Theory of Constraints Healthcare Logic Matters Objections

A Guide to Implementing the Theory of Constraints (TOC)
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Objections/Obstacles

There are 4 major objections or obstacles that will be put forward in response to developing the generic cloud, or any of the symptomatic clouds that fall out of it, when there are people don’t fully understand the nature of the solution.

Here is our generic cloud once again, or at least the A-B-C part of it.

Underlying the B entity is our negative fantasy;

Into this construct people who don’t understand the solution, or who do understand it and fear its coming about, will slot in a series of D-D’ conflicts. The objection or obstacle to moving forward is always verbalized as the D.

Here is the first.

Let’s look at this and the underlying assumptions.

Looking at C-D’ side, basically in order to ensure appropriate treatment we are going to have to do things differently, and in order to do things differently we are going to have to make time available to learn these new things. Learning new things that ultimately makes us more effective does not jeopardize our B of protecting funding.

However, if people are uncomfortable it is quite clear that they can invoke the D of “not make time available” as an excuse for inaction. Under less than full leadership and understanding people can and do argue that in order to protect funding we must not make time available because to do so would waste critical time available and so would lead to cost ballooning. We will investigate how people see this as allowing costs to balloon in a moment.

However, it should be clear that the C of ensuring appropriate treatment (by learning something new) is perfectly jeopardized by not making time available.

This brings us to our second set of D-D’ conflicts.

Let’s have look.

Having “don’t” on the lower D’ may not seem correct at first, but it is. Let’s check why this is. Looking at D we can see that if we control everything everywhere (all of the time) then we will be able to protect funding. After all if anything untoward were to happen, we would see it in the measurements for sure – right? This is what management is all about, is it not? But we know that controlling everything everywhere is part of the problem not part of the solution. All the heartache that we put up with is that even after all the effort expended controlling everything we still don’t seem to be able to protect the available funds, we end up needing more and more funding, not less.

OK, how about the other side?. Don’t control everything is the future state that we want to be in when we have our finger on the pulse so to speak. A future where just one or two key measures will tell us in an instant where we are, and moreover, ensure that we can provide appropriate treatment.

When people claim that they can’t make time, you can be sure that they are telling the truth, and the reason is that they are too damn busy trying to control everything in the process everywhere. The alternative of having spare time because you only control what is critical to the process is at this point in time a foreign concept. If we wrote in D’ “control some things, some places all of the time,” we could remove the “don’t” but the “don’t makes the fact that it is opposite more clear.

Summing up; the C of ensuring appropriate treatment is indeed jeopardized by controlling everything everywhere.

Now let’s go a little deeper into the problem.

I mentioned that even when people do understand the solution, they may fear its coming. Why is this?

Let’s have a look at the next conflict. This one is hardly likely to be verbalized but it is there nonetheless.

Having no time to spare as a consequence of controlling everything everywhere is for many people an intimate part of their current sense of identity and they are not about to challenge that, not if they don’t understand the solution, or indeed if that solution poses a threat to their current standing within their organization.

If a person is comfortable with the solution they will be comfortable with the challenge to their current identity because they can see an even stronger identity as a consequence of the improvements, and this enables us to ensure the C of appropriate treatment. Not challenging our current sense of identity will certainly jeopardize the C of ensuring appropriate treatment.

Do you see how important it is to have the next stone to step to before we have to take the step? If the stone isn’t there, no matter of faith is going to make people step forward.

OK, let’s tidy this up, there is one further set of D-D’ conflicts.

Let’s have a look at these.

This is more for completion than anything else, and is more for face to face work with a group in facilitation, but let’s still have a quick look.

I have used the example before of my own value of “simplicity.” For me this is a “toward” value, I consciously seek to embrace simplicity. I have certainly seen many people espouse similar ideals but scratch the surface and you will find the counter value is stronger and people are in reality seeking to escape the counter value. In this case the counter value is “complexity” and people are seeking to avoid or escape complexity.

The trouble is the more we avoid it, the more we invite it in. Do you see that; having no time, having to control everything everywhere (all of the time), not challenging our current sense of identity, and relying upon our “away from” values are all part of the same problem. These are all reasons why we continue to put up with what we don’t want.

The only reason that this could be is that we don’t understand the solution. The cure is to go back until the people concerned do understand the solution.

People will verbalize; “we don’t have time” with ease. They are much less likely to verbalize that we must control everything everywhere all of the time, but that won’t be far from their conscious knowledge. However, the notion of having to challenge our own sense of identity and more importantly our operating values will be buried deep within the subconscious and we have to help people to find these.

The simpler we can make the transfer of knowledge, the less likely we are to encounter these problems. That is the art of good facilitation.

Summary

People step out to do their best. We are supplying them with a new solution that might at first seem quite foreign. No matter how simple we make the explicit new “know-why” the old tacit “know-how” may step in and block true understanding. The less explicit and more tacit we make the knowledge transfer the more likely we are to be successful. However, every time we come across an obstacle that says “we don’t have enough time” we can be sure that the solution has not been understood completely or fully and we must step back and work out where to pick the solution up from.