2 - Bill West_28 TOCPA UK 09 November 2016

International Conference of the TOC Practitioners Alliance - TOCPA www.tocpractice.com

09 November 2016, UK

Making TOC, through QFI’s Pride and Joy approach, Credible in the NHS Bill West, QFI, UK 09 November, 2016

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Bill West Brief bio Worked in financial services for more than 20 years during which time got to know TOC (as well as Alex, Oded and Eli) finishing on the Management Board of Zurich FS UK Life Business. Set up QFI Consulting with Alex Knight and Helen Gibb in 2003. Our primary focus has been the development of a TOC based application in healthcare. This is now complete!

Place for the photo of the presenter

www.qficonsulting.com

Background

• The current reality • “Jonah” in a number of organisations • The big consultancies and software suppliers • Lean etc • Bringing Pride and Joy to market • Early projects • Building new relationships • Working with the NHSI

The NHSI Workshops NHSI Midlands and East Spreading Best Practice in Emergency Care Workshop

• Senior leadership teams from Trusts across the Midlands, East and South (led By COO’s plus their improvement teams) • 35 Trusts attended 1 of 3 days of workshops • TOC and Pride and Joy presented alongside COO of Ipswich • Lots of examples included

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TOCPA International Conference

09/11/2016

The Theory of Constraints Invented by Dr Eliyahu M. Goldratt

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© QFI Consulting LLP – all rights reserved

The Theory of Constraints The Theory of Constraints developed by Dr Eliyahu M. Goldratt and described in his famous novels, focus on achieving breakthroughs in performance in large, complex environments dominated by high uncertainty • Operations management • Project Management • Strategy • Supply Chain • Marketing and Sales • The Thinking Processes

https://www.toc-goldratt.com 6

http://www.tocico.org © QFI Consulting LLP – all rights reserved

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Achieving a breakthrough in the quality, safety, timeliness and affordability of care

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The core problem REQUIREMENT

ACTION

Provide highquality, safe and timely care for all patients

Add more (front-line) resources

Conflicting decisions about where best to spend money

OBJECTIVE

Be an everflourishing healthcare system

CONFLICT

REQUIREMENT

Be financially stable

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Budget overruns

ACTION

Reduce (front-line) resources

Clinical targets not met


Why is this important situation becoming increasingly urgent?

It is important to notice that the cause of this problem cannot be simply placed at the feet of the people running the system. ‘The core problem of healthcare’, Dr Eliyahu M. Goldratt, www.toc.tv. See Pride and Joy, pages 63-64. 10


Criteria against which a solution should be judged Any solution must simultaneously: • create an ever-flourishing health and social care system • rapidly improve the quality, safety and timeliness of patient care • rapidly improve the affordability of care • all without creating more complexity for staff.

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Providing high-quality, safe, timely and affordable care: a patient-centred and clinically led approach

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A health and social care system

Home

Home

Home

Days

Days

Community health services

4 hours

Ambulance arrivals

Home

Days



12 hours

ED

AU

Rehab, Community, Mental Health

Acute

Residential, nursing care

Minor walk-ins Days

Electives GP referrals

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Outpatients


Days


Weeks



If there is variation in patient acuity but no disruption or delay then…

4 hours

Emergency department

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12 hours

Assessment unit

Days

Wards


If there is variation in patient acuity AND disruption AND delay then…

4 hours

Emergency department

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12 hours

Assessment unit

Days

Wards


In summary

Local optima does not add up to a global optimum

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There will be only a few places limiting the performance of the entire system


The Pride and Joy solution

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Direction of solution The four key principles: •

A patient-centred, clinically led approach is an essential element of the way forward. The approach is patient-centred by basing the expectations of the timeliness of care solely on each individual patient’s need. It is clinically led by setting the expectations on clinical grounds alone.

•

The primary objective is to improve patient flow through all pathways simultaneously. By identifying which task or which resource is most often causing the most delay to the most patients across the system and through improving synchronisation of resources we are able to rapidly improve flow without any extra resources.

•

A focused process of ongoing improvement to balance patient flow is vital. Balancing flow is entirely different to balancing capacity. This is a common mistake when trying to improve such systems. We need to identify the few underlying causes that most often disrupt patient flow and how to safely eliminate them.

•

Removing local measures of optimisation is essential when improving multiple, interacting chains of activity. Without removing these measures, local optimisation will continue to disrupt patient flow and stagnate the process of ongoing improvement.

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The two critical patient flow questions

Of all the things I could try to improve, which one should I improve first? Of all the patients I could work on next, which one should I work on next?

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Direction of solution

Patient X’s clinical recovery period

Admission date

Clinically based planned discharge date (PDD) Task 1 Task 2 Task 3

Patient X

Task 4 Task 5

Multidisciplinary team meeting (MDT)

Patient X is in the red zone, caused by the estimated end date of Task 2, for which the blue resource is responsible. 20


Time Admission

Patient A

PDD

MDT Admission

PDD

Patient B Admission

PDD

Patient C Admission

The evidence shows that the blue resource is causing most risk of delay to most patients most of the time.

PDD

Patient D Admission

PDD

Patient E 21


Time Admission

Patient A

Resources will be synchronised as they work on patients in PDD order.

PDD

MDT Admission

PDD

Patient B Admission

PDD

Patient C Admission

PDD

Patient D Admission

PDD

Patient E 22


Admission

Patient A

Resources will be synchronised as they work on patients in PDD order.

PDD

MDT Admission

PDD

Patient D Admission

PDD

Patient C Admission

PDD

Patient E Admission

PDD

Patient B 23


As a result of our time-based buffer analysis, we can: • identify which task-resource combination is most often causing the most delay to the most patients • analyse the start, end and distribution of duration of these critical task-resource combinations against planned discharge dates • identify the correct level of resourcing for these few, critical resources and for the wider resource pool • implement an effective process of focused improvement. 24


The Pride and Joy elements

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What are the main elements? 1.

Pride and Joy, the book – a unique marketing and sales tool which shows potential clients and staff the solution through an entertaining business novel.

2.

The strategy and tactic document – detailing the underpinning logic of the whole solution. It highlights the necessary and sufficient strategies and tactics to achieve and sustain the breakthrough.

3.

The education tools – providing staff with the opportunity to experience for themselves the paradigm shift in understanding.

4.

The Pride and Joy software – the new, positive bureaucracy for the client to initiate and sustain the breakthrough in performance.

5.

The ‘DNA’ document – the underpinning expertise required to deliver the solution and which forms the basis of the education of the consulting team guiding the client.

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In summary Improving patient flow and simultaneously improving the quality, safety, timeliness and affordability of patient care without creating more complexity for staff

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Thank you

Questions

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2 - Bill West_28 TOCPA UK 09 November 2016

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