Theory of Constraints: An Holistic Approach To Solutions Architecture, Why You All Are Doing It Wrong and What To Do Instead
9/2/2016 12:45 PM
I am running around doing the daily last Wednesday, Rotary in the morning, quick workout, write my little epistle to you, dear readers, Lions over lunch, when I met one Kent Newtown, PE. Kent spent his professional life in the town I grew up in and have returned to. The more I talked to him, the more excited I got. He referenced a book I read several years ago called "The Goal" by Eliyahu Goldratt. "The Goal" demonstrates the Theory of Constraints (TOC) with a series of vignettes illustrating one manager's quest to improve his employee's productivity.
That doesn't seem to have a lot to do with Health Information Technology (HIT) until you look at it a little deeper, and have someone smart like Kent explain it to you and literally give you an executive summary of both a book "Necessary But Not Sufficient" and 7 hours of presentation by Mr. Goldratt.
In the presentation Mr. Goldratt explains that
If we want to be successful with the implementation of new technology, we must find the things that helped us live with the old limitations and change the rules to take advantage of the new methods.
In this blog you have heard me preach about Bob Cratchit and Jacob Marley and how nothing has really changed since 1843 except that Bob Cratchit XXXII doesn't get ink on his fingers when he works with his spreadsheets. You have heard me crow about how a small group of bright people came up with an industry changing car, the Mustang, and a cast of thousands in focus groups almost murdered the pony car eight years later with the Mustang II. This is precisely what Mr. Goldratt is talking about in his book and presentation.
Mr. Goldratt goes on to state that a client talking to a software provider should only care about
"....making sure my people have the data they need. Your computers, your software - I don't want to know about them. I don't want to hear about bugs. I don't want to hear about new versions. I don't want to hear about hardware. That's your headache. What I want are the end results; the information available when my people need it, where they need it and in the form they need it in."
Well said, Eli, well said. If you, Mr. Manager, are going to mandate all the technologies, processes and design patterns, apparently you know as much about it as we do and you should just develop the solutions yourself. As the President of Sentia Systems and Sentia Health, I can unequivocally state "that's fine with me." You all keep doing what you are doing and you will keep getting what you already have. That's the same thing you've had with Marley and Co. since 1843.
So what does that all mean for healthcare? Well, let's consider what 'rules' we have to change. Let's further assume that doctors know what they are doing and give the best care they possibly can. That leaves all the ancillary systems and protocols that practitioners use to get the job of dispensing care done. enter Sentia Systems and Sentia Health. If you want me to solve your problems, the software is a black box, you input some stuff, you get out the stuff you need. In the case of healthcare, practitioners document care, and a check shows up. It costs the practitioner nothing, no medical coding, no billing, no EMR and its associated implementation costs, and it costs the patient about 1/10th of what they pay their current insurance company to do the same job. Health insurance companies make the process more complicated than it really is with all the little Cratchits and focus groups. We propose to do away with health insurance as we know it altogether, ditch the 'rules' that go along with health payments, and automate the entire process.
We've taken the Theory of Constraints and the holistic approach to designing solutions to the streets and are actually building software that automates entire industries. In this case the healthcare industry, but Sentia Systems has several clients who have automated entire businesses. They literally click the button that sends out bills at the end of the month and that is it. Work complete.
Go buy "Necessary But Not Sufficient." Understand why Bob Cratchit XXXII doesn't have ink stained fingers but still does nothing different that his Great^31 Grandfather did in 1843. Ask for better.
- Technology can bring benefits if and only if it diminishes a limitation and
- Long before the availability of technology we developed modes of behavior, policies, measurements and rules to help us accommodate the limitation