toc应用在医疗卫生系统的案例

1、TOC应用在医疗卫生系统的案例nterview with Dr. Antoine Van Gelder A South African Hospital University of Pretoria 采访安托万凡塞尔达医生 南非比勒陀利亚大学一家医院 DW: You're not a typical Eli Goldratt disciple, are you? 伟福：你并不是个典型的高德拉特信徒，对吧？ AV: I'm a university professor with a dual appointme

2、nt, head of the department of internal medicine at the University of Pretoria and head of the department of internal medicine at Pretoria Academic Hospital. In 1992 1 got an invitation to attend one of Eli Goldratt's courses in Pretoria. Not one run by him himself but by a subsidiary of the Gold

3、ratt Institute. At that time I knew nothing about theory of constraints and 1 had not read The oaL 1 got myself into this out of curiosity more than anything else. 塞尔达：我是有双重职务的大学教授，我是比勒陀利亚大学内科医学部主任，也是比勒陀利亚学术医院内科医学部主任，1992年我受邀参加高德拉特在比勒陀利亚的一个课程，不是由他本人开的，而是由高德拉特学会的分会开的，那时我对TOC制约法一无所知，也没有读过目标，参与其中可

4、能主要还是出于好奇。 DW: Why? What kind of help were you looking for? 伟福：你想寻求怎样的帮助呢？ AV: Let me put it this way. I was literally sitting in my office, with my head in my hands, highly frustrated, with piles of paper all around me, going through correspondence. 1 opened a letter, saw that it was

5、 another invitation to a course, threw it away, and as 1 threw it in my wastepaper basket my eye caught the price of this particular course. It was the South African equivalent of about $18,000. That caught my attention. 1 thought if any course was worth that amount it was worth looking at. This was

6、 a two week course in production management, the invitation was addressed to the engineering faculty. It had gotten to the medical faculty by mistake. The course was actually offered free to university professors. So because of my deep frustration with some of the management issues 1 had in my depar

7、tment, and because I had some time off the next week, 1 phoned. 1 planned to only go for the first week, because this was the time 1 had available. 1 was told that 1 had to attend the full two-week course. 1 said, "Yeah, we'll see about that." 塞尔达：这样说吧，我当时坐在办公室里，托着下巴，有点沮丧，周围是一堆堆的一

8、文件和信函，我打开了一封信，又是一封邀请我参加课程的信，扔掉它吧，但当我把它扔进废纸篓里的时候，我一下子看到了课程的价钱，它引起我注意，换算成南非货币，是大约一万八千元。我想，课程这么值钱，就值得看看，这是个为期两周的课程，讲的是生产管理，邀请函是寄给工程学院的，误投到了医学院，大学教授可以免费出席，由于我对自己部门中的一些管理问题十分头疼，下周我正好轮休，我就打了电话报名，我本来计划只参加一周，因为我的空闲时间就只有这么多，但对方说我必须参加两周的全部课程，我就说：“好，那我就来看看吧。” DW: But you went? 伟福：那你去了吗？ AV: I we

9、nt the first week. The course was taught with reference to a production environment and the logic around it. Now you don't find much of this logic-the reality trees and that sort of thing-in The Goal. Quite a lot of that is in It's Not Luck, which was published later. But the logic grabbed m

10、e because 1 was this frustrated man who was running a department of medicine and 1 had not been trained to do that. 1 had no insight into management issues. Suddenly I saw that here was a potential way of analyzing my department.塞尔达：第一周我去了，课程是讲生产及当中的逻辑，目标一书对这逻辑着墨不多，例如现况图之类的东西，但后来出版的绝不是靠运气就多得多了，这逻辑吸引

11、了我，因为我当时正灰心丧气，我在管理一个医学部，但是我从来没有接受过管理培训，对于管理问题，我毫无见识，突然间，我看到这可能是分析我们部门的一个方法。 DW: What were the parallels? 伟福：关联在哪呢？ AV: My department was in chaos, total chaos. Everything coming and going, not knowing what was what-much as things were in the factory that is the setting of The Goal. Du

12、ring the course, The Goal was mentioned. 1 bought it, read it through in one night, and 1 thought to myself, that's my environment. A chaotic system is not necessarily a factory. It could be a hospital with people coming and going. It could be a department with a whole lot of prima donnas-the do

13、ctors-that need to be managed. That parallel struck me. 塞尔达：我们系一片混乱，人人忙忙碌碌，但说不出所以然就像目标那样。课程提及目标，我就买了一册，一个晚上就读完了，我想，书中所说的，就是我面对的环境，混乱的系统不一定只出在工厂，人来人往的医院也有，可能是一大群自以为是的医生所在的部门，这就需要管理，这相似之处令我吃惊。 Now if 1 can answer your question a bit more precisely. When one is introduced to theory of constra

