IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v18y2021i19p10083-d643137.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal
    Department of Distance Learning, Bahiana School of Medicine and Public Health, Salvador 40285-001, Brazil)

  • 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
    Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal)

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.

Suggested Citation

  • Gustavo M. Bacelar-Silva & James F. Cox & Humberto R. Baptista & Pedro Pereira Rodrigues, 2021. "Identifying and Addressing the Underlying Core Problems in Healthcare Environments: An Illustration Using an Emergency Department Game," IJERPH, MDPI, vol. 18(19), pages 1-22, September.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:19:p:10083-:d:643137
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/18/19/10083/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/1660-4601/18/19/10083/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. James F. Cox, 2021. "Using the theory of constraints’ processes of ongoing improvement to address the provider appointment scheduling system execution problem," Health Systems, Taylor & Francis Journals, vol. 10(1), pages 41-72, January.
    2. Umble, Michael & Umble, Elisabeth J., 2006. "Utilizing buffer management to improve performance in a healthcare environment," European Journal of Operational Research, Elsevier, vol. 174(2), pages 1060-1075, October.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Reyes, Pedro M. & Li, Suhong & Visich, John K., 2012. "Accessing antecedents and outcomes of RFID implementation in health care," International Journal of Production Economics, Elsevier, vol. 136(1), pages 137-150.
    2. Miguel Angel Ortíz-Barrios & Juan-José Alfaro-Saíz, 2020. "Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review," IJERPH, MDPI, vol. 17(8), pages 1-41, April.
    3. Cui, Nanfang & Demeulemeester, Erik & Bie, Li, 2016. "Incorporation of activity sensitivity measures into buffer management to manage project schedule riskAuthor-Name: Hu, Xuejun," European Journal of Operational Research, Elsevier, vol. 249(2), pages 717-727.
    4. Xuejun Hu & Erik Demeulemeester & Nanfang Cui & Jianjiang Wang & Wendi Tian, 2017. "Improved critical chain buffer management framework considering resource costs and schedule stability," Flexible Services and Manufacturing Journal, Springer, vol. 29(2), pages 159-183, June.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:18:y:2021:i:19:p:10083-:d:643137. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.