TOC Doctor aims to bring the benefits of Theory of Constraints to enable rapid improvement in medicine and wellness. Please join me for the journey. 

Check Your System

Check Your System

I have a friend, a colleague, who works for a large hospital corporation. He’s always telling me about this or that thing that the leadership has done there that is counterproductive. 

For example, the doctors have a schedule and the schedules aren’t always full. If a doctor is fully booked in an afternoon and they need to add a patient, rather than showing that the patient is an overbooking, they put the patient in an empty morning slot even though they are seen in the afternoon. The patient would be seen either way, but this way the system has no way to know or improve on the overbooking.

Here’s another one he told me. The hospital is in a growing urban area and parking has always been a problem. Employees have, for the last two years, been looking forward to the hospital building a new parking structure. It’s hard to find free places to park in the surrounding neighborhood. So, the parking deck opened, and everyone can park. Fixed, right? Nope. The hospital will let employees park there, but they have to pay. Oh, and they’re not allowed to park in the neighborhood anymore. I bet you wonder how they’ll know if any do. They’ll have hospital police walking around watching at shift change to see where people go to find their cars.

So, as you might imagine, this hospital has a few morale problems. Leadership has seen this. Here’s their latest fix.

All employees had to attend leadership workshops with a consultant who wrote a book on positive thinking. The book talks about how gossip and negative speech in the workplace hurts morale. Every employee got a book, too. Except my colleague, because they ran out, and you know, doctors don’t really count to a hospital administrator. 

Anyway, my friend goes to the workshop. The speaker is full of the usual inspirational stories and feel good messages. People are nodding their heads and getting into it. They really can complain less, and, yes, their fewer complaints really will make this hospital a better place. 

And my friend is looking around at all this, and maybe because he didn’t get a book, maybe because he’s a critical thinker, he’s not getting with the program. He’s wondering something completely different.

He’s wondering why the speaker and the hospital see the employees as the source of the problem. He’s wondering why any employee negativity isn’t seen as a result of something larger and more systemic. He’s wondering why the people that have to change aren’t the ones at the top? Maybe he’s been hanging out with me too much or reading too many of the booksI recommend on TOC.

This place really is a classic example, but you see it everywhere. Leadership sees a problem. It never occurs to them that the problem is something they did. They see only the straw that broke the camel’s back, never the policy that over-weighted the camel. They focus on that straw. Who brought that straw? Who allowed that straw to be loaded? Which low level supervisor said that someone could do that? All these questions have a common assumption.

People are shitty and need a lot of rules. Think about it. It’s a common assumption. Not just in hospitals, but in our lives, everywhere we look. It’s an incredibly common assumption. We could make a different one.

Eli Goldratt, the guy who described TOC, developed a different set of assumptions by which he lived his life. Here they are:

  1. People are good
  2. Every conflict can be removed
  3. Every situation, no matter how complex it initially looks, is exceedingly simple
  4. Every situation can be substantially improved; even the sky is not the limit
  5. Every person can reach a full life
  6. There’s always a win-win solution

Let’s just take the first one for now. People are good. Yes, they are. They don’t wake up in the morning and say, “I’m going to go get a job at a hospital and screw things up for the people that run the place. The more trouble I make, the happier I’ll be.” They wake up wanting to do good. They go to work to try to do good. They look for ways the system will let them do good. That means that when people act as if they aren’t good, it is an undesirable effect of some cause in the system. The people aren’t the problem; the problem is in the system.

My friend’s bosses never learned that, but my friend has. Maybe it is because I’ve made him read Goldratt’s books. Maybe he just sees people for what they are. 

It’s hard to work in a system where the leader or leaders don’t see the problems they create. It doesn’t matter if the system is a family, a Boy Scout troop, a hospital, a multi-national company or a country. It’s all the same to the universe; the size doesn’t matter. People want to leave such a system if they can. Small systems are easier to leave than large systems. Maybe that’s one reason system leaders keep trying to enlarge their systems. 

I Won't Change a Thing, I Swear

The Logic of Consequences

The Logic of Consequences