Alex Knight presented the opening keynote of the 2014 TOC ICO conference on the topic of Improving global healthcare with the Theory of Constraints. Knight has been involved in TOC for Healthcare for many years, and he has a new book on the topic, Pride and Joy, and the discussion followed on the path of the book. The talk used the familiar TOC setup of describing the situation (What to Change), suggesting a direction of the solution (To What to Change), and how to make that happen (How to Cause the Change).
The healthcare scenario is very familiar. It's in the news, and dire predictions come at us all the time. Almost every country can bring up statistics that show the spending on healthcare is growing, whether measured on a total spend, per capita, or a fraction of GDP. Knight talked about the familiar paths that countries address from the perspective of TOC: what are the variable costs, and what are the fixed costs in a hospital. Variable costs comprise about 20%, and a large part of this is the cost of drugs. So, what do we see? Countries hammering on pharmaceutical companies or making difficult decisions about the effectiveness of drugs and whether to offer them. Why not focus on the fixed costs instead? The largest component of this is staffing expense, and many organizations are focusing on these areas: reducing staff or focusing on making them "work harder."
Neither of these approaches seem to be working. And they create a lot of animosity and don't work in a win-win environment. Knight suggests there is possibly a different approach - and a different way of thinking about the concept of successful care. What if we focused on the quality of care and the timeliness of care? Have there been efforts that have been successful on these factors? Have those results connected to the productivity numbers? There are results, but Knight left it for the audience to pull them from his presentation or provide new examples.
So, if quality and timeliness of care is the direction, how to make it happen from a TOC perspective? Knight proposed a new articulation of the Four Principles of Flow as linked to a healthcare perspective:
- Improving patient flow is the primary objective of any methodology
- A focused process of ongoing improvement to balance patient flow must be in place
- A patient-centered, clinically-led approach is at the core of a the way forward
- Eradicating local performance measures is essential to improving the whole chain of activities.
Another way of saying this is that we want to simplify our perception of the system. Knight showed a simple graphic of the variety of incoming and outgoing flows of patients. From this perspective, the whole system is very complex. But shifting to something patient-centric, such as Knight's wording of Flow.
Knight closed with an exhortation from Eli Goldratt to handle the big obstacles. Don't drive around them. Don't ignore them. If they are big enough, you must create a highway over the obstacle. Not only does this make this easier for you, but it also makes it easier for the people coming behind you. (There is a video clip of Eli saying this, but it doesn't seem to be easily
One thing I would have liked to hear more about is the impact of timeliness of care on patient outcomes. In manufacturing and projects, I have seen these effect, and I assume similar things appear in healthcare. The longer people are in the hospital, the higher the likelihood of adverse events. The longer before care is received, the higher the risk that the small problem gets worse. And adverse events and worse conditions almost always result in more spending. Conversely, the more quickly we can care for patients - get them through the system - the more patients we can handle with a given system.