Gijs Andrea_12 TOCPA Conference_Eng_April 2014_Russia

download Gijs Andrea_12 TOCPA Conference_Eng_April 2014_Russia

of 29

description

Gijs Andrea_12 TOCPA Conference_Eng_April 2014_Russia

Transcript of Gijs Andrea_12 TOCPA Conference_Eng_April 2014_Russia

  • 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!

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    Gijs Andrea

    [email protected]

    Founder International House of TOC

    Consultant, Implementor, Trainer

    MSc TOC Healthcare Management

    25 years experience in Health

    Train people & improve processes

  • 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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    Increasing demand

    Decreasing budgets

    Increasing competition

    Increasing costs

    Time

    Costs (mainly staff)

    Budgets

    Healthcare developments

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    Healthcare developments

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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)

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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)

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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)

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    TOCs Claim

    Which patient first?

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    Reasons for Delay=> Start a project

    TOCs Claim

    Which improvement first?

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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)

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

    U

    M

    B

    E

    R

    O

    F

    P

    A

    T

    I

    E

    N

    T

    S

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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)

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    TOCs claim

    SOURCE: Oded Cohen (2006)

    Thinking clearly

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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)

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    TOCs claim: quality

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    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

  • 12th International Conference of the TOC Practitioners Alliance - TOCPA

    www.tocpractice.com

    www.tocpractice.com

    Gijs Andrea

    International House of TOC

    [email protected]

    More information