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com

12th International Conference of the

TOC Practitioners Alliance - TOCPA
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April 26-27, 2014 Moscow, Russia

Increase Quality of Care

AND
Decrease Costs per Patient
Yes, You Can!
Gijs Andrea, International House of TOC, The Netherlands
April 28, 2014

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12th International Conference of the TOC Practitioners Alliance - TOCPA

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Gijs Andrea

Founder International House of TOC

Consultant, Implementor, Trainer
MSc TOC Healthcare Management
25 years experience in Health
Train people & improve processes

G.Andrea@HouseofTOC.com

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12th International Conference of the TOC Practitioners Alliance - TOCPA

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Presentation outline
Healthcare developments
Implementing TOCs claim: achieving a simultaneous
breakthrough in quality AND financial performance
Proving TOCs claim: results are significant

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Healthcare developments

Increasing demand
Decreasing budgets
Increasing competition
Increasing costs

Budgets
Costs (mainly staff)

Time

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Healthcare developments

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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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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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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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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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TOCs Claim
Blame versus UDE
Blame

UnDesired Effect

We must always wait on

Radiology
Doctors admit patients on
the wrong wards
Management does not
provide us enough capacity
Nurses are never available
when they are needed
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Often Radilogy results are not

available at the right moment
Sometimes patients are
admitted on the wrong ward
Sometimes patients have to
wait too long
Sometimes patients do not
receive treatment on the
right time

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TOCs Claim
UDE vs BLAME
Nurses spend a lot
of time searching
and checking

There is too much

pressure and stress

Nurses deliver care

on improper wards

Patients are admitted

on improper wards

Patients are discharged

too fast

Patient are waiting

too long on a
wailtinglist

There are (partial)

admission stops

There are no beds

available

Patients stay too

long
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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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TOCs Claim
Invalidate faulty assumptions
Need
Manage and
decrease costs
Goal
To be a good
careprovider
now and in the
future

Need
Improve quality of
care (in all its
aspects)

Behavior
Employ less staff
and/or money

Behavior
Employ more staff
and/or money

Assumption: we are not able to

improve with current staff/money
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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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TOCs Claim
Improve flow
Home

Outpatient
clinic
Emergency
Dept

Home

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Home

Home

Social
Services

Diagnostics
Assessment

Home

Social
Services

Operating
Theatre

Home

Home

Social
Services

Nursing
Home

Clinical
Wards

Home

Home

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TOCs Claim
Apply a Buffer: medically needed recovery time
Medically Estimated
Discharge Date

Admission

OK

Register Discharge
Related Tasks

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Pay attention

Act now!

Escalate

Register Reasons for

delay

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TOCs Claim
Which patient first?

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TOCs Claim
Which improvement first?

Reasons for Delay

=> Start a project

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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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TOCs Claim
The Opportunity

SPREAD LENGTH OF STAY

180
ALL WARDS.

25% capacity needed

160

600
140

500

75% capacity needed

400
120
NUMBER OF PATIENTS

300
A1

100

200

A2
A3

100

B2

80

B3

0
1

10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55

60

40

MEAN = 50/50

20

0
1

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

47

49

51

53

55

57

NUMBER OF DAYS

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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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TOCs claim
Thinking clearly

SOURCE: Oded Cohen (2006)

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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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TOCs Claim
The other sides win?
Revenu

Truly
Variable
Costs

Throughput

Operating
Expenses

Net Profit

Current

200

40

160

170

-10

10%
increase

220

44

176

170

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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TOCs claim: affordable

ALOS 2011 week 1 40 (start year) 7,02 mean of all patients

ALOS 2012 week 1 40

6,33 mean of all patients

ALOS 2013 week 1 - 40

5,06 mean of all patients

Reduction:

28 % mean diff.

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TOCs claim: quality

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TOCs claim: rewarding

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

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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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More information

Gijs Andrea
International House of TOC
G.Andrea@houseoftoc.com

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12th International Conference of the TOC Practitioners Alliance - TOCPA