A Theory of Constraints Approach to Health Technology Assessment

Groop, Johan; Reijonsaari, Karita; Lillrank, Paul

doi:10.1109/etelemed.2010.28

Cited by 8 publications

(11 citation statements)

References 10 publications

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“…Tsitsakis (2010) applied the TOC in five public hospitals in Greece, aiming to solve capacity problems, long waiting lists and low occupancy rate in hospitals. Groop et al (2010) suggested a constraint-based alternative to increase the transfer rate rather than reduce costs in a home healthcare service in Finland. Nematipour et al (2014) described the application of the TP–TOC in the hospital supply chain of five hospitals in Iran and uncovered the core problem, the environmental instability, which requires larger inventories to prevent shortages.…”

Section: Introductionmentioning

confidence: 99%

The thinking process of the theory of constraints applied to public healthcare

Bauer

Vargas

Sellitto

et al. 2019

BPMJ

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Purpose The purpose of this paper is to present an approach based on the thinking process of the theory of constraints (TP–TOC) to support decision-makers, managers and professionals of health to diagnose and improve healthcare systems focusing on the service quality deployed to patients. Design/methodology/approach A case study was developed in a SUS-affiliated philanthropic hospital in southern Brazil, through the analysis of its ED processes and application of the TP–TOC. The Current Reality Tree and the Evaporating Cloud tools of the TOC were used to identify the root causes (RC) and their connections with undesirable effects. Findings The analysis of this case helped to understand and identify the causes of the current problems in the analyzed processes related to internal management and external causes. The proposed approach allowed the hospital team to progress in the understanding of such causes in a sequential manner, giving conditions to apport different perceptions and to identify relevant facets and causes related to the problem. The research provided a systemic and an integrated vision of the losses in the organizational processes and indicated the steps to be prioritized in order to eliminate such losses. Originality/value The paper proposed an approach that allowed the systematic and systemic analysis of organizational processes through the application of the TP–TOC. The recognition of the existence of RC responsible for processes losses represents an excellent opportunity for improvement because it allows managers to focus their efforts on the more productive areas.

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Section: Introductionmentioning

confidence: 99%

The thinking process of the theory of constraints applied to public healthcare

Bauer

Vargas

Sellitto

et al. 2019

BPMJ

View full text Add to dashboard Cite

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“…The TOC is about ‘managing the flow of a good or a person through a system and not about managing the capacity within a system’. TOC views every organization as ‘a chain of interdependent events (or processes) where the performance of each event (or process) is dependent upon the previous event’ [ 18 ]. However, maximising the efficiency of a microsystem at the expense of the macrosystem decreases organisational outcomes [ 11 ] and should be avoided.…”

Section: Introductionmentioning

confidence: 99%

“…Instead, the focus should be on improving the efficiency of primary constraints, and not non-constraints. A focus on the latter could lead to ‘efficiencies syndrome’, whereby the efficiency of non-constraints is increased, thus reducing the efficiency of the entire system [ 18 ]. Management of primary constraints is key to the attainment of good patient outcomes [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Health services in Trinidad: throughput, throughput challenges, and the impact of a throughput intervention on overcrowding in a public health institution

Bahall

2018

BMC Health Serv Res

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BackgroundThroughput might be partially responsible for sub-optimum organisational and medical outcomes. The present study examined throughput and the challenges to ensuring optimum throughput in hospitals, and determined the effectiveness of a throughput intervention in reducing overcrowding in a public healthcare institution in Trinidad and Tobago.MethodsFirst, a literature review of throughput and its processes in relation to improving hospital care was conducted. Second, the challenges to throughput in healthcare were reviewed. Data were also collected from print media, hospital records, and the central statistical office in Trinidad and Tobago to discuss throughput and describe the throughput status in hospitals. Finally, the effect of a throughput intervention on overcrowding was determined. The intervention was implemented over six months, from October 2010 to March 2011, and comprised three stages of a five-stage throughput process: transferring patients to a specific medical ward, bedside electrocardiograms (ECG), and promptly obtaining patient investigative reports and patient files.ResultsProblems with the throughput process led to prolonged delays or failures in obtaining lab reports, radiology services, ECGs, and pharmaceutical supplies, as well as inadequate social work services and other specialised services. During the throughput intervention, there was a reduction in overcrowding/overflow to 5–10 patients per day with a daily admission rate of 58. However, at post-intervention, there was increased overcrowding/overflow to 20–30 per day but fewer admissions (52 per day) i.e. similar to pre-intervention period. Additionally, there was an increase in bed complement in the department of medicine from 209 (2011) to 227 (2012). Overcrowding continued into 2016 and beyond: medical admissions in 2016 were 46.4 per day and the medical bed capacity was 327 (indicating a 44% increase in capacity from 2012).ConclusionHospital throughput processes are currently suboptimum. Improving specific throughput processes or targeting the greatest primary constraints might help decrease overcrowding.

