This is the final posting on our clinic case study on how to use a hybrid version of the Thinking Process' Future Reality Tree (FRT). As I say in this posting, I don't recommend this method, but when time is a factor, this hybrid version can work effectively to create an improvement action plan. Traditionally, after creating a Current Reality Tree, one would then perform a full Thinking Process (TP) analysis using all of the TP trees, but because time was a factor, I developed what I am referring to as a "hybrid" Future Reality Tree (FRT). The FRT essentially transforms all of the Undesirable Effects (UDE’s) from the CRT into Desirable Effects (DE’s). In other words, we simply state the opposite condition expressed in the UDE’s to create the DE’s.
The figure above is the FRT that was created. In order to convert the UDE’s to DE’s in the FRT, it is necessary to insert injections or improvement ideas that will transform the UDE’s to DE’s. The injections for this hybrid FRT are color-coded in green. Please note that the “bow-tie-like symbols” used in the FRT are intended to demonstrate the magnitudinal effects of the injections. Theoretically, if we were to implement the injections, as stated in the FRT, most of the UDE’s would disappear and patient wait times could be significantly reduced.
I would like to be able to tell you that all of the injections were implemented, but such was not the case. And to be honest, I’m not certain that they will ever be. One of the problems this team faced was the lack of involvement of the Attending Physicians and the clinic leadership which are critical factors for the success of this or any improvement initiative. My intention in this posting was to simply demonstrate how the CRT and hybrid FRT could be used to develop an effective improvement plan.
The Constraints Management Thinking Process (TP) tools truly are an effective way to demonstrate and highlight the changes that must be made in order to achieve the desired end-state. The important point here is that it is not always necessary to follow the rigors of a full TP analysis. I don’t recommend the methodology I used, but when time is a factor, I recommend using some kind of shortened version. I have always believed that as improvement agents we should learn tools and make them our own as long as the end product is useful.
There is no doubt that the world of healthcare is very complicated and full of uncertainty. In addition, conflicts permeate throughout each and every healthcare facility I have worked with. However, just because healthcare organizations are complicated and complex, does not translate that there are not simple solutions. In fact, in the example I presented in this posting, the proposed solutions do not require expensive equipment or hiring an army of new people. The fact is, complex problems usually always require simple solutions.
Three key points to consider when attempting to improve a seemingly difficult problem such as excessive patient wait times are:
1. Identify and focus on the core problem or problems. Healthcare organizations (or any organization for that matter) will always have a multitude of problems or undesirable effects (UDE’s). I have seen many organizations attempting to solve all of these UDE’s one-by-one, when in reality they were simply working on the symptoms of a larger core problem. If the true core problem(s) is/are correctly identified and the effort to correct them is done so in a focused way, then many or most of the symptoms will disappear simply because these UDE’s are usually always connected through sufficiency type logic (“if-then” relationships).
2. By identifying the relatively few constraints that exist within any organization will always result in significantly less effort for the resources charged with improving the organization’s flow. It matters not whether we’re working on the flow patients, products or services, the fact of the matter is that the constraint controls the output rate of any process or system.
3. Many of the problems we observe within an organization such as a healthcare facility are the direct result of policies that were probably put in place as a result of a previous corrective action. Many of these policies are probably outdated now and should be eliminated.