Identifying and Addressing the Underlying Core Problems in Healthcare Environments: An Illustration Using an Emergency Department Game.

Gustavo M Bacelar-Silva,James F Cox,Pedro Pereira Rodrigues,Humberto R Baptista

doi:10.3390/ijerph181910083

Abstract

The emergency department (ED) crowding is a critical healthcare issue worldwide that leads to long waits and poorer healthcare outcomes. Goldratt’s theory of constraints (TOC) has been used effectively to improve such problematic environments for more than three decades. While most TOC solutions are simple, with many viewing them as purely common sense, they represent paradigm shifts in how to manage complex, uncertain, and silo environments. Goldratt used a simple dice game with a straight flow (I-shape) to illustrate the impact of dependent resources and statistical fluctuations in managing resources. Additionally, games help to overcome resistance to change and gain ownership by having participants develop their solutions. This new cooperative game illustrates an ED environment where patients may follow different care pathways according to their clinical needs, timeliness of care is measured in minutes, the demand is highly uncertain, and treatment must frequently start almost immediately. A Monte Carlo simulation validated the TOC solution to this ED game, achieving results similar to the real TOC’s implementations. Moreover, this article provides a thorough process to Socratically introduce TOC to healthcare professionals and others to recognize that the EDs’ (like other healthcare systems’) core problem is the traditional approach to managing them.

Highlights

An emergency department (ED) is a medical facility where emergency patients can receive timely and specialized care without prior appointments, but it is not the reality in many healthcare organizations
The general flow starts upon walking into the ED (WALK-IN), the patient is processed at REGISTRATION and follows to TRIAGE and MEDICAL ASSESSMENT
That is the aim of the theory of constraints (TOC) solutions: always try to achieve both requirements (B and C) of the evaporating cloud

Summary

Introduction

An emergency department (ED) is a medical facility where emergency patients can receive timely and specialized care without prior appointments, but it is not the reality in many healthcare organizations. ED crowding is a critical healthcare issue worldwide, and it has been worsening over time. Several studies have reported adverse consequences of ED crowding for both patients and staff [1,2,3,4]. ED crowding affects patients in many ways. It increases delay in medical assessment and adequate treatment, which may prolong physical and emotional suffering, contribute to worsening clinical conditions and avoidable complications, elevate exposure to error, and, increase mortality [1,2,3,4]. Staff experience increased stress levels, including exposure to violence, and reduced adherence to clinical guidelines during ED crowding [2]

Objectives

Methods

Results

Discussion

Conclusion