A Guide to Implementing the Theory of Constraints (TOC)





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Emergency Department

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& Discharge

Logic Matters




No Delay Nursing & Discharge – Not On-Line

I have made a conscious decision not to put this solution on-line, and that certainly is at odds with the rest of the site but the exception stands.  A close colleague who is well aware of the content thought that I had finally come to my senses; “the content is priceless and you were going to give it away!”  But that isn’t my reasoning.

My reasoning is that when something is free, it is very rarely truly appreciated.  It is too easy for healthcare management and clinicians to read the solution, actively agree with it, and then do nothing.  It is the “do nothing” part that I have so much trouble with.

To write a cogent solution, with all of its underlying logic marked off, is orders of magnitude more difficult than “just doing it” based upon knowledge, intuition, and experience.  There is just one “writer” who must meet the expectations of many critics and that can only happen by addressing the underlying fundamental issues.  This has taken longer, and with more effort, than I could have first imagined is possible.  The outcome has to be that something is done, rather that “do nothing.”

In other “free market” commercial enterprises to which the rest of the website applies to, the customers or consumers at least have some freedom of choice between suppliers.  Whether the suppliers choose to be more efficient and effective in supplying value really is up to them, and the customers can play an active part by way of their consider support or lack thereof.

Of course this is a bit of a fantasy about the free market, and I prefer to subscribe to the notion that the free market in fact is only truly effective in the very limited act of culling-off the very ineffective, and even then that can be somewhat circumscribed if you can argue that you are “too big to fail.”

Public service healthcare is different, and it is different because there is, in general, a monopoly supplier.  This shouldn’t be a problem of itself.  Indeed it should be the maximal solution, the cost of the “risk” is spread over the entire population.  The cost-per-head should be the lowest due to economy of scale and economy of scope (large populations can support one or two very specialized specialists for example).  However, by virtue of monopoly, the patient is locked out of this process and can’t vote with their feet.  And for all the discussion about Lean in healthcare, the patient seems to be the very last person to be asked about “value.”

In my country we “sample” every discharged patient for their experience in hospital (did you like the food, were the staff friendly?) and we call this “quality” but it is a perversion of statistics and we are singularly careful never to ask patients waiting at home, depressed and in chronic pain, what they think of the situation.  Is this a travesty or not?  I happen to think that it is.

The people who can address this are, together, the management and the clinicians.  The patients can demand action, but only the management and the clinicians together can put this into effect.  So the question is, what do we do for nursing and discharge then?  Let’s have a look.

No Delay Nursing & Discharge – Outline

The constraint in nursing and discharge ought to be lack of patients.  So seldom is this now achieved that we have probably forgotten what it was once like.  However, it need not be like this.  If we were to look at the current constraints in our wards we would probably find that they are many and varied, and changing all the time.  But this is misleading.  There are a few, maybe just one or two which are prime candidates at any one time, and which must be addressed and removed.  Of course this will uncover further issues that must also be addressed and removed, but suddenly we have a process of on-going improvement.

What is missing at the moment are some very basic “tricks of the trade” of the operations specialist that can bring order to chaos in a very short time.  I guess the question is whether you are really “up for it” or not?  Which is it?

The solution is here, but it is locked.

No Delay Nursing & Discharge


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