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12th International Conference of the TOC Practitioners Alliance - TOCPA
www.tocpractice.com
www.tocpractice.com
April 26-27, 2014 Moscow, Russia
12th International Conference of the
TOC Practitioners Alliance - TOCPAwww.tocpractice.com
Gijs Andrea, International House of TOC, The NetherlandsApril 28, 2014
Increase Quality of Care
AND
Decrease Costs per Patient
Yes, You Can!
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12th International Conference of the TOC Practitioners Alliance - TOCPA
www.tocpractice.com
www.tocpractice.com
Gijs Andrea
Founder International House of TOC
Consultant, Implementor, Trainer
MSc TOC Healthcare Management
25 years experience in Health
Train people & improve processes
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12th International Conference of the TOC Practitioners Alliance - TOCPA
www.tocpractice.com
www.tocpractice.com
Healthcare developments
Implementing TOCs claim: achieving a simultaneous
breakthrough in quality AND financial performance
Proving TOCs claim: results are significant
Presentation outline
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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www.tocpractice.com
Increasing demand
Decreasing budgets
Increasing competition
Increasing costs
Time
Costs (mainly staff)
Budgets
Healthcare developments
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12th International Conference of the TOC Practitioners Alliance - TOCPA
www.tocpractice.com
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Healthcare developments
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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Healthcare developments
If Medical Costs keep rising and rising, then somewhere
in time there must occur a turning point where:
People cant or wont afford it anymore
AND/OR
Quality is being decreased below an acceptable level
AND/OR
Pressure on care professionals becomes unbearable
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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Healthcare developments
If we really want to dispose of a sustainable healthcare
system, it must be
Affordable now and in the future
Deliver quality always to all patients
Challenging and rewarding to work in
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12th International Conference of the TOC Practitioners Alliance - TOCPA
www.tocpractice.com
www.tocpractice.com
TOCs Claim
The underlying assumptions we use to develop and
implement TOCs claim achieving a simultaneous
breakthrough in quality and financial performance:
People are Good
Every conflict can be removed
Every situation is exceedingly simple
Every situation can be substantially improved
Everybody can live a full life
There is always a win-win solution
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
1. People are Good
People tend to blame other people. Once you blame someone,
your ability to think clearly is blocked.
You will be able to refrain from blaming people when you are
convinced there is no reason to blame them.
Harmony exists in any relationship between people.
(Eli Goldratt/Lisa Lang: The Choice)
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
Blame UnDesired Effect
We must always wait on
Radiology
Often Radilogy results are not
available at the right moment
Doctors admit patients on
the wrong wards
Sometimes patients are
admitted on the wrong ward
Management does not
provide us enough capacity
Sometimes patients have to
wait too long
Nurses are never available
when they are needed
Sometimes patients do not
receive treatment on the
right time
Blame versus UDE
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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There is too muchpressure and stress
Patient are waitingtoo long on a wailtinglist
There are no bedsavailable
There are (partial) admission stops
Patients are dischargedtoo fast
Nurses deliver care on improper wards
Patients are admittedon improper wards
Nurses spend a lot of time searching
and checking
Patients stay toolong
TOCs Claim
UDE vs BLAME
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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The Claim of TOC
2. Every conflict can be removed
Peoples perception is that conflicts are a given and the best we
can do is to seek a compromise.
When we face a conflict, lets do exactly the same thing
scientists do when they encounter a contradiction; lets insist
that one of the underlying assumptions is faulty.
When we pin down the underlying assumption that can be
removed, we will remove the cause of the conflict; we solve the
conflict by eliminating it.
(Eli Goldratt/Lisa Lang: The Choice)
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
Invalidate faulty assumptions
Goal
To be a good
careprovider
now and in the
futureNeed
Improve quality of
care (in all its
aspects)
Behavior
Employ more staff
and/or money
Need
Manage and
decrease costs
Behavior
Employ less staff
and/or money
Assumption: we are not able to
improve with current staff/money
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
3. Every situation is exceedingly simple
There is nothing wrong with peoples brainpower; there is
something very wrong with peoples perception of reality.
