Theory of constraints for publicly funded health systems

Abstract

This thesis aims to fill the gaps in the literature of the theory of constraints (TOC) in publicly funded health systems. While TOC seems to be a natural fit for this resource-constrained environment, there are still no reported application of TOC's drum-buffer-rope tool and inadequate customizations with regards to defining system-wide goal and performance measures.The "Drum-Buffer-Rope for an Outpatient Cancer Facility" chapter is a real world case study exploring the usefulness of TOC's drum-buffer-rope scheduling technique in a publicly funded outpatient cancer facility. With the use of a discrete event simulation model populated with historical data, the drum-buffer-rope scheduling policy is compared against "high constraint utilization" and "low wait time" scenarios. Drum-buffer-rope proved to be an effective mechanism in balancing the inherent tradeoff between the two performance measures of instances of delayed treatment and average patient wait time. To find the appropriate level of compromise in one performance measure in favor of the other, the linkage of these measures to system-wide performance measures are proposed.In the "Theory of Constraints' Performance Measures for Publicly Funded Health Systems" chapter, a system dynamics representation of the classical TOC's system-wide goal and performance measures for publicly traded for-profit companies is developed, which forms the iii basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC's process of ongoing improvement in publicly funded health systems.The "Connecting Low-Level Performance Measures to the Goal" chapter attempts to provide a framework to link the low-level performance measures with system-wide performance measures.It is claimed that until such a linkage is adequately established, TOC has not been fully transferred to publicly funded health systems.iv

Pricing and Capability Planning of the Referral System Considering Medical Quality and Delay-Sensitive Patients—Based on the Chinese Medical System

“…Bansal and Taylor [48] focused on the evaluation indicators of the service quality. In general, the study of medical quality focuses on the interaction between the influencing factors of medical quality and the customers' perception [49] [50] [51].…”

A system dynamics-based model to implement the Theory of Constraints in a healthcare system

“…Sahraoui and Elarref 37 applied the five steps of the TOC to analyze a healthcare system and find better solutions to the cancellation problem of elective surgeries and state that the cyclic process of applying the TOC ensures continuous improvements. Sadat 38 proposed a SD representation of the TOC process to improve publicly funded health systems and to increase the quality and quantity of lives. Pawlak 39 implemented the TOC to support the nurse workforce shortage and to find the influence factors.…”

Improving the productivity and efficiency of an integrated mental and addiction care

“…It likens systems to chains [5]. As the chain analogy maintains that the chain is only as strong as its weakest link ("bottleneck," "constraint"), TOC provides insight into process improvement efforts by focusing on the constraint (the root cause of the problem), not just picking random or "low hanging" fruits [6]. According to Dettmer [5], a simple production system that uses raw materials runs them through five components (A, B, C, D, and E) of processes, and turns them into finished products.…”

“…Many productivity and efficiency methods and measurements (e.g. DRG, NordDRG, FullDRG, ACG, APG, DEA, Monte Carlo DEA, and MOO) have been developed and proposed for social and health care [6][7][8][9][10][11][12]. Pritchard et al [13] complain that the potentiality of the Productivity Measurement and Enhancement System (ProMES) intervention for the effectiveness of organizations and teams is not utilized, mainly because "people are working in jobs that severely limit what they can contribute."…”