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Theory of Constraints (TOC) As an Operations Improvement Methodology at the Private Healthcare Sector in Cyprus Spyridon Bonatsos

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Theory of Constraints (TOC) As an Operations Improvement Methodology at the Private Healthcare Sector in Cyprus Spyridon Bonatsos Theory of constraints (TOC) as an operations improvement methodology at the private healthcare sector in Cyprus Spyridon Bonatsos To cite this version: Spyridon Bonatsos. Theory of constraints (TOC) as an operations improvement methodology at the private healthcare sector in Cyprus. Business administration. Université de Strasbourg, 2019. English. NNT : 2019STRAB021. tel-02965900 HAL Id: tel-02965900 https://tel.archives-ouvertes.fr/tel-02965900 Submitted on 13 Oct 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Université de Strasbourg Ecole Doctorale Augustin Cournot HuManiS (ED 221) THESE POUR L’ OBTENTION DU DOCTORAT EN SCIENCES DE GESTION Application de la Théorie des contraintes (TOC) dans le secteur des soins de santé privé à Chypre THESE présentée par: Spyridon Bonatsos Soutenue le: 20 March 2019 “τα πάντα ρεῖ” – “Everything flows.” Heraclitus JURY Directeur de thése Thierry Nobre Professeur, Université de Strasbourg Rapporteurs Irène G eorgescu Professeur, Université de Montpellier François M eyssonier Professeur, Université de Nantes Membres Philippe Wieser Professeur, Ecole Polytechnique Fédérale de Lausanne Christophe Baret Professeur, Université de Aix Marseille Acknowledgments With this opportunity, I would like to convey my sincere thanks and gratitude to the University of Strasbourg for honoring me with accepting my enrollment to the doctoral program. First and foremost, my deepest gratitude to my supervisor, Professor Thierry Nobre for his valuable support, guidance, and encouragement throughout this journey. Professor Nobre, I cannot find the right words to express my gratitude for helping me grow and develop myself. Your faith in my abilities has armed me with superpowers. Your way of encouraging me is something that I have started using to people around me. Indirectly, you positively affect the lives of people that you will never meet. This is a great contribution to the world. I would also like to appreciate and thank the members of the jury Professors Georgescu, Meyssonnier, Wieser and Baret for their time and effort reviewing, correcting and contributing to this Thesis. Sylvie and Karin thank you for everything. You all make a powerful whole that we all of us really need to go forward. Thank you. I would like to thank Bill Dettmer for his support and for giving so generously his knowledge on the Theory of constraints. Mr. Dettmer, I consider myself a lucky person because I had great teachers in my life. You are one of them. And finally, a million thanks to Phillip Marris. Phillip, you are the hero behind of all these. You have encouraged me to start this Ph.D. journey and also to be trained by Dettmer. This treasure that I will carry with me through time, is because of you. Thank you, I owe you a huge debt of gratitude. My deepest gratitude to the managers of the clinic, who have helped to enhance the success of my Ph.D. Thesis. All this time that I have been with you in the hospital, you have demonstrated how is to be a great leader. Thank you from the bottom of my heart for all of your help, care and wisdom. Hearty thanks to my wonderful family for supporting me during this four-year adventure. I will never forget the picture of all of us sitting around the table and studying i some for the first grade and others for their Ph.D. What beautiful times … I love you all. Abstract It is evident all over literature that healthcare faces operational challenges. Healthcare worldwide is experiencing issues like rising costs and poor quality. Without a true solution, physicians will face lower incomes, patients will pay more, and services will be restricted. The healthcare sector faces increased demand and ineffective services. The healthcare sector is characterized by high levels of complexity, uncertainty, and variation. The aim of this research is to explore the degree of effectiveness of the Theory of Constraints methodology, as an improvement methodology, at the operational environment of a private general-purpose hospital in Cyprus. This research focuses, describes and analyses the implementation of the Theory of Constraints in two different healthcare sub-systems being the housekeeping function (linen management system) and the surgery department (Operating Room) of the hospital. The research is executed into an action research framework where the action research cycles are blended with the Theory of Constraint’s change approach. The action research cycles are implemented via TOC tools and components. From the TOC suite the Five Focusing Steps, the Drum Buffer Rope, the Logical Thinking process, and the Replenishment solution have been implemented. The data collection methodology comprised of both qualitative and quantitative methods. The main approach though is qualitative. For primary data collection – Observation, Interviews (Semi-structured and unstructured) and field data collection were used. The data collected was analyzed by the TOC tools as described in the literature. Excellent results were also measured after the implementation of TOC in one Operating Room. The practice of the Drum Buffer Rope (DBR) managed to create 10 hours of available time per week which can be used to add more surgeries, promising to increase the Throughput of that single operating room by more than 30%. ii This study shows how TOC’s components were adapted to specific sub-systems characteristics in order to improve the research field. Being consistent with the action research philosophy, employees were actively involved throughout the process and conclusions are drawn regarding their acceptance requirements towards the TOC methodology. This study makes theoretical and professional contributions through its findings. Theoretical contributions have been developed for the Goal and Future Reality Trees. A managerial template has been constructed summing up all the findings from all the TOC’s developments aiming to guide managers through the improvement process. iii Contents Acknowledgments .......................................................................................... i Abstract .......................................................................................................... ii List of Figures .......................................................... viii List of Tables .............................................................. x List of Acronyms and Abbreviations ....................... xi Introduction ................................................................ 1 Chapter 1 .................................................................... 7 Theory of Constraints (TOC) - the theory ............... 7 1.1 Introduction to the Chapter ........................................................................ 7 1.2 An evolution - Standing on the shoulders of Giants. ................................ 8 1.3 TOC Philosophy and Key principles ........................................................ 16 1.4 TOC Components ...................................................................................... 19 1.4.1 The Five Focusing Steps (5FS) ........................................................... 19 1.4.2 Thinking Process Tools (TP Tools) .................................................... 25 1.4.3 TOC Performance Measures ............................................................... 37 1.5 TOC Generic Solutions.............................................................................. 39 1.5.1 Drum Buffer Rope (DBR) .................................................................. 39 1.5.2 TOC Replenishment ........................................................................... 44 1.5.3 Critical Chain Project Management (CCPM) ..................................... 48 1.5.4 Throughput Accounting (TA) ............................................................. 49 1.6 Setting the mindset… ................................................................................. 50 1.6.1 TOC and Process of Change ............................................................... 50 1.6.2 TOC and Operations ........................................................................... 59 1.6.3 TOC and Systems ............................................................................... 61 1.7 Chapter Summary ..................................................................................... 64 Chapter 2 .................................................................. 65 Management of Healthcare Operations and Theory of Constraints – a synergy ....................................... 65 2.1 Introduction to the Chapter ...................................................................... 65 2.2 Service Operations Management.............................................................. 66 2.2.1 Systems categorisation and classification ........................................... 66 2.3 Research in Improvement of healthcare Operations .............................. 73 2.4 Theory of Constraints (TOC) in Services ................................................ 78 2.5 TOC and Healthcare.................................................................................
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