Achieving rapid and significant results in healthcare services by using the theory of constraints

Health Syst (Basingstoke). 2022 Aug 29;13(1):48-61. doi: 10.1080/20476965.2022.2115408. eCollection 2024.

Abstract

Lack of timeliness and capacity are seen as fundamental problems that jeopardise healthcare delivery systems everywhere. Many believe the shortage of medical providers is causing this timeliness problem. This action research presents how one doctor implemented the theory of constraints (TOC) to improve the throughput (quantity of patients treated) of his ophthalmology imaging practice by 64% in a few weeks with little to no expense. The five focusing steps (5FS) guided the TOC implementation - which included the drum-buffer-rope scheduling and buffer management - and occurred in a matter of days. The implementation provided significant bottom-line results almost immediately. This article explains each step of the 5FS in general terms followed by specific applications to healthcare services, as well as the detailed use in this action research. Although TOC successfully addressed the practice problems, this implementation was not sustained after the TOC champion left the organisation. However, this drawback provided valuable knowledge. The article provides insightful knowledge to help readers implement TOC in their environments to provide immediate and significant results at little to no expense.

Keywords: Theory of constraints; healthcare services management; ophthalmology; patient flow; process of ongoing improvement.

Grants and funding

This work was supported by the FCT – Fundação para a Ciência e a Tecnologia as part of a PhD scholarship [PD/BD/129829/2017]. This PhD scholarship was funded by the European Social Fund and national MCTES funds. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this manuscript.