Fifteen year progress report on achieving breakthroughs in health and social care using the Theory of Constraints

Transcription

1 Fifteen year progress report on achieving breakthroughs in health and social care using the Theory of Constraints Presented By: Alex Knight, QFI Consulting LLP Date: June TOCICO. All rights reserved.

2 Overview History of progress to date Theory in practice and practice in theory Identifying and explaining the inherent simplicity Lessons learnt Opening a new market Building the detailed solutions Building the supporting software Creating the consulting capability What next for Health and Social Care? Implications for opening other industries 2

3 History of progress to date The starting point Yes, but will it ever work in the health environment? Over 30 successful implementations in the UK, Holland, Australia and USA. To-date penetrated less than 10% of the UK acute health market. Now have proven applications in marketing, sales, emergency and planned care (emergency, discharge, operating theatres and outpatients) New research and implementations underway in mental health care and the wider social care environment 3

4 History of progress to date In times of fundamental transition, the first substantial actions of any major initiative must produce immediate substantial benefits. The subsequent actions must continue to demonstrate further substantial and sustainable benefits. When we started it took us 18 months to produce immediate substantial benefits. The same project today will deliver bigger results in 8 weeks or less. Some implementations have now sustained and built on these improvements for more than 7 years. 4

5 Results Visit for case studies and results sheets 5

6 Theory in practice and practice in theory Identifying and explaining the inherent simplicity TOCICO. All rights reserved.

7 The Emergency Stream Community Hospitals Social Services Surgical Specialist Medical Theatre Assessment KEY Beds Outpatient Schedule Emergency Department Other nonbottleneck resources: Minors GP Referrals Majors 7

8 The Planned Care Stream Community Hospitals Social Services Surgical Specialist Theatre Schedule KEY Beds Outpatient Schedule Other nonbottleneck resources: GP Referrals 8

9 The System Community Hospitals Social Services Surgical Specialist Medical Theatre Assessment KEY Beds Outpatient Schedule Emergency Department Other nonbottleneck resources: GP Referrals Minors GP Referrals Majors 9

10 How to solve such a seemingly complex problem TOCICO. All rights reserved.

11 To achieve a system-wide breakthrough requires answers to these questions Of all the patients I could work on next, which one should I work on next? Of all the things I could change: Where are the few places in the whole system I need to change? What are the necessary actions to take in these few key places? If I take these actions, what will be the impact on the performance of the whole system and over what timescale? If leave things as they are what will be the outcome? 11

12 The assumptions upon which the analysis can be conducted Dissect the system into manageable parts Dissect the system into distinctive pathways Dissect the system by resource type 12

13 Dissect the system into manageable parts Outpatient Schedule What are the drawbacks? Assessment Miss-synchronisation, silo mentality and local optima conflicts, to name a few. Emergency Department LOCAL OPTIMA DO NOT ADD UP TO GLOBAL OPTIMUM 13

14 Dissect the system into distinct pathways Community Hospitals Social Services Surgical Specialist Medical KEY Theatre Assessment Beds Other nonbottleneck resources: Outpatient Schedule Emergency Department GP Referrals Minors GP Referrals Majors 14

15 Dissect the system into distinct pathways Community Hospitals Social Services Surgical Specialist Medical KEY Theatre Assessment Beds Outpatient Schedule Emergency Department Other nonbottleneck resources: GP Referrals Minors GP Referrals Majors 15

16 What are the problems with this approach? Key to success is improving the flow through the whole system Key resources that impact the flow of the whole system often work across many streams of the flow Improving any one stream of flow will not improve the whole system and can actually damage the flow through the whole system 16

17 Dissect the system by resource type Community Hospitals Social Services Surgical Specialist Medical KEY Theatre Assessment Beds Outpatient Schedule Emergency Department Other nonbottleneck resources: GP Referrals Minors GP Referrals Majors 17