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“…In literature, the evidence suggests that enhanced health technologies generally increase rather than reduce healthcare expenditures. Indeed, nations with a greater degree of integration into the health system have relied on spending controls and global budgets to control costs [15,19].In this direction, this paper reviews the different contributions existing in literature regarding the methodologies connected to the HTA, highlighting the alternative approaches proposed [20,21] and identifying the main weaknesses.A lack of unified generally accepted analysis schemes still exists. The methodologies currently used are consequently unsatisfactory: the literature that criticizes the cost-effectiveness analysis (CEA) is wide, currently being the most widespread evaluation methodology.…”

mentioning

confidence: 99%

“…In this direction, this paper reviews the different contributions existing in literature regarding the methodologies connected to the HTA, highlighting the alternative approaches proposed [20,21] and identifying the main weaknesses.…”

mentioning

confidence: 99%

From Health Technology Assessment to Health Technology Sustainability

et al. 2018

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This paper aims to propose a methodological lens to the assessment of technological innovations in healthcare based on the principles of social, economic, and political sustainability. Starting from the consideration of a lack of a unified interpretative framework of health technology assessment, using a content analysis of the relevant literature on the topic, we identified both the scientific perspectives adopted by the scholars and the most widely discussed topics. Consequently, the less explored scientific areas were framed, and, therefore, those more susceptible to further investigation came to light. The result is an overall picture which highlights the absence of unified and generally accepted approaches to evaluation, together with the lack of awareness on the fact that the multiplicity of methods adopted is essentially connected to the multiplicity of innovations, for each of which a method (or a set of methods) of preferable evaluation can be prefigured. Based on these observations, we propose a general reference framework for evaluation, based on the Viable Systems Approach (vSa), and a schematic outline of the connections between the complexity of innovations and the evaluation methodologies.Sustainability 2018, 10, 4748 2 of 22 other relates to the increasingly demanding policy makers and funders, who require greater evidence for new and existing therapies [6].Adopted primarily in the USA in the 1970s [7,8] and rapidly spread in Europe in the following decades, HTAs are currently being introduced in most countries of the world [3]. During the 1970s, the focus was to summarize the evidence concerning studies on the cost effectiveness of health interventions. Afterwards, at the end of the 1990s, HTA widened its focus from the evaluation of only large, expensive and machine-based technologies also to smaller technologies and healthcare, addressing broader issues (organizational, social implications, and ethics) [7]. Currently, the health technology assessment processes critically evaluate reimbursement submissions of pharmaceuticals, simple medical devices, and complex medical devices, such as hospital technologies [9], vaccines, procedures, health services, and public health interventions. Therefore, they are becoming an important tool to support health policy decisions in many countries [9].Nowadays, the importance of HTAs has increased further, also spreading in Central and Eastern European countries. HTA activities have a national focus associated with the Ministry of Health and, by influencing health policy documents of the European Commission, it seems likely that, in the future, the HTA will be institutionalized somehow as part of the EU's activities. The task of applying HTA techniques for the evaluation of new health technologies is devolved to the different government support bodies (e.g., NICE in the UK, IQWIG in Germany, and AGENAS in Italy).Thus, HTAs act to define a policy research approach that examines the short and long-term social, economic, and political consequences of the applicatio...

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A Theory of Constraints Approach to Health Technology Assessment

Cited by 8 publications

References 10 publications

The thinking process of the theory of constraints applied to public healthcare

The thinking process of the theory of constraints applied to public healthcare

Health services in Trinidad: throughput, throughput challenges, and the impact of a throughput intervention on overcrowding in a public health institution

From Health Technology Assessment to Health Technology Sustainability

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