Toward Integrating Theory of Constraints and Deming into the HCA

Curriculum

M. Scott Stegall, MHSA, Ph.D. Mary K. Madsen Ph.D., R.N., FAAMRUniversity of Wisconsin—Milwaukee

2006 AUPHA Undergraduate WorkshopChicago, IL

November 19, 2006

Toward Integrating Theory of Constraints and

Deming into the HCA Curriculum

Email for PDF of presentation slides:

sstegall@uwm.edu

Overview

• Why should HCA programs be interested in Deming and Goldratt?

• What are SoPK and TOC?• What are the key undergraduate education

and training goals for SoPK and TOC?• How were Deming and Goldratt integrated

into the UWM curriculum?• What market is there for students so

educated?• What are the available resources?

My Background…not an expert but…

• Began introducing Deming and Goldratt to HCA students back in the early 90s– Graduate work in SPC– Attend Deming Four Day Seminar– Several presentations at Deming Institute

Conference meetings– Academic Jonah– Deming Immersion Program

Why should HCA programs be Why should HCA programs be interested in interested in SoPKSoPK and TOC?and TOC?

• TOC and SoPK are changing the British National Health System (NHS).– Examples of Change

– See overheads at: • http://www.healthcare-toc.com/results_files/Page392.htm

If the UK, why not the US?

• Applies within a system…– Do we have a healthcare system?

• Who is trained to do it?– Theory of Constraints in Healthcare 11/06

USA

What are What are SoPKSoPK & TOC?& TOC?

• Deming (SoPK) –Transformation– System of Profound Knowledge

• Four Parts

• Goldratt (TOC)—Throughput– Theory of Constraints

• Focus on Bottleneck

Deming (SoPK) System of Profound Knowledge• SoPK as Design Principles

– Psychology• Intrinsic vs. extrinsic motivation for coordination

– Theory of Knowledge• Perception of reality—truth or maps

– Variation• Predetermined source vs. investigation of process

– Systems• Independent vs. interdependent processes

Goldratt: Focus on the bottleneck!!!

• Explicit Questions– What to change?– To what to change?– How to cause the change?

• Implicit Question– Why change?

• System is producing “undesirable effects” UDEs

Integration of SoPK & TOC

• TOC Provides Aim for SoPK– Work on weakest link of chain for bottom line

results

• SoPK Provides Culture for TOC– TOC withers without an environment of trust

• I tell my students they must know if a process is stable or not and whether it is the bottleneck or not before they are capable of effective management.

• Handout: TOC within SoPK

What are the key undergraduate What are the key undergraduate education and training goals for education and training goals for SoPKSoPK and TOC?and TOC?

• SoPK– Psychology

• Type and temperament

– Theory of Knowledge• PDSA cycle, measurement, primer on philosophy of science,

concept maps, and knowledge vees

– Variation• Control Charts

– Systems• Process studies & general systems theory

What are the key undergraduate What are the key undergraduate education and training goals for education and training goals for SoPKSoPK and TOC?and TOC?• TOC

• Bottlenecks: physical, policy, paradigm • Focusing Steps

• Thinking Process• Logic Trees

• Three Ps: Now and in future• profit, people, product/service

• Five Focusing Steps• Drum-Buffer-Rope• Layers of Resistance to Change

How were Deming and Goldratt How were Deming and Goldratt integrated into the UWM curriculum?integrated into the UWM curriculum?

• Hired faculty member with background and training• Course changes:

– Add sophomore Leadership course– Convert junior Healthcare Process Measurement course to statistical

process control, process studies and philosophy of science as well as measurement

– Convert junior Epidemiology to managerial epi with science focus– Add senior Advanced Systems Thinking

• Integrate Deming and Goldratt (Senge for grads and doctoral students)

• Provides 12 credit hours…in addition we have quality course• Program Director & Department Chair support every step of

the way!

What market is there for What market is there for students so educated?students so educated?

•GE Medical•Direct Supply•Graduate schools?•Long-term care facilities ?

What are the available What are the available resources?resources?

