[1. The speaker emphasizes the importance of leadership and organizational culture in successful TOC implementations. 2. The speaker shares experiences from past implementations, highlighting the impact of leadership and culture on the outcome. 3. The speaker proposes a model for understanding and addressing leadership and culture issues in organizations.]
This presentation provided the health context: UK healthcare is the largest employer in Europe with a workforce of over 1.3 million people, many of whom operate as highly qualified front-line staff (doctors and nurses); the largest London teaching hospital employs more staff than, for example, the whole of Hewlett Packard Europe; in a typical teaching hospital, there are more than 400,000 visits to outpatient clinics per year; 60,000 inpatients; 25,000 operations and 75,000 attendances to the accident and emergency department; the 'Number One' pledge of the UK government at the last election was to deliver a breakthrough in performance in healthcare; in the last three years, the national budget has been increased by over 30% and the number of patients treated has increased by 3.7%; there are backlogs of between 9 and 18 months for operations; and many chief executive / senior management posts remain unfilled. The chain of activities in healthcare includes inputs from ambulances, general practitioner referrals and elective surgery patients to admissions and emergency, acute, community hospital, residential and nursing care, and social and healthcare activities. Buffers were placed in the emergency department to identify and eliminate problems through weekly multi-team one-hour buffer management meetings. Results include: hospital '1' treated over 95% of patients in less than 4 hours; hospital '2' achieved 100% performance at 4 hours; therefore, it shifted its goal to three hours and achieved over 95%. Buffer management has been implemented across the full system to identify and eliminate problems, thus reducing task time averages and standard deviations associated with patient care.
