Q1: Hey Gijs, You've already told me a good bit about your TOC background, but can you now tell me what you do with TOC today?
There are a number of things I do with TOC today.
First of all I (with my company TOCreate) support 4 hospitals with their implementation of TOC as a management philosophy. Such a project consists of 3 elements, of course based on generic TOC principles. First we free up capacity in exactly the same way as Jean Sloan in Fife (Scotland) described, namely by running workshops and installing Jonah software on every ward. We achieve exactly the same results as in Five: a decrease in average length of stay of patients on the wards somewhere between 20 and 40%. This results in empty beds, less work in progress (a term which we normally do not use in the hospital, because in our case it refers to people…), less stress for nurses and doctors and of course (up to a certain limit) room for more patients to be treated. In The Netherlands there is a huge pile of WIP, meaning that there are a lot of patients waiting between steps in the process of their treatment. Normally nobody is aware of that phenomenon, because everybody knows a doctor is always very busy with hundreds of patients, the operating theatre is an expensive resource and should be used 100% of the time and is planned weeks or months in advance and every bed on a ward must be utilized by a patient every single day of the year. Local optimization is the leading principle in today’s healthcare in my country. Except of course in those hospitals that are implementing TOC right now.
The second step in the TOC process is to create new streams of revenues. We do that by getting Throughput Accounting in place, thus delivering insights in how to decide on a new product mix and generating more throughput, of course without raising inventory and/or operating expenses too much. The capacity freed up by Jonah will be used to extend on the hospital’s already existing areas of excellence and furthermore on free products (not touching the constraint) or products with the highest contribution per CCU (if that ever exists in healthcare, I’ll come to that later on). A very important part of this step is teaching the hospital to think, as Eli puts it. We educate management and medical staff on using the Thinking Processes to break clouds in healthcare and to create win-win solutions for both hospitals, insurance companies (it would take a complete weblog to explain how The Netherlands take care of the financial aspects of their healthcare system) and patients.
The third step in the whole process is to create sustainability or, as we better understand it, POOGI. I now know that that’s the most difficult part of making TOC the main way of management. At least as long as the majority of organizations live with the illusion that the fittest survives, meaning one has to fight to stay alive. I think that it would be a major breakthrough for healthcare and other areas if we all realize that the red curve can be part of our daily life without trying to kill the other one, but instead create win-win solutions for all parties involved. I hope and expect a lot of knowledge, experiences and wisdom from the way the Japanese embark on the TOC vessel and teach us some more about harmony.
To be honest with you: we have achieved astonishing results in step 1 of this process in healthcare and are now exploring step 2. It again is remarkable how fast our pushing TOC turns into the hospital pulling to enter a next phase. Working with the logic of TOC always seems to automatically lead to the next step. And I am happy that we still have some time to go before we get into the roller coaster of step 3.
The other things I do, are educating and training people in TOC Basics, Buffer Management for Healthcare, Thinking Processes and Throughput Accounting. We started our adventure back in 2004 and already educated more than 20 consultants, almost 40 managers and more than 200 nurses and doctors.
Last but not least we put energy into the TOC Network Nederland in order to bring people together and have them share their experiences on TOC, thus contributing to our own POOGI and our own inspiration; and theirs of course. None of those I do on my own, I work closely together with my partner Jacqueline within TOCreate and with other TOC experts in The Netherlands and abroad. By the way: not to mention my wife and kids who saw their spouse and dad reading Eli, listening to Eli and looking at Eli almost day and night. I think they know Eli even better than I do!
All of our accomplishments would not have been here in The Netherlands if it wasn’t (and still is!!) for Alex Knight and his people in the UK. It is really a great honor to work with him on shifting my own paradigm and after that of Dutch healthcare. If you are interested in his way of thinking and working visit www.healthcare-toc.com and have yourself surprised about what already exists today in the UK.