People believe that reality is complex, therefore they are looking
for sophisticated explanations and complicated solutions.
The key is the acceptance that any real life situation, no matter
how complex it initially looks, is actually, once understood,
exceedingly simple.
(Eli Goldratt/Lisa Lang: The Choice)
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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Emergency
Dept
Diagnostics
Assessment
Operating
Theatre
Clinical
Wards
Nursing
Home
Social
Services
Social
Services
Social
Services
Home Home HomeHome Home
Home Home Home
Outpatient
clinic
Home
TOCs Claim
Improve flow
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
Apply a Buffer: medically needed recovery time
Register Reasons for delay
OK Pay attention Act now!
Register Discharge Related Tasks
Escalate
Admission Medically EstimatedDischarge Date
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
Which patient first?
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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Reasons for Delay=> Start a project
TOCs Claim
Which improvement first?
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
4. Every situation can be substantially improved
The undesirable effects people complain about are the result of
a conflicta conflict between the parties in cases of
relationships, and an internal conflict in cases of individuals.
People, and companies, lower expectations when they use
protective mechanisms to camouflage from themselves the big
chronic problems; the problems that they already gave up on
resolving.
Those who are not prepared will be blind to the stream of
opportunities life presents them.
(Eli Goldratt/Lisa Lang: The Choice)
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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0
20
40
60
80
100
120
140
160
180
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57
N
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M
B
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P
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NUMBER OF DAYS
SPREAD LENGTH OF STAY
A1A2A3B2B30
100
200
300
400
500
600
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55
ALL WARDS.
TOCs Claim
75% capacity needed
25% capacity needed
MEAN = 50/50
The Opportunity
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
5. Everybody can live a full life
You claim that the only things standing in the way of me
thinking clearly are some specific obstacles and practice.
Rather than leaving it to chancewhat people call good luck
chances of living a full life will be much greater if you learn to
think clearly.
Youll be able to generate, or at least to recognize, the right
opportunities and youll be better able to have more stamina to
persistently follow enough of them to fruition.
(Eli Goldratt/Lisa Lang: The Choice)
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs claim
SOURCE: Oded Cohen (2006)
Thinking clearly
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
6. There is always a win-win solution:
For every relationship there is a change that will cause the
parties to each achieve what they need from the relationship.
Compromise is the attempt to share a finite cake. Seeking a
compromise is a situation in which the more you win, the more I
lose; seeking a compromise is, by definition, a win-lose
approach.
If we want our win to be bigger we have to ensure that the
other sides win will be bigger.
(Eli Goldratt/Lisa Lang: The Choice)
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs Claim
The other sides win?
Revenu Truly
Variable
Costs
Through-
put
Operating
Expenses
Net Profit
Current 200 40 160 170 -10
10%
increase
220 44 176 170 6
20%
increase
240 48 192 170 22
20%
increase
+ T/CU*
260 48 212 170 42
* See Principles of Throughput Accounting
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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ALOS 2011 week 1 40 (start year) 7,02 mean of all patientsALOS 2012 week 1 40 6,33 mean of all patientsALOS 2013 week 1 - 40 5,06 mean of all patientsReduction: 28 % mean diff.
TOCs claim: affordable
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs claim: quality
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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I just have to admit...
Focus on your goal increases both timeliness of
care and flow of patients.
I can always admit my patients now!
Medical Docter
TOCs claim: rewarding
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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TOCs claim realized
If we really want to dispose of a sustainable healthcare
system, it must be
Affordable now and in the future
20 40% capacity made available
Deliver quality always to all patients:
Most patients most of the time receive care on the
right moment on the right place
Challenging and rewarding to work in
Doctors and Nurses co-operate even better
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12th International Conference of the TOC Practitioners Alliance - TOCPA
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Gijs Andrea
International House of TOC
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