased by over 30% and the number of patients treated has increased by 3.7%; there are backlogs of between 9 and 18 months for operations; and many chief executive / senior management posts remain unfilled.  The chain of activities in healthcare includes inputs from ambulances, general practitioner referrals and elective surgery patients to admissions and emergency, acute, community hospital, residential and nursing care, and social and healthcare activities. Buffers were placed in the emergency department to identify and eliminate problems through weekly multi-team one-hour buffer management meetings.  Results include: hospital '1' treated over 95% of patients in less than 4 hours; hospital '2' achieved 100% performance at 4 hours; therefore, it shifted its goal to three hours and achieved over 95%.  Buffer management has been implemented across the full system to identify and eliminate problems, thus reducing task time averages and standard deviations associated with patient care.

 

Knight, A., et al. (2004). Making TOC the main way in health and social care. TOCICO International Conference: 2nd Annual Worldwide Gathering of TOC Professionals, Miami, FL, Goldratt Marketing Group.

                This paper summarizes the lessons learned so far in opening up the health industry to TOC and provides the details of our latest work in reducing the queues for elective operations. Key learning points include: 1. Dealing with which current policies to challenge and what to leave to the future. 2. Better understanding of the critical distinction between planning and execution. 3. Reducing uncertainty by limiting the horizon of the planning.  Benefits to attendees: 1. Exposure to a challenging project in the middle:  being able to participate in dilemmas that are active now. 2. Getting ideas that could work in other service organization. 3. Widening one’s perception on the usage of TOC in non-profit organizations.

 

Masuda, K., et al. (2013). Holistic management in a pharmaceutical company. TOCICO International Conference: 11th Annual Worldwide Gathering of TOC Professionals, Bad Nauheim, Germany, Theory of Constraints International Certification Organization.

                It takes about 10-15 years to launch the new drug medicines after pharmaceutical companies discover the promising compounds. This means that pharmaceutical companies tend to accept the dilemma of not releasing new products immediately even though there are promising active agents at hand. Pharmaceutical companies also tend to have a large stock of inventory because the shortage of products supporting good health is not permitted. Senju Pharmaceutical Co., Ltd. (based in Japan) is faced with the same problems as other drug companies. Since 2012, we have started a holistic management withTOC to pursue 'harmony' and to build a 'well-muscled' operation. Through the company-wide TOC implementation, timelines of R&D projects were shortened aggressively, and delays of the schedule were recovered in close coordination and cooperation. The stocks of raw materials and products were kept at a low level by making win-win relationships with partners. Work itself became a learning environment and is helping our staff grow rapidly. The staff within and outside the company has begun to perform in harmony with each other. Although our challenge has just begun, we would like to share small successes which would lead to a large change in the pharmaceutical industry by this holistic approach.

 

Reid, R. (2005). Applying the TOC thinking processes (TP) in a healthcare organization. TOCICO International Conference: 3rd Annual Worldwide Gathering of TOC Professionals, Barcelona, Spain, Goldratt Marketing Group.

                James Holt made the presentation for Richard Reed.  He added his comments to the overheads.  The purposes of this presentation are to provide a framework for analysis of a system; background of the organization being studied; what to change: the UDEs, conflict clouds, core conflict cloud (CCC) and current reality tree (CRT); to what to change, the tabular analysis, strategic injection (Inj.) and future reality tree (FRT) and some management implications.  The case study is the Planned Parenthood of New Mexico (PPNM), which performs medical services including annual exams, sexually transmitted diseases (STD) testing and treatment, pregnancy testing, abortion, tubal ligation, vasectomy, etc. to 21,943 patients in 2004. They also provide educational services.  The presentation focuses on what to change and what to change to.  The goal, and four necessary conditions (quality medical services, safe and secure work environment, remain financially solvent and maintain PPFA accreditation) are discussed.  The prerequisites for each requirement are provided.  UDEs include: long wait times for some patients; clinic financial viability is threatened; many personnel (clinicians, support staff and clinic managers) are highly stressed; clinic staff turnover is higher than desired; some patients leave the clinics dissatisfied; and the physical appearance of some clinic facilities is shabby.  The storylines for the first five UDEs were converted to evaporating clouds (ECs) with assumptions then to a core conflict cloud with assumptions.  The CRT is provided. Injections to the core conflict cloud are provided.  James provided his assumptions: There is no way to improve the patient per hour rate; we cannot improve the patient show-up rate; the quality of service is equal to the time with the doctor; there is nothing we can do to improve our processes. Richard’s two strategic injections are: The PPNM clinics’ managers and clinicians align their personal as well as their professional goals with the new overall clinic goal of a balanced approach of delivering quality medical services while maintaining financial viability; and The PPNM clinics have a new appointment scheduling system that satisfies most needs of managers, clinicians, support staff, and patients alike.

