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

Gustavo M. Bacelar-Silva, James F. Cox, Humberto R. Baptista and Pedro Pereira Rodrigues
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Gustavo M. Bacelar-Silva: Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, 4200-450 Porto, Portugal
James F. Cox: Management Department, Terry College of Business, University of Georgia, Athens, GA 30602, USA
Humberto R. Baptista: Vectis Solutions, São Paulo 04088-004, Brazil
Pedro Pereira Rodrigues: Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, 4200-450 Porto, Portugal

IJERPH, 2021, vol. 18, issue 19, 1-22

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.

Keywords: hospital emergency service; hospital administration; delivery of health care; problem-based learning; board game; theory of constraints (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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