Using TOC in Healthcare

Based upon the preliminary results of Bruce Nelson and my new book, The Critical Methodology for Theory of Constraints, Lean and Six Sigma (TLS), the interest level for using TOC in the healthcare field seems to be quite high.  I had over 100 requests for a free copy of Epiphanized and they're still coming.  For those of you who don't know, our new book was released yesterday and it looks to be doing very well, so Bruce and I thank you.

This morning, I woke up to find an absolutely wonderful article written by James Cox III, PhD, Timothy M. Robinson, MD and Wendy Maxwell.  The title of the article is, Applying "Theory of Constraints" to Solve Your Practice's Most Vexing Problem.  It's an article about how basic TOC was used to improve a medical practice significantly and cited one example of taking one medical practice from break even to + $3.5 million per year without spending much money at all.  Here is a link to this article and I encourage everyone to read it:

http://www.aafp.org/fpm/2014/0900/p18.pdf

Bob Sproull

An Update on Our New Book

Yesterday I received a request to post something about our new book, Focus and Leverage: The Critical Methodology for Theory of Constraints, Lean and Six Sigma (TLS).  So in today’s post I will do just that.  I might add that Bruce Nelson was the lead on this book and in my opinion, Bruce did an outstanding job of putting this book together.
 

This book is written as a sequel to the second edition, Epiphanized: Unifying the Theory of Constraints, Lean and Six-Sigma. This story focuses on the continuing adventures of Connor Jackson, Joe Pecci, Sam Henderson, and Becky Chen (Jackson). In the sequel these characters apply their common sense approach and knowledge of problem solving and process improvement by getting involved in two new industries. First, is a company named Aviation Dynamics. They are a Maintenance, Repair and Overhaul (MRO) facility. The company is suffering from poor on-time due date performance, and a new backlog of work that is putting extreme pressure on management and the employees. Because of their bad performance they are fearful of losing some of the new work, which is up for contract renewal. Because of the past performance some customers aren’t happy. Second, some of the characters get involved with Saint Luke’s hospital after a less than perfect visit to the ER. The team presents a strategy to help the hospital reduce and manage the ever increasing wait times for hospital services, especially in the hospital emergency room.

 

To quote Bruce, from our Preface, “While you might think that these two industries are at opposite ends of the spectrum, both are plagued by the same types of common problems.  Both have significant wait time problems defined by delayed completion of services and delivery of products, and both are hearing very negative comments from their customers.  These problems are all due in part to their inability to analyze the system and figure out what to change.  Both have “outdated thinking and ideas” about systems management and flow.  Both have previously applied the methods and concepts from Lean and Six Sigma, but have had very little sustained improvement to show for their efforts.  When they are exposed to the TLS methodology, good things start to happen at both organizations.”

 

“We hope, with this book, we are able to show the reader the necessary systems thinking best suited to find and analyze what the system issues really are and the consequences to the system for not resolving those issues. In the sequel, we have expanded on two concepts first introduced in the appendix section, second edition of Epiphanized. The first concept is the discussion and application of the Interference Diagram (ID) and Intermediate Objective (IO) Simplified Strategy, or ID/IO Simplified Strategy. The ID/IO Simplified Strategy is a product of combining several TOC thinking process tools into a single thinking tool. The ID/IO is a comprehensive and combined approach used to discover and analyze prevalent system issues and in doing so, much less time is required to achieve the desired results. The second concept is the inclusion, discussion and application for the Multiple-Drum-Buffer-Rope (M-DBR) concept and how it applies to both of these industry systems. Also, in the sequel we introduce the reader to the TLS methodology cycles. The first cycle discusses which steps to take. The second cycle discusses how to take those steps. And, the third cycles describes what the expected results should be.”

 

“We wish you, the reader, an enhanced understanding and success on your continuous improvement journey. We truly believe that if you follow the guidelines and methods we have laid out, your journey will be much easier and hopefully, more profitable.”

 

We also have included a piece on how the hospital improvement team, with Connor’s guidance was able to significantly reduce one of the key metrics in hospitals today, Door to Balloon Time.  This metric is associated with stemi-type heart attacks where time is of the essence.  We all know about how difficult wait times are in hospitals, so we’ve given the readers a glimpse of how to reduce them.

That’s a summary of some of the things we have presented in this book and we’re both very excited about how it will be received, especially by our healthcare readers.  If you have friends who work in either the healthcare field or the MRO industry, we would very much appreciate it if you would let them know about our book.

 

Happy Holidays from Bruce and me,

Bob Sproull

New Book Announcement: A Sequel to Epiphanized

Bruce Nelson and I are proud to announce the upcoming release of our long-awaited sequel to Epiphanized – Unifying Theory of Constraints, Lean and Six Sigma, 2^nd Edition. The book is scheduled to be released on December 13^th and we are both excited about it.  The title is: Focus and Leverage: The Critical Methodology for Theory of Constraints, Lean and Six Sigma (TLS).

The primary characters remain the same, but this time the storyline features two different industries: Maintenance, Repair, and Overhaul (MRO) and Healthcare (hospital) environments. 
This book expands and highlights the two improvement methods first introduced in the appendix section of Epiphanized: the Interference Diagram (ID)/Intermediate Objectives (IO) map (ID/IO Simplified Strategy) and Multiple-Drum-Buffer-Rope (M-DBR).

Both of these innovative methods are the result of some much-focused thinking that allows for multiple improvement methods, and steps, to be combined into a single thinking process tool. This groundbreaking new method is designed to save time and money and allows faster and better results to be achieved.

