|
A Guide to Implementing the
Theory of Constraints (TOC) |
|||||
|
No Delay Emergency Department – Not On-Line I have made
a conscious decision not to put this solution on-line, and that certainly is
at odds with the rest of the site but the exception stands. A close colleague who is well aware of the
content thought that I had finally come to my senses; “the content is priceless
and you were going to give it away!”
But that isn’t my reasoning. My
reasoning is that when something is free, it is very rarely truly
appreciated. It is too easy for
healthcare management and clinicians to read the solution, actively agree with
it, and then do nothing. It is the “do nothing” part that I have so much
trouble with. To
write a cogent solution, with all of its underlying logic marked off, is
orders of magnitude more difficult than “just doing it” based upon knowledge,
intuition, and experience. There is
just one “writer” who must meet the expectations of many critics and that can
only happen by addressing the underlying fundamental issues. This has taken longer, and with more
effort, than I could have first imagined is possible. The outcome has to be that something is
done, rather that “do nothing.” In
other “free market” commercial enterprises to which the rest of the website
applies to, the customers or consumers at least have some freedom of choice
between suppliers. Whether the
suppliers choose to be more efficient and effective in supplying value really
is up to them, and the customers can play an active part by way of their
consider support or lack thereof. Of
course this is a bit of a fantasy about the free market, and I prefer to
subscribe to the notion that the free market in fact is only truly effective
in the very limited act of culling-off the very ineffective, and even then
that can be somewhat circumscribed if you can argue that you are “too big to
fail.” Public
service healthcare is different, and it is different because there is, in
general, a monopoly supplier. This
shouldn’t be a problem of itself.
Indeed it should be the maximal solution, the cost of the “risk” is
spread over the entire population. The
cost-per-head should be the lowest due to economy of scale and economy of
scope (large populations can support one or two very specialized specialists
for example). However, by virtue of
monopoly, the patient is locked out of this process and can’t vote with their
feet. And for all the discussion about
Lean in healthcare, the patient seems to be the very last person to be asked
about “value.” In my
country we “sample” every discharged patient for their experience in hospital
(did you like the food, were the staff friendly?) and we call this “quality”
but it is a perversion of statistics and we are singularly careful never to
ask patients waiting at home, depressed and in chronic pain, what they think
of the situation. Is this a travesty
or not? I happen to think that it is. The
people who can address this are, together,
the management and the clinicians. The
patients can demand action, but only the management and the clinicians
together can put this into effect. So
the question is, what do we do for emergency department then? Let’s have a look. The
constraint in an emergency department ought to be lack of patients. So seldom is this now achieved that we have
probably forgotten what it was once like.
However, it need not be like this.
If we were to look at the current constraints in emergency department
we would probably find that they are many and varied, and changing all the
time. But this is misleading. There are a few, maybe just one or two
which are prime candidates at any one time, and which must be addressed and
removed. Of course this will uncover
further issues that must also be addressed and removed, but suddenly we have
a process of on-going improvement. What is
missing at the moment are some very basic “tricks of the trade” of the
operations specialist that can bring order to chaos in a very short
time. I guess the question is whether
you are really “up for it” or not?
Which is it? The
solution is here, but it is locked. This Webpage Copyright © 2008-2009
by Dr K. J. Youngman |