The Impact of Theory of Constraints (TOC) in an NHS Trust

This study investigated the impact of theory of constraints (TOC), a change methodology previously employed in the private sector and now adapted to the health sector, on three NHS Trust departments, Neurosurgery, Eyes and ENT, especially in relation to reducing waiting lists in the system and improving throughput of patients. Data was collected over a period of 40 months, on a number of NHS performance indicators, before and after the TOC intervention. An interrupted time series design with switching replications was used to investigate the impact of the intervention. An overall ARIMA analysis indicated that TOC had an impact in both Eyes and ENT. Out of 18 measures, 16 went in the direction of the hypotheses - the probability of these changes in the predicted direction by chance alone was 0.0006. However, there was a lack of significant improvements in neurosurgery that was associated with the size of the system, complexity of treating neurological disorder, heavy reliance on support services, impact of emergencies on elective work and the motivation and receptiveness of staff to the proposed changes. Practical implications of this study showed that in order for organisations to maximise the benefits of TOC, organisations should take into account the social environment in which they exist. The importance of customising the intervention to the local needs of each department, and the requirements for leadership and robust project management are highlighted in this study. Failure to do so can potentially derail the change process.

Lubitsh, G., Doyle, C. & Valentine, J. (2005) The Impact of Theory of Constraints (TOC) in an NHS Trust, Journal of Management Development, Vol. 24, No. 2, pp 116-131.