14、ints, the first thing you see is a system where the causality is hidden. In other words, it's chaotic. Things happen, you have no control. Suddenly, though, it becomes a system that can be analyzed in terms of certain key points-leverage points. And one learns that addressing these key points-ra

15、ther than launching a symptomatic firefight-is the way to exert control over these systems. Remember, this was in the early 1990s, before frameworks like systems theory had moved to the forefront and become part of the main buzz. Though the theory of constraints doesn't talk about systems theory

16、, already it was offering an approach by which a complex system could be managed in terms of a few key leverage points. 现在我可以更确切地回答你的问题，你接触TOC制约法之前，看看你身处的系统，当中的因果关系是不明显的，换句话说，系统很混乱，你没法控制，但突然间，它变成了一个可以用某些关键点杠杆点来分析的系统，然后你就明白好好管理这些关键点就可以控制这些系统，而不只是靠一些表面的、救火式的行动。不要忘记，那是九十年代初，当时系统理论之类的观念尚未走到前台成为时尚学说

17、的一部分，虽然TOC制约法不谈系统理论，但它已经提出了一个主张，即通过一些关键的杠杆点来管理复杂的系统。 DW: Did you wind up attending both weeks of the course? 伟福：最后你是不是参加了全部两周的课程？ AV: Correct. Then 1 came back to the hospital. There are two points 1 want to make. The first was that 1 underwent a mental change. In stead of thinking th

18、at things were too complicated, too complex and not manageable, I now saw that if 1 could analyze the system cor- rectly, it was manageable. That was the first important breakthrough that I had, and many people I've taught this to subsequently have had the same breakthrough. There is a way-find

19、it! 塞尔达：是的，之后我就回到了医院，我想讲两点，第一，我的心态发生了变化，以前我觉得事事棘手、太复杂，没法管理，而现在我看到，如果我正确地分析系统，就可以管理它，这是我第一个重要突破，之后我把这个教给了很多人，他们也获得了突破。是有办法找出解决方案的！ Second, our outpatient clinic, like most hospital outpatient clinics at that time, and even now in many parts of the world, was plagued by inefficiencies and lo

20、ng waiting lists. The more we fought the ineffi- ciencies, the more money we poured into the system, the longer the waiting lists seemed to become. This is the problem with the national health system in Britain as we speak. Now in my department, it seemed to me as though the processing of patients b

21、y doctors could really be viewed as a production line, just as in The Goal. The times are differ- ent, and obviously people aren't machines. All of those issues 1 ac- knowledged. But 1 saw that parallel. 第二，我们的门诊部，就像当时的大多数医院门诊部一样，甚至和现在世界上很多地方的门诊部一样，被低效率和和长长的轮候清单困扰着，我们越花气力来应付效率问题，投入系统的钱越多，轮候

22、清单就越长，英国全国卫生体系也有同样的问题。在我的部门中，医生处理病人的流程可以看成是一条生产线，就像目标那样，当中步骤所需时间当然不同，人也不是机器，这些我都得承认，但是，我还是看到了相似之处。 DW: How did you attack the problem? 伟福：你是从何入手解决问题的？ AV: The manager in charge of that clinic and 1 sat down and 1 told her about the principles used in The Goal. Between the two of us-wi

23、th her doing most of the work-we identified our constraint. We realized that we lost a tremendous amount of capacity whenever patients or doctors wouldn't show up for scheduled appointments. That time lost was not recoverable. So we developed a call-in list, which we called the patient buffer. A

24、 day or two before a scheduled appointment we would phone patients and make sure that they would be coming into the clinic. If not, we would find substitute patients. The result was less loss of capacity. Our waiting list at that time was about eight or nine months long, which is common for this typ

25、e of waiting list. As a mat-ter of fact in the UK now some of these waiting lists are over one year In about a six month period we got our waiting list below four months, which was roughly half of what most other hospitals were doing in South Africa at that time. 塞尔达：我和门诊部经理坐下来，告诉她目标一书所表达的原则，我们

26、两个人，主要是她，花点时间就找出了我们的制约因素，我们明白到，安排好约见，但医生或病人到时却没有来，我们就损失了大量产能，失去的时间是不能挽回的，于是我们就制定了一个电话清单，把它叫做病人缓冲，在病人接受诊治之前的一两天，我们打电话给他们，确保他们能按预约时间到医院来，如果来不了，我们就让其他病人替补，结果产能的损失减少了，我们当时的轮候清单有八九个月长，很标准的了，事实上，英国一些轮候清单超过一年长，而我们在大约在六个月内，就把轮候时间降至不到四个月，这大约是当时南非大多数医院排队时间的一半。 DW: Yours is a public hospital? 伟福：你们的医