• Websites– Great Britain

• National Health Service NHS Improvement Leaders’Guides (see at site below)

• http://www.wise.nhs.uk/sites/toolandtechniques/ILG/pages/The%20Guides.aspx

– Deming • www.deming.org• http://deming.edu/demingcoop.html

– Goldratt• www.goldratt.com• www.dbrmfg.co.nz

• Deming Textbooks– Deming, W.E. The New Economics: For Industry, Government, Education,

2nd ed., MIT Press, Cambridge, MA, 1994.– Deming, W.E. Out of the Crisis, MIT Press, Cambridge, MA, 1986.– Neave, Henry R. The Deming Dimension, SPC Press, Knoxville, TN, 1990.– Scholtes, P.R. The Leader’s Handbook: A Guide to Inspiring Your People and

Managing the Daily Workflow, McGraw-Hill, New York, NY, 1998.

– Brassard and Ritter. The Memory Jogger II, GOAL/QPC, Methuen, MA, 1994. – Melton, Kim. Introduction to Statistics for Process Studies, second edition,

McGraw-Hill, New York, NY, 1993.– Wheeler, D. Understanding Variation: The Key to Managing Chaos, SPC

Press, Knoxville, TN, 1993.– Balestracci and Barlow. Quality Improvement: Practical Applications for

Medical Group Practice, second edition, Center for Research in Ambulatory Health Care Administration, Englewood, CO, 1996.

– Wheeler, D. and Chambers, D., Understanding Statistical Process Control, Second Edition, SPC Press, Knoxville, TN

– Wheeler, D., Advanced Topics in Statistical Process Control, SPC Press, Knoxville, TN

• Goldratt Textbooks– Goldratt, Eliyahu M. and Jeff Cox. The Goal,

third edition, North River Press, Great Barrington, MA, 2004.

– Goldratt, Eliyahu M. It’s Not Luck, North River Press, Great Barrington, MA, 1994.

– Scheinkopf, Thinking for a Change: Putting the TOC Thinking Processes to Use, St. Lucie Press, 1999.

– Right and King We All Fall Down: Goldratt's Theory of Constraints for Healthcare Systems, North River Press, 2006

Textbooks

• Integration of Deming & Goldratt– Lepore C. & Cohen, O. Deming and Goldratt: The

Theory of Constraints and the System of Profound Knowledge, North River Press, Great Barrington, MA, 1999.

• Misc Textbooks– Berens, Linda V. Understanding Yourself and Others: An

Introduction to Temperament, 2nd edition, Telos Publications, Huntington Beach, CA, 2000.

– Covey, Stephen R. The 7 Habits of Highly Effective People: Restoring the Character Ethic, Fireside, New York, NY, 1990.

– Kauffman, Jr., Draper L. Systems 1: An Introduction to Systems Thinking, S.A. Carlton, Minneapolis, MN, 1980.

– Keirsey, D. The Sixteen Types (edited from Please Understand Me II), Prometheus Nemesis Book Co., Del Mar, CA, 1998.

– Myers, Isabel Briggs Introduction to Type: A Guide to Understanding Your Results on the Myers-Briggs Type Indicator, 6th edition, Consulting Psychologists Press, Palo Alto, CA, 1998.

– Senge, P. The Fifth Discipline: The Art and Practice of the Learning Organization, second edition, Doubleday, New York, NY, 1994.

Faculty Preparation• Jonah Program (TOC)

– Two week program—contact Goldratt Institute

• Deming Institute Fall Conferences (SoPK)– Beginning four day conference– Advanced four day conference

• Tapes and Books– See both websites

• Practice Important– Get into the field

• Service learning• Faculty service or consulting

Toward Integrating Theory of Constraints and

Deming into the HCA Curriculum

Email for PDF of presentation slides:

sstegall@uwm.edu

Toward Integrating Theory of Constraints and Deming into the

HCA Curriculum

M. Scott Stegall, MHSA, Ph.D. Mary K. Madsen Ph.D., R.N., FAAMRUniversity of Wisconsin—Milwaukee

2006 AUPHA Undergraduate WorkshopChicago, IL

November 19, 2006