 

Richards, R. and H. Robinson (2010). Short-duration-task critical chain project management. TOCICO International Conference: 8th Annual Worldwide Gathering of TOC Professionals, Las Vegas, NE, Goldratt Marketing Group.

                This presentation provides an introduction to the issues and solutions of short-duration-task critical chain project management (CCPM). Short-duration-task CCPM deals with projects in which a significant portion of the activities has durations of minutes or hours, and where status updates are needed on sub-day intervals. In addition, how to deal with the injection of new tasks or whole projects is addressed. Application areas include certain healthcare and manufacturing applications.

 

Ronen, B. and S. Pass (2011). Throughput enhancement in operating rooms:  Doing more with existing resources. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                The presentation describes the implementation of TOC and focused management principles to the management of operating rooms in hospitals and clinics in order to achieve enhanced Throughput and quality along with reduced lead times.  The presentation objectives are:  1. To present case studies that demonstrate the use of simple and practical tools to significantly increase throughput, reduce lead time and enhance quality in operating rooms, 2. To present the implementation process of TOC and focused management techniques, philosophy and tools in operating rooms. Material covered:  a) The implementation of TOC focusing steps and focused management tools for increasing throughput, enhancing quality, and reducing lead time; b) The implementation of the complete kit concept in operating rooms; c) Application of strategic concepts and tools to improve operating rooms' value; d) To present cases in which the methodology was applied resulting in double digit throughput improvement, while enhancing clinical quality.

 

Smits, P. (2009). Using critical chain project management to drive innovation in a general hospital. First European TOCICO Regional Conference, Amsterdam, The Netherlands, Goldratt Marketing Group.

                This presentation is about managing a 600-bed general hospital in The Netherlands on a day-to-day basis which is enough of a challenge as is. On top, in early 2008, the Maasstad Ziekenhuis hospital (www.maasstadziekenhuis.nl), turned out to have no less than 180 active projects! Active may be a bit of an overstatement, since some projects were well planned and managed; however, quite a few were unclear and often struggling or even dormant. In fact, we were facing all the well-known undesirable effects of project management: lead times of projects were long (often > 1 year); due date performance was poor (if a clear due date was defined at all); and task and project priorities were unclear.  Having viewed Eli Goldratt’s webcast on critical chain project management (CCPM), Maasstad Ziekenhuis – in cooperation with TOC Resultants (www.toc-resultants.com) decided to implement project management basics and CCPM on top of that.  Today, the hospital board is actively involved in selecting, planning and monitoring the execution of supra-departmental projects with the following results: the number of concurrent projects was reduced by 40%; average project lead time was reduced from > 1 year to < 8 months; and > 90 % of projects are finished on time, within scope and budget.  Currently, our focus is on securing the CCPM knowledge and processes in our organization and rolling CCPM out to intra-departmental projects. This initiative should be finished by the end of 2009.

 

Stratton, R. (2012). Buffer management in context. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

                This presentation explores the conceptual origins of buffer management in the context of TOC developments across make to order (MTO), engineer to order (ETO), make to availability (MTA) in manufacturing environments, in addition to more recent developements in the service sector. The presentation relates the buffer management concept to the seminal work of Shewhart (1931) and Ohno (1978) and discusses the practical and theoretical basis for extending the buffer management concept to enhance ‘lean’ developments, with particular reference to construction and healthcare management.

 

Stratton, R. (2013). Buffer management in context (Encore). TOCICO International Conference: 11th Annual Worldwide Gathering of TOC Professionals, Bad Nauheim, Germany, Theory of Constraints International Certification Organization.

