This website covers knowledge management, personal effectiveness, theory of constraints, amongst other topics. Opinions expressed here are strictly those of the owner, Jack Vinson, and those of the commenters.

How do you feel about your work place? Are you excited about the people and the work?  Or have the well-meaning policies and ineffective "improvements" grown wearying?  Even worse, have you started dreading going to work because of all the chaos?  Depending where you are, reading a story about such a situation could be painful or it could be very engaging.

Linda Seed finds herself thrust into the leadership of a hospital that seems to be stuck in perpetual chaos in Pride and Joy by Alex Knight (book website). And for me, I found the book quite engaging - I didn't even take time out to write many marginal notes.  

Pride and Joy is a business novel written by a long-time Theory of Constraints consultant.  The characters in the story do not talk about TOC directly. Of course, they use TOC principles and concepts, but the focus is on telling the story and showing how those various principles might fit into a larger whole.  Of course, since this is a TOC novel there is a business that is failing (the hospital), a guru character (Linda Seed's graduate school friend - who works for free!?!), and some minor outside-of-business life plot elements.  

Knight does an interesting job of showing the high level process of describing What to Change, What to Change To, and How to Cause the Change which is a core way of thinking within the TOC community. This is also connected to how people react to proposed changed: if they don't understand the "what to change" or the direction of the change, the specific steps to get there are going to look suspect.  Not only at the overall view of the organization, but as people or departments come into the picture, Knight shows what happens if you skip steps here (people resist change).  And how those same people can become true believers, if you take them through the thinking and incorporate their perspective on building the solution.  "Treat people like adults" is a theme that Knight repeats a few times.

While Knight didn't mention Theory of Constraints in this book, he clearly articulated some of the more recent concepts that have come out of the TOC community: flow and core TOC beliefs. He talked about flow - in this case the flow of patients through the hospital - and throughout the story, I picked out several ways in which the Four Concepts of Flow apply (more detail on these in an early blog post).

  1. Improving flow (or equivalently lead time) is a primary objective of operations. - Shorten the time people are in the hospital (usually waiting for someone) to ideally what is only clinically required.
  2. This primary objective should be translated into a practical mechanism that guides the operation when not to produce (prevents overproduction). - Difficult to do directly, as the incoming flow to the hospital is not in their control. But they still described a few actions to help this.
  3. Local efficiencies must be abolished. - There were many examples of local optimizations that significantly damaged the overall flow of patients: batching, blanket budget cuts, etc.
  4. A focusing process to balance flow must be in place. - They designed a buffer management system designed around the flow time for each patient and used it to drive priorities everywhere.

The other aspect is the TOC core beliefs.  The guru character in the story articulates a number of these explicitly as he is talking to other characters, and others of them come out in the story.  I'm not sure what these are called exactly, but they largely come out of thinking around "inherent simplicity" of systems.  This is best articulated in one of Goldratt's last books, The Choice (my re-review from earlier this year)

  • Reality is exceedingly simple
  • People are good
  • Every conflict can be removed
  • There is always a win-win (solution)
  • Every situation can be substantially improved

One aspect of the story that didn't get emphasized was a clarity of thinking that came as the characters started describing the problem.  Specifically around the goal of the system: why does the system exist? Why do we do the things that we do? The characters in the story went from all the measures and rules to becoming laser-focused on the patient and the policies/practices that get in the way of that focus. I would have been interested in some discussion of how they clarified the goal.  Maybe for hospital personnel this is already clear, but I suspect not.  Having a well-articulated, shared understanding of the goal of the system helps start the discussion of what to change, what to change to, and how to cause the change.  It is often listed as "step 0" of the TOC five focusing steps.

Why Pride and Joy?  By the end of the story, Linda Seed and her colleagues are once again excited about the work they are doing. Characters who were considering retirement or career changes are reenergized in their work at the hospital. The place is becoming a point of pride for the characters.

This book is similar to a previous hospital-focused TOC novel, We All Fall Down (my review from 2008).  In that story, the TOC elements were much more in the fore.  And the specific solution developed in the story went in a different direction because the problem they were solving was different.  I kept thinking of that solution in the context of this book, because I suspect it could have been a small part of the larger effort described here as well - but diving into those specifics would have detracted from the story presented in Pride and Joy.

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