The two storylines move the reader through the necessary system analysis, problem identification, and solution implementation. The novel format aids in presenting several realistic situational discussions as well as a multitude of graphs and figures to explain the step-by-step process for success.  The storyline of this book weaves some well-known and some not-so-well-known thinking tools into the problem-solving sphere to provide you with an understanding of how to first discover and then overcome issues not readily known or expected at the start of any project.

Bruce and I sent our book to several well-respected improvement experts to get their take on our new book and here is what they had to say in their Editorial Reviews:

 

"This book, Focus and Leverage, discusses the powerful results that can be obtained when observing and analyzing a business from a holistic, systemic point of view, and then explains how Lean-Six Sigma initiatives are substantially improved with the system focusing mechanism, provided by Theory of Constraints (TOC). ... This book defines two very practical and robust applications that I consider the most powerful planning tool available today: the Interference Diagram (ID) combined with the Intermediate Objective (IO) map, or the ID/IO simplified strategy concept. ... In the book, Bruce Nelson and Bob Sproull use the business situation from two seemingly different business environments, and yet illustrate the commonality between the two. First is the situation from a Maintenance, Repair and Overhaul (MRO) facility, and second is the situation of a Hospital Emergency Room. Using this innovative method they show how significant leaps in business performance can be obtained in a very short period of time.

This book also introduces an interesting and innovative concept for system planning and scheduling. It is a scheduling concept that the authors refer to as M-DBR (Multiple-Drum-Buffer-Rope), which is a valid refinement of the traditional DBR proposed by TOC."
―David Poveda, M.A.Sc., CDDP Instructor; Owner & Director, FLOWING Consultoria

"Wow… what a great book and sequel to Epiphanized. A detailed, step-by-step guide to problem solving in any industry, not only covering the technical problems a company may face while running an improvement project and the mechanics of improvement, but also detailing the human and cultural changes a company will need to address when undertaking the journey to improvement. I was there… while reading the book, I felt as though you put me in the story working side by side with Conner, Sam and Joe as they took Aviation Dynamics and Saint Luke’s from near failure to success. I especially liked seeing this book written from Conner's perspective and seeing his genius come out in the story while guiding Sam, Joe and their clients to succeed in their efforts. Bottom line is that this is a great how-to book with a fantastic real life story line."
―Mark Rader, Lean Six Sigma Master Blackbelt

"Some authors write revolutionary business management books that question industry practices and propose a truly different new and convincing approach. That is true of Bruce Nelson and Bob Sproull’s books. Some books are so enticing that you are torn between finishing the book and starting to apply the ideas it presents. This is such a book. ... The authors are passionate and experienced ‘changers’ or ‘improvers.’ You will sense this throughout the novel. ... I have been mixing Lean, TOC, and Six Sigma together for more than 25 years. I know it works; it works well. Don’t just buy this book … read it, think about it, adapt it to your context, and try to apply at least some of it."
―Philip Marris, CEO Marris Consulting, Paris, France, Founder and Administrator of the LinkedIn "TLS―TOC, Lean & Six Sigma" Group

 

For those of you who don’t know us, here is a brief summary of who we are.  Bruce took the lead on this book and worked his magic to create a very, very good book.

Bruce Nelson is an independent consultant (co-owner, Focus and Leverage Consulting) specializing in the enhanced profitability of organizations in a variety of business segments. Bruce received his BS degree from Weber State University, Ogden, Utah. In addition, he is board certified by the Theory of Constraints International Certification Organizations in the TOC Thinking Processes, TOC Operations Management, and TOC Project Management and is a certified Jonah, Jonah’s Jonah, and Academic Jonah. Bruce is an internationally recognized professional in Constraints Management and Systems Analysis.

Bruce has 33 years combined experience as an educator, executive, and consultant with numerous Fortune 500 companies and a number of international organizations and companies. Bruce is the coauthor of two books: Epiphanized: A Novel on Unifying Theory of Constraints, Lean, and Six Sigma, Second Edition (coauthored with Bob Sproull, Taylor & Francis) and Epiphanized: Integrating Theory of Constraints, Lean and Six Sigma (North River Press). He is also a frequent contributor to my Focus and Leverage blog site. (http://focusandleverage.blogspot.com).

Bob Sproull is an independent consultant who, along with Bruce Nelson, owns and operates Focus and Leverage Consulting, a Management Consulting firm specializing in improving the profitability of organizations from all business sectors. Bob is a certified Lean Six Sigma Master Black Belt, a Theory of Constraints Jonah, and an experienced manufacturing executive who has served as Vice President of Quality, Engineering, and Continuous Improvement for two different manufacturing companies. He has an extensive consulting background in manufacturing, healthcare, and MRO and focuses on teaching companies how to maximize their profitability through an integrated Theory of Constraints, Lean and Six Sigma (TLS) improvement methodology.

Bob is an internationally known speaker and is the author of four books: Second Edition Epiphanized: Integrating Theory of Constraints, Lean and Six Sigma (co-authored with Bruce Nelson 2015, Taylor & Francis); Epiphanized: Integrating Theory of Constraints, Lean and Six Sigma (coauthored with Bruce Nelson, North River Press); The Ultimate Improvement Cycle―Maximizing Profits Through the Integration of Lean, Six Sigma and the Theory of Constraints (Taylor and Francis); Process Problem Solving―A Guide for Maintenance and Operations Teams (Productivity Press).

Bruce and I hope you enjoy our sequel and that your holiday season is filled with joy and happiness.

Bob Sproull