                This presentation explores the conceptual origins of buffer management in the context of TOC developments across make to order, engineer to order, make to availability (MTO, ETO, MTA) manufacturing environments and more recently in the service sector. The presentation relates the buffer management concept to the seminal work of Shewhart (1931) and Ohno (1978) and discusses the practical and theoretical basis for extending the buffer management concept to enhance ‘lean’ developments, with particular reference to construction and healthcare management.

 

Stratton, R. and A. Knight (2010). Managing patient flow using time buffers. TOCICO International Conference: 8th Annual Worldwide Gathering of TOC Professionals, Las Vegas, NE, Goldratt Marketing Group.

                This presentation demonstrated how the common control functions underpinning simplified drum buffer rope (SDBR) and critical chain project management (CCPM) applications have been successfully applied to managing patient flow across health and social care. The presentation showed how this approach has been practically delivered together with an assessment of the current limitations. The presentation concludes by using the control functions to explain why attempts to use kanban control in the management of patient flow has not proved to be fruitful.

 

Stratton, R. M., et al. (2011). Panel discussion: Healthcare. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                This panel discussion provided an opportunity for the audience to ask questions related to individual presentations and questions to the panel members as a whole.  The initial discussions revolved around how we motivate the healthcare industry to implement TOC as the solution.   Alex Knight responded that doctors and nurses must be educated in TOC and provide the leadership to move TOC into healthcare.  Boaz Ronen believes that there is enough money in healthcare that TOC experts must move into healthcare to address the problems.  Gary Wadhwa, MD, believes that TOC must address the systemic conflict and that there are significant opportunities.  Lisa A. Ferguson, PhD, discussed that there are people around the world implementing TOC in healthcare.  She believes that we must find each other and move forward healthcare together.  Alex Knight has been implementing TOC in healthcare for 15 years.  He believes he has been building stability in processes.  His question is: How are we going to collaborate to work with people around the world?  We must build on generosity; get more results faster; build processes; etc.  It is the practical stuff that we need to do.  Dr. Ferguson indicated that she has a transformational S&T tree for hospitals and as does Alex Knight to collaborate on building and distributing the BOK.  A discussion of the combination of lean and six sigma and TOC evolved.  Two panelists have extensive experience in lean and six sigma; they indicated that the lean and six sigma implementation had little impact on the bottom line.   TOC does the job of achieving excellence faster than anything else, especially when used to integrate the key concepts of lean and six sigma; the power of TOC is its focus.

 

Uga, A. and Y. Kishira (2013). TOC for mental health in an organization with proof of concept in a major Japanese company. TOCICO International Conference: 11th Annual Worldwide Gathering of TOC Professionals, Bad Nauheim, Germany, Theory of Constraints International Certification Organization.

                Mental health issues are ubiquitous among various workplaces around the world; Japan is not an exception. Depression among employees has been recognized as a serious problem to be tackled in many major corporations. A significant number of 'self-help' books have been sold, while mental healthcare has become a growing concern in corporations in recent years. Mental health counselors have been taking in clients year after year, trying to resolve their issues on an individual basis. Yet, we have not seen a significant improvement. There must be a wrong assumption in dealing with the issue.

 

van Aart, M. A. (2009). Dealing with change in hospitals quickly and efficiently by means of horizontal leadership and TOC. First European TOCICO Regional Conference, Amsterdam, The Netherlands, Goldratt Marketing Group.

                Hospitals in The Netherlands and elsewhere in western society are faced with the question of how the human compassionate aspect of care can be combined with efficiency.  The environment includes the aging population, the rising demand for care, a looming staff shortage, the autonomy of the private specialist and the introduction of hospitals in the marketplace. In terms of healthcare, the answer to this problem lies in new organizational principles which are in line with ‘the process concept of organization’. This process concept sees organizations not so much as vertical structures with top-down and bottom-up forces, but rather as horizontal processes of value creation at different levels: client process, work process and management process. This change affects the nature of leadership in hospitals. While previously leadership was mostly embedded in the vertical power structure and dependent on position, it is now increasingly having a crossroad function, whereby the interests of many stakeholders have to be met. Today's leadership is moving towards a dialogic, dynamic organizational process in which a great deal of change is affected. How does this horizontal leadership work, and how can it be used in such a way that processes of change and renewal lead to meaningful results? And how can leadership qualities be developed that turn horizontal leadership into a fruitful process of human and organizational development?  In the period 2006 – 2009, the Maasstad Ziekenhuis hosptital in Rotterdam has tested these horizontal principles by means of the ’Methodology van de Evidential’ (Bekman) ’Theory of Constraints (TOC).’ This presentation described the outcomes of an action research project which formed part of that process - undertaken for an MSc dissertation on TOC Healthcare Management (Nottingham Trent University, UK). The project presented the research on the applications of these principles in the areas of operations (discharge, A&E, elective and outpatients), project management, finance and measurements, distribution and supply chain, marketing, sales and rapid response. The main focus of the project, which proved successful very quickly, was on the role of leadership and organizational development.

