TOC Thinkers

Q&A with Gijs Andrea - TOC in Healthcare

I've been chatting a bit recently with Gijs Andrea who uses TOC in healthcare over in The Netherlands.

I'm going to publish a few questions and answers, but first here's a wee essay which Gijs wrote to introduce himself and experiences.

1985 - The Goal

Eli Goldratt visits The Netherlands. He explains his Theory of Constraints to a large audience in Utrecht. I have just switched from the telecom industry to healthcare. I don’t know why, but I was touched by the invitation to listen to an amazing story about Jonah. The show by Eli was inspiring: a small man on the stage, very, very self confident and sometimes shouting to me that it was really very simple!! But Eli talked about money, money, money! And as far as I knew, healthcare was everything BUT money. So how could I ever use Throughput, Operational Expenses and Inventory in a hospital?? It was about patients and doctors and nurses. I buy a book and leave puzzled….

1995 - The Haystack Syndrome

Eli Goldratt visits The Netherlands again. In Noordwijk he unfolds new insights, new technology and new logic. I have just started my own consultancy company in healthcare and searched for fast growth.

Again the Theory was very simple and very face-slamming. How could I not understand and not use it? How as a manager of my company could I calculate a loss when deciding on the P and Q? I almost left in deep depression and desperate to be able to translate his logic to my business. I buy a book and leave hopeful …..

2003 – The Critical Chain

Eli Goldratt must love The Netherlands: he comes again!! I feel my hope from the past still burning inside. Healthcare is still a mess: costing too much, producing too little, despite of all my consultancy work! There must be another way. Eli explains his Viable Vision in his own Eli-way, confronting me with everything I do not want to hear: identify the constraint and exploit it! Healthcare is one BIG constraint, capacity and money to begin with, but I again listen. There must be a way to apply such simple logic in complex healthcare. At last I dare to ask Eli about healthcare. He almost chokes, almost swallows his pipe, seems to look for help from above and asks me if I really want to continue working in healthcare. There are so many other areas in life to shift paradigms…but if I insist: talk to Patrick Hoefsmit and Alex Knight, they know more. I buy a Self Learning Program and leave inspired ….

2005 – The Race

Eli Goldratt again shows up behind the dunes of the low country, he seems to live there almost. He hasn’t changed a bit. He is still the same as the one in the Self Learning Program: inspiring, touching, moving people from where they are to where they do not want to be at first. I now know what he is talking about and I now know how to apply his logic in healthcare. The first hospital in The Netherlands has taken the challenge to shift a paradigm and apply TOC to achieve more of its goal: getting patients through the system (healthier of course!). And I took the challenge: let TOC be the main way in healthcare! It took a couple of years, but it’s never too late to shift your paradigm! I don’t buy books any more ….

2015 – The Viable Vision

Eli Goldratt still loves The Netherlands and not only for its beautiful skies and far sights across a flat country. Healthcare is so perfectly organized: no waiting lists at all, treatment is given instantly and rapidly at low cost. Nurses and doctors always smiling and taking time for every patient. Eli notices buffer management all over the place and feels really at home when taking his yearly body scan. He still feels strong enough to jump and shout and emphasize that TOC is of strategic importance for every industry, whether it is about profit or about not-for-profit. His Viable Vision is not a vision anymore: it is real and it works! You must be an idiot not to use it!

Gijs Andrea
TOCreate BV
The Netherlands

More to come ...

Q&A with Gijs Andrea - TOC in Healthcare - Q1

Q1:  Hey Gijs,  You've already told me a good bit about your TOC background, but can you now tell me what you do with TOC today? 

There are a number of things I do with TOC today.

First of all I (with my company TOCreate) support 4 hospitals with their implementation of TOC as a management philosophy. Such a project consists of 3 elements, of course based on generic TOC principles. First we free up capacity in exactly the same way as Jean Sloan in Fife (Scotland) described, namely by running workshops and installing Jonah software on every ward. We achieve exactly the same results as in Five: a decrease in average length of stay of patients on the wards somewhere between 20 and 40%. This results in empty beds, less work in progress (a term which we normally do not use in the hospital, because in our case it refers to people…), less stress for nurses and doctors and of course (up to a certain limit) room for more patients to be treated. In The Netherlands there is a huge pile of WIP, meaning that there are a lot of patients waiting between steps in the process of their treatment. Normally nobody is aware of that phenomenon, because everybody knows a doctor is always very busy with hundreds of patients, the operating theatre is an expensive resource and should be used 100% of the time and is planned weeks or months in advance and every bed on a ward must be utilized by a patient every single day of the year. Local optimization is the leading principle in today’s healthcare in my country. Except of course in those hospitals that are implementing TOC right now.