27、院是一家公立医院吗？ AV: Yes, we're part of the state health system. In other words, not for profit. Patients pay only a small amount for services. Later on, after 1 started consulting with the Goldratt Institute in South Africa, we looked at a large private hospital, 600 beds, a flagship hospital wi

28、th neuro- surgery and all the high-tech stuff. The issue there was loss of capac-ity in the operating rooms. The spin-off effect of that was that sur-geons were leaving the hospital and going to other private hospitals.It was a serious situation.We found that instead of focussing on local optima-mak

29、ing sure that my little department comes first-the real question people should be asking is, what can 1 do to achieve the larger goal of the hospital, which is to throughput new patients? It's a simple concept but implementing it took about two months of meet-ing with staff. Each person then dev

30、eloped an action plan aimed at making sure more patients moved through the system more efficiently. In a period of a year, this hospital moved from a 20% shortfall on its budget to where it began showing a profit 塞尔达：是的，我们是国家卫生体系的一部分，换句话说，是非谋利的，病人只需支付一小部分服务费用，后来，我和南非的高德拉特学会联手进行顾问工作，面对一家很大的私营医院，

31、有600张病床，是一家具神经外科及高科技的旗舰医院，那里的问题是手术室产能丢失，这产生的负面效应就是医生不断离职，加盟其他私营医院，情况很严重。我们发现，部门不应以自己为先，只顾局部效益，而应该问自己：我可以做点什么事来达到医院的更远大的目标增加医院在病人处理上的流量？相关的概念并不复杂，但实施就需要花两个月时间动员员工，跟他们开会，每个人都制定一个行动计划，旨在保证更多病人会更快速有效地流过医院的系统。实施开始后的一年内，这家医院由原来的20%财务预算赤字，转化为有盈利。 DW: So you've become a Goldratt consultant yourself

32、 伟福：那么，你自己就成为了高德拉特顾问了？ AV: Yes. 1 presented the results from our hospital's outpatient clinic at one of the Goldratt symposia in the early 1990s. This was the first report of a medical implementation of the theory of constraints. Eli Goldratt was there to hear my presentation, and afte

33、rwards he in-vited me to join the Goldratt Institute as an academic associate. 1 was based at the university but involved in the implementations of his consulting company. 1 did quite a bit of work in the mining industry-nothing to do with medicine! It was pure theory of constraints, straight out of

34、 the book. It allowed me to develop my own skills. 塞尔达：是的，九十年代初，我在一个高德拉特论坛上展示我们医院门诊部的成绩，这是第一个关于TOC制约法在医学界的应用的报告，当时高德拉特聆听了我的报告，之后他就邀请我作为学界会员身份加入高德拉特学会。我的主要工作还是在大学里，但也参与高德拉特学会的顾问工作，我在采矿业中做了不少工作，都跟医疗无关！那纯是TOC制约法的应用，紧跟书本上的概念，这些活动提高了我的管理能力。DW: What's a doctor doing advising mining companies?

35、0;伟福：一位医生为采矿公司当顾问，那是怎么一回事？ AV: It's interesting that you say that. I'm a physician, not a surgeon, In other words I'm a thinker, not a doer. 1 say that facetiously but as a physician, it's all about diagnosis. And the whole process of diagno-sis, whether it's a patient or an

36、 organization, is the application of the scientific method. Eli Goldratt says that his theory of constraints is simply the application of the scientific method. So it's almost natural that an advisor to a mining company-in terms of diagnosing what's wrong and what to do about it-could be a p

37、hysician. In fact some of the teaching materials that the Goldratt Institute uses refer to the medical model. It asks trainee consultants, How does a doctor ap-proach the problem? It gives them a parallel for how you diagnose problems in organizations. 塞尔达：你这问题很有意思，我是内科医生，不是外科医生，换句话说，我是动脑筋的人，不是动手的人，这说法有点滑稽，但说到底，作为内科医生，诊断就是主要任务。而诊断的整个过程，不管对象是病人还是机构，都是科学方法的应用，高德拉特说他的TOC制约法只是科学方法的应用而已，所以，为采矿公司诊断难题及寻找解决方案的人是内科医生，可以说是很自然的了，其实，高德拉特学会使用的一些教材也参照医学模式问接受培训的顾问：医生是怎样对待问题的？这为他们诊断机构内的问题提供了借镜。 DW: That's interesting. Eli has said that his overriding ambition in life is to teach the