Saturday, February 21, 2015

Theory of Constraints in Healthcare

As I told you in one of my last posts, Bruce Nelson and I have been busy formatting the second edition of Epiphanized which will be published in the next month or two.  This has taken much of my time and I apologize to my loyal readers for being out of touch.

In todays posting I want to let everyone know about a fantastic book I just finished reading.  The title is Pride and Joy and is written by Alex Night.  I was going to write a review myself, but then I looked on Amazon at reviews already written and decided to post several of these because what I wanted to say is encapsulated in these reviews.  I will say, however, that this is one of the best books I have ever read and I'm not limiting that comment to healthcare, which is the subject matter in this book.  Here are several of the reviews from Amazon.

Alex Knight’s “Pride and Joy” is a business novel describing the use of theory of constraints (TOC) in the healthcare arena. “Pride and Joy” has the potential of doing to healthcare what Goldratt’s The Goal did to manufacturing and supply chain. That can only happen if the reader passes the book on and on to others. The story is about a 900 bed failing hospital in the UK. That setting is of no matter as many and much of the descriptions are identical to the US news accounts of the Veteran’s Administration hospitals’ catastrophes. Whether the hospital is for-profit, for-purpose, government, etc. the operations description is the same; chaos reigns 24 X 7. The healthcare environment is comprised of never-ending life-and-death decisions. Put these decisions in a dependent event and statistical fluctuations environment and the decision makers feel like ducks in a shooting gallery. Alex describes the environment and crisis situations where they could take place in the US, UK, Australia, Canada, etc. The problems are universal. Though the hospital environment is very complex the solutions to patient flow and focus are simple and effective. Alex with his two decades of healthcare experience has provided a silver bullet for each of the different flows in a major hospital. These solutions are described in detail in the form of a novel. Alex describes the unpredictability of emergency department demand and how to manage it effectively. He also describes how to use an assessment unit to buffer the flow to various wards in a hospital. He then describes how to plan, schedule and control out patient care. Each of these environments represents a distinct patient flow BUT each flow uses common resources of the hospital and healthcare supply chain. Each patient is unique. The situation is complex and impossible to many BUT as anyone in TOC knows the more complex the situation the simpler the solution. Alex proves this to be correct. Once you read each solution; your response should be: That’s brilliant! You end up making this statement a number of times throughout the book. The story is very interesting and if one is knowledgeable in theory of constraints, he or she would realize that Alex has developed some unique solutions to manage the patient streams. This novel should be required reading for everyone in healthcare. It provides instructions on how to get more patients through the hospital quicker with higher quality and less resources (without exhausting them) and bring pride and joy to all healthcare stakeholders involved. In my opinion, this book may provide the solution to implementing universal healthcare without bankrupting the country for the US.

3 of 3 people found the following review helpful
By Gerald I. Kendall on July 3, 2014
This is the best book on hospital administration and patient care I've ever read. The cost-centric approach to running hospitals has led to one disaster after another. Everyone working on the front lines of a hospital knows it. But until the conflict between cost reduction and patient care was clearly explained in Alex Knight's book, there seemed to be no way out. Knight painstakingly shows how a focus on patient flow reduces the time it takes to see and treat patients in a hospital, and consequently increases hospital revenues. Based on real life experiences in multiple countries, Pride and Joy is a must read for anyone involved in any aspect of delivering patient care in a hospital environment.
The combination of challenges of managing hospitals, surgeries, multiple practitioner specialties, scheduling dilemmas and patient behaviors make for a very complex system. What Knight proves in this book is that, inside this very complex system, there exists inherent simplicity. The book enables a much better understanding of how current methods of scheduling both diagnostics and surgery lead to poor use of all the resources in the system. The crises of daily bed management only compound the administration nightmare.

About a decade ago, I heard a presentation from one of the hospital administrators who had applied the system's approach explained in Pride and Joy. I was astounded at how much change could be accomplished within a few months, how a hospital could move from less than 70% of patients meeting target discharge dates to almost 100%, without adding staff and without additional overtime or "working harder".

This book is a prescription for the healthy administration of any hospital, anywhere in the world. It is a great achievement to see science applied not just to medicine, but to management!
I read Pride & Joy with high expectations. First, experience has shown me that the best system and powerful principles to make improvements in any organization are coming from TOC - Theory of Constraints. Second, I had the fortune of working along side Dr. Goldratt for some years and finally, and I have seen what Alex Knight is capable of doing when in the lead. The approach taken and presented in the book, provides clarity. This to me is the foremost the key important contribution of Alex's work. He has delivered and entertaining story with explanations that are solidly linked to reality. It is not only in countries of socialized medicine systems or hybrid approaches to the healthcare problem that are suffering the effects of raising costs and the deterioration of efficacy, effectiveness and at the end productivity of the service. The better our expectation of life, the worse the probability that we will have to deal with a catastrophic event, that will be poorly tended to by our health systems. The problems of flow and patients, with the problems of synchronizing capacity of the hospitals, services, specialties, all hinge in the understanding of how to ensure that problems are diagnosed quickly and rightly, then that the assignment of patients to the right treatment in the right timing with the proper care. Understanding that the system in a Hospital and beyond in a Health Care system, is just that, a system...where the things that determine the success and the flow is the realization that what drives the system are not only the actions, but the interactions.

My most favorite counter intuitive solution described is when the KEY most expert resources, the most experienced doctors are assigned in the front lines to ensure the proper diagnosis is made. When you complement this process with managing the capacity of the operating theaters, the synchronization with the test labs and the supporting staff, the outcome is productivity...More patients correctly treated well, released faster.

I hope Alex's book provide a vehicle to open the minds of the people that must then to this system before is too late. A new refreshing look at what is possible is needed, and this is provided when one looks at the Health Services Industry as a system.

5.0 out of 5 stars Great healthcare management book if you're tired of the status quo, September 11, 2014

This review is from: Pride and Joy (Paperback)

I thought this was a great book that provided a fresh look at healthcare administration. I'm a clinic manager of multiple primary and urgent care clinics, and I constantly hear how "we need more staff," and "we're too busy". This is true because we continue to rely on common practice rather than thinking about common sense methods of improvement.

This book gives a great refresher on some very important management, production, and flow principles taught in "The Goal," which you should also read, but Pride and Joy is geared towards multiple different healthcare environments, including the Emergency Department, inpatient floors, and outpatient clinics. This book gave me a great start on how to think about implementing some basic principles to improve the flow through my clinics, with the goal of bringing "pride and joy" back to the healthcare workplace.

I am already implementing a buffer system in my urgent care clinics to ensure there are always patients ready for the doctors to see, and am working towards identifying which resources are causing the most delay to patient flow most frequently, using techniques illustrated in this book. Our patient volumes have recently gone up significantly, but thanks to our initial efforts based on principles from this book, we have maintained our flow and patient satisfaction continues to rise.

If you're a healthcare worker and are tired of cutting costs, layoffs, and everything else that makes you pull your hair out, you'll definitely enjoy this book.

Bob Sproull

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