The second step in the TOC process is to create new streams of revenues. We do that by getting Throughput Accounting in place, thus delivering insights in how to decide on a new product mix and generating more throughput, of course without raising inventory and/or operating expenses too much. The capacity freed up by Jonah will be used to extend on the hospital’s already existing areas of excellence and furthermore on free products (not touching the constraint) or products with the highest contribution per CCU (if that ever exists in healthcare, I’ll come to that later on). A very important part of this step is teaching the hospital to think, as Eli puts it. We educate management and medical staff on using the Thinking Processes to break clouds in healthcare and to create win-win solutions for both hospitals, insurance companies (it would take a complete weblog to explain how The Netherlands take care of the financial aspects of their healthcare system) and patients.

The third step in the whole process is to create sustainability or, as we better understand it, POOGI. I now know that that’s the most difficult part of making TOC the main way of management. At least as long as the majority of organizations live with the illusion that the fittest survives, meaning one has to fight to stay alive. I think that it would be a major breakthrough for healthcare and other areas if we all realize that the red curve can be part of our daily life without trying to kill the other one, but instead create win-win solutions for all parties involved.  I hope and expect a lot of knowledge, experiences and wisdom from the way the Japanese embark on the TOC vessel and teach us some more about harmony.

To be honest with you: we have achieved astonishing results in step 1 of this process in healthcare and are now exploring step 2. It again is remarkable how fast our pushing TOC turns into the hospital pulling to enter a next phase. Working with the logic of TOC always seems to automatically lead to the next step. And I am happy that we still have some time to go before we get into the roller coaster of step 3.

The other things I do, are educating and training people in TOC Basics, Buffer Management for Healthcare, Thinking Processes and Throughput Accounting. We started our adventure back in 2004 and already educated more than 20 consultants, almost 40 managers and more than 200 nurses and doctors.

Last but not least we put energy into the TOC Network Nederland in order to bring people together and have them share their experiences on TOC, thus contributing to our own POOGI and our own inspiration; and theirs of course. None of those I do on my own, I work closely together with my partner Jacqueline within TOCreate and with other TOC experts in The Netherlands and abroad. By the way: not to mention my wife and kids who saw their spouse and dad reading Eli, listening to Eli and looking at Eli almost day and night. I think they know Eli even better than I do!

All of our accomplishments would not have been here in The Netherlands if it wasn’t (and still is!!) for Alex Knight and his people in the UK. It is really a great honor to work with him on shifting my own paradigm and after that of Dutch healthcare. If you are interested in his way of thinking and working visit www.healthcare-toc.com and have yourself surprised about what already exists today in the UK.

Q&A with Gijs Andrea - TOC in Healthcare - Q2

Q2: What are you most proud of achieving with TOC?  Why are you proud of this?

The thing I am most proud of achieving with TOC is definitely that I could inspire a lot of people to take the challenge of shifting to a new paradigm in healthcare management. It took a long time and a lot of support from several TOC experts to transfer my good feeling about TOC, which started back in 1985 as I wrote in my little essay for Eli, into a workable solution for Dutch healthcare. Of course I was lucky (but it’s not luck..) to meet the right people at the right time and to work with a few people who trusted me on my blue eyes. Of course I had a lot of septic people in my audiences who helped me to learn more, to ask more, to think more and thus getting me more focused on the subject. And now there is a growing community of ‘believers’ if you like that are thoroughly aware of the enormous value of TOC as a new way of managing organizations. And the really big difference is: it is fun to do! I only see smiling people around me, as if they discovered a new secret…. And that’s exactly why I am proud on what I achieved with TOC: it can not be stopped any more, that is for sure!

Ok, don’t let me take myself too far from the subject. Because in spite of my pride of what we reached so far, there is so much more to do and so much more to learn and so many more people to convince. There are only about 100 hospitals in The Netherlands and a lot more institutions for elderly care, we talk about 1 million people working in healthcare to date. We spend about 70 billion Euros every year on healthcare (which is some 10 percent of our national gross product). When you realize that there is not really a capacity constraint within the system itself (a lot of policy constraints, that’s for sure) and we prove to be able to free up 20 to 40% of that capacity, then you know we are talking about of lot of money being wasted. And that means that we still have a major task to perform. Not to mention the rest of Europe….. I love the red curve!