constraint theory and Pareto Optimals…

Brian Gregory, MD, MBA • Wayne, good question. Healthcare is a funny animal–you have constraints within constraints.

One of the main tenets of ToC is to pick what you want to be the constraint.

In the case of the OR (ER, radiology, and many other places in the hospital) you have multiple agents (surgeon, anesthesiologist, nurses, hospital administration) each wanting to be the top constraint. By that I mean each wants the others to subordinate their schedules and manpower to their own.

With simulation, you focus on one agent to exploit and subordinate all the activities around that agent. You’ll create a system that maximizes throughput for that agent.

Pick a different agent and do it again. Rinse and repeat until you run out of agents.

So…who decides who gets to be the top constraint? Yep, its political…

Now comes the fun part:
(1) Healthcare is a service industry, and time is the biggest factor in cost and revenue.
(2) The value (in utils) of a unit of time varies throughout the day with each agent. (a surgeon who needs to wiz will gladly depart from the OR and slow down the case).
(3) With the appropriate software (::grin::) you can change the constraint to whomever is valuing time the most at any point.
(4) Maximizing and splitting total economic return (a discussion all its own)

Not so surprisingly, most people controlling the schedules in those ORs don’t understand ToC, and can’t analyze the tradeoffs so that everyone comes out ahead. It’s more of a tug-of-war with the not surprising inefficient result.

In the OR, it’s easy to increase everyone’s utils (and economic return) by understanding these concepts and scheduling accordingly.

That’s why its easy to achieve some pareto optimals (and better total economic return).

I’ll send you our paper when we’re finished with it.

About Brian D Gregory MD, MBA

Board Certified Anesthesiologist for 30 years. TOC design and implement for 30 years. MBA from U of Georgia '90: Finance, Data Management, Risk Management. Practiced in multiple US states and Saudi Arabia at KFSH&RC and KFMC Taught residents in two locations. Worked with CRNAs for 20 years.
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