Applying the theory of constraints in health care: Part 1--The philosophy.

The imperative to improve both technical and service quality while simultaneously reducing costs is quite clear. The Theory of Constraints (TOC) is an emerging philosophy that rests on two assumptions: (1) systems thinking and (2) if a constraint "is anything that limits a system from achieving higher performance versus its goal," then every system must have at least one (and at most no more than a few) constraints or limiting factors. A constraint is neither good nor bad in itself. Rather, it just is. In fact, recognition of the existence of constraints represents an excellent opportunity for improvement because it allows one to focus ones efforts in the most productive area--identifying and managing the constraints. This is accomplished by using the five focusing steps of TOC: (1) identify the system's constraint; (2) decide how to exploit it; (3) subordinate/synchronize everything else to the above decisions; (4) elevate the system's constraint; and (5) if the constraint has shifted in the above steps, go back to step 1. Do not allow inertia to become the system's constraint. TOC also refers to a series of tools termed "thinking processes" and the sequence in which they are used.