 

Wadhwa, G. (2007). Viable Vision: Achievable in healthcare. TOCICO International Conference: 5th Annual Worldwide Gathering of TOC Professionals, Las Vegas, NV, Goldratt Marketing Group.

                This presentation is a case study of Adirondack Oral and Maxillofacial Surgery clinic and their first (achieved by using TOC/lean/six sigma) and second (achieved by using the transformational strategy and tactic (S&T) tree and the decisive competitive edges of reliability and rapid response) Viable Vision.  Gary Wadhwa, MD, provided  his background in education, in business, operations, lean, six sigma, system dynamics, balanced scorecard, theory of constraints, etc. and how he implemented these tools at his practice to transform them from a break-even practice to making several million dollars in profit each year.  He discusses the use of throughput accounting and the transformational S&T tree to determine the impact of the product mix on profits and eventually how to free up enough capacity to also do 30-40% pro-bono work while still making high profits.

 

Wadhwa, G. (2009). Viable Vision for healthcare. 1st Annual North American Regional TOCICO Conference, Tacoma, WA, Goldratt Marketing Group.

                This presentation discussed a 10-step process for successfully implementing a Viable Vision (VV) for healthcare.  The steps are: 1. Delimit the boundaries of the system within our span of control but within the context of the larger system.  2. Agree upon the goal of the system. 3. Agree upon performance measurements for the system. 4. Develop a VV for the organization using the RRR (reliability and rapid response) transformational strategy and tactic (S&T) tree.  5.  Get an insight into your system and its current performance by using the systems dynamics model. 6. Identify gaps between the VV and current performance. Write these down as un-desirable effects (UDEs). 7.  Identify core conflicts and injections to the core conflicts that are causing the gaps or UDEs.  Use injections to change UDEs to DEs (desirable effects) and develop the future reality tree (FRT).  8. Validate injections on the system dynamics model to see the effect.  9.  Develop the prerequisite tree and the transition tree to implement the super injections on our road to the VV.  10.  Continuously improve system performance and measure with the system dynamics model.  This process was discussed in some detail based on its application to Adirondack Oral and Maxillofacial Surgery clinic.

 

Wadhwa, G. (2011). Can TOC fix our ailing healthcare system? TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

                Unlike for-profit organizations with a clear goal of improving economic value now and into the future, the stakeholders of a health system, such as government, private industry and healthcare providers have conflicting interests. All stakeholders in the healthcare system, including consumers of healthcare seem to agree that the current performance of the healthcare system is undesirable. In the US, the conflict between two opposing ways to solve the healthcare system-wide problems has reached the highest sociopolitical level with proposals, such as Obama care and Free Market healthcare. The theory of constraints thinking processes (TP) could provide win-win solutions to eliminate all of the current healthcare system’s un-desirable effects (UDEs). The TP could be utilized as an effective tool for aligning the conflicting positions to achieve one clear goal and the necessary conditions for a flourishing healthcare system: availability of affordable, high quality of care for all US citizens, and an environment that provides incentives for innovations and continuous improvements.

Wright, J. (2009). Sustaining healthcare improvement with TOC. 1st Annual North American Regional TOCICO Conference, Tacoma, WA, Goldratt Marketing Group.

Healthcare around the world is facing increasing capacity challenges and turning to the industrial world for help. TOC is gaining traction in the global healthcare market. What needs to be done to prepare the people who make up the majority of the ‘process units’ for the changes TOC can bring? How can our industrial applications sustain a process of ongoing improvement (POOGI) in a sector that is so important to all of us?