International Conference of the

TOC Practitioners Alliance - TOCPA

www.tocpractice.com

09 November 2016, UK

Making TOC, through QFIs

Pride and Joy approach,
Credible in the NHS
Bill West, QFI, UK
09 November, 2016

Your logo

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 COOs 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

TOCPA International Conference

09/11/2016

The Theory of Constraints

Invented by
Dr Eliyahu M. Goldratt

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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
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http://www.tocico.org
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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

Budget
overruns

ACTION

Reduce
(front-line)
resources

Clinical
targets
not met

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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.
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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

Community
health
services

Community
health
services

12 hours

ED

AU

Rehab,
Community,
Mental Health

Acute

Residential,
nursing care

Minor
walk-ins
Days

Electives
GP
referrals

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Outpatients

Community
health
services

Days

Community
health
services

Weeks

Community
health
services

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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

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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

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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

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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 patients 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 Xs 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.
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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
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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
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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
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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.
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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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