18 What are the problems with this approach? Most resources are non-bottlenecks Improving non-bottlenecks does not improve the flow through the whole system Saving money on non-bottleneck resources by reducing capacity often creates a system of wandering bottlenecks, which can become a nightmare to manage 18

19 Underpinning assumption: the more complex the system the more inherent simplicity that exists Identifying the inherent simplicity Set a clinically-based treatment time for all patients Sequence all resources to meet the clinically-based treatment time Identify which resource is most often causing the most time delay to the most patients across the whole system? Focus ALL improvement efforts on this key resource Initiate a process of focused system-wide improvement 19

20 Time Buffers Patient 1 MDT Clinically based Planned Discharge Date Admission date This patient is in the red and the blue resource is the cause of the patient being in the red 20

21 MDT PDD 1 Patient 1 Admission date Question: Which resource is most often causing the most time delay to the most patients across the whole system? MDT PDD 2 Patient 2 Admission date Patient 3 Patient 4 Patient 5 Admission date Admission date MDT MDT MDT PDD 4 PDD 3 PDD 5 Answer: The blue resource is causing the most delay across the most patients! Would you like to know the size of the delayed days and which period of the week or year this is at its worse? By the way the blue department is already on the case and is following the updated sequence to overcome these delays. The Continuous Improvement teams are looking into offloading the blue and training up the red to avoid this problem in the future. Admission date 21

22 Buffer Community Hospitals Social Services Buffer Buffer Buffer Specialist Discharge Surgical Discharge Medical Discharge Theatre drum schedule Buffer Theatre Schedule Buffer Assessment KEY Beds Buffer Outpatient Schedule Buffer Emergency Department Other nonbottleneck resources: GP Referrals Minors GP Referrals Majors 22

23 OUTCOMES Every patient has a plan and the status of that plan is clear to everyone during the patient journey. Every task manager has a clear priority list and is clear on the impact they are having on every patients journey. If a patient s journey is being delayed it is clear who is the primary cause of the delay and what recovery actions are necessary. At all times clinicians and managers know the size of the total delays across the system and the impact on current and future performance. Improvement efforts can be focussed on the resource causing the most delay across the most patients A sustainable breakthrough is quickly and safely achieved. 23

24 Lessons learnt opening a new market Results matter: we adopt a whatever it takes approach with each new project. Success has been our key ingredient to our marketing effort. Peer to peer referral works exceptionally well in this professionally dominated environment. We have used the Solution For Sales approach as the core of our sales efforts. We have stayed below the radar until we had irrefutable evidence of success and now we are going for it! 24

25 Lessons learnt building the detailed solutions Stick to the TOC Theory even when initially it does not appear to fit. Use the How to evaluate a good idea approach to constantly examine outcomes in reality against your predictions. Do not incorporate inappropriate elements to the solution just to keep the client happy/onboard. 25

26 Lessons learnt building the supporting software Follow the six questions in Necessary but not sufficient. This book is a goldmine and we would never have achieved what we have if we had not followed it. Develop a blueprint of the proposed direction of solution first and only then develop software. Almost all the effort is in ensuring the specification is correct. Do not incorporate inappropriate elements to the solution just to keep the client or your own staff happy/onboard. Integrate as lightly as possible Be very patient! 26

27 Lessons learnt creating the consulting capability My conclusion is that entering a new industry for a professional TOC consultant can prove to be just as difficult as for an industry expert learning to apply TOC in their industry for the first time. Dogma is the devil incarnated. Look in the mirror before you choose to enter a new industry. 27

28 What next for Health and Social Care? Complete our work on key ingredients of success: Solution development Software development Our own marketing development Consulting capability development Build irrefutable evidence of success in more countries Document and publish 28

29 Implications for opening up other industries My challenge to this community is to take the lessons learnt in health and social care systems and apply to other new industries Our organisation is also developing similar breakthroughs in both the legal and financial services industry It is time to achieve breakthroughs in many other industries using TOC 29

30 THANK YOU QUESTIONS 30