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Using the theory of constraints’ processes of ongoing improvement to address the provider appointment scheduling system design problem

J.F. Cox III
Health Systems. October 1, 2018

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Health care is in crisis today: costs are rising, demand exceeds supply, quality is questioned and patient wait times are excessive while providers and staff are simultaneously overworked and frustrated. No one has a comprehensive system solution to providing more, cheaper, better, and faster health care, even in primary care practices, the first link in the health care supply chain. Additionally, this link like others frequently experiences the combination of complexity, uncertainty, and local optimisation simultaneously to create a chaotic environment. Health care problems have been called ill-structured (also “wicked”) and because of their tangled web of stakeholders with different and conflicting objectives defy traditional optimisation research methodologies. Proper design and management of the provider appointment scheduling system (PASS) provides a direction for a win–win health care solution (more, cheaper, better, and faster). Our objective is to provide a generic strawman process for developing a robust PASS for most environments. A theory of constraints thinking processes (TP) analysis was conducted on the academic research using a primary care practice to validate both entity and causality existence. From this integrated analysis, a robust process for designing a PASS resulted. Last, we show that Goldratt’s TP provides a logical, rigorous framework for qualitative research and design science.