Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T19:25:13.413Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving the process of developing technical reports for health care decision-makers: Using the Theory of Constraints in the Evidence-Based Practice Centers

Published online by Cambridge University Press:  27 February 2006

Meenal B. Patwardhan ,
Antonio Sarría-Santamera  and
David B. Matchar
Meenal B. Patwardhan
Affiliation:
Duke University
Antonio Sarría-Santamera
Affiliation:
Spanish Agency for Health Technology Assessment
David B. Matchar
Affiliation:
Duke University
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To apply the Theory of Constraints (TOC) to the Evidence-based Practice Center (EPC) process.

Methods: Participants in the EPC process were interviewed, and the technical contracting literature was reviewed. Undesirable effects (UDEs) that might occur in the EPC process were identified and, in a TOC Current Reality Tree (CRT), a fundamental UDE was selected and tracked back to potential root causes, focusing on the core “constraint.” The resulting draft CRT was presented at an EPC directors' meeting and finalized. From possible solutions obtained from interviews and literature, a Future Reality Tree (FRT) was constructed.

Results: Three UDEs were identified and that a report is not used was deemed fundamentally undesirable. Nine root causes were identified, and using the CRT, a core constraint emerged: EPC partner does not know how to conceptualize and articulate needs, objectives, and specifications. Two change strategies (“injections”) appeared to address the core constraint: establish an ongoing relationship between partners, EPC, and Agency for Healthcare Research and Quality early in the process, and use a changes clause; in a FRT the injections lead to the positive outcome—the production of a successful EPC report that meets partner needs and, therefore, will be used.

Conclusions: As with any complex enterprise, the EPC needs to engage in self-reflection and active improvement to maximize its value. The development of technical reports intended to inform decision making represents a complicated area, involving a network of interrelated processes. Using the TOC permitted us to understand process failures; results serve as a guide to improvement.

Keywords

Health technology assessmentTheory of ConstraintsQuality improvementEvidence-based medicine
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 1 , January 2006 , pp. 26 - 32
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Canadian Health Services Research Foundation. 2005. Evidence-based decision-making. Available at: http://www.chsrf.ca/knowledge_transfer/pdf/EBDM_e.pdf. Updated June 2000. Accessed July 12
Canadian Health Services Research Foundation. 2005. Knowledge transfer: Looking beyond health. Available at: http://www.chsrf.ca/knowledge_transfer/pdf/ktransfer_e.pdf. Updated October 2000. Accessed July 12
Canadian Health Services Research Foundation. 2005. If research is the answer, what is the question? Available at: http://www.chsrf.ca/knowledge_transfer/pdf/research_e.pdf. Updated 2001. Accessed July 12
Cole PS. 2003. How to write a SOW. Vienna: Management Concepts;
Department of Defense. Handbook for preparation of statement of work (SOW). Available at: http://www.acqnet.gov/Library/OFPP/BestPractices/pbsc/library/DODhandbook.pdf. Updated 1996. Accessed July 12, 2005.
Dettmer HW. 1997. Goldratt's theory of constraints: A systems approach to continuous improvement. Milwaukee: ASQ Quality Press;
Federal Acquisition Regulation. 2005. FAC 24. Available at: www.arnet.gov/far/. Updated 2004. Accessed July 12
Frenk J. 1992 Balancing relevance and excellence: Organizational responses to link research with decision-making. Soc Sci Med. 35: 1397– 1404.Google Scholar
Kershaw R. 2005. Using TOC to ‘cure’ healthcare problems. Management accounting quarterly. Available at: http://www.imanet.org/ima/sec.asp?TRACKID=CID=1030DID=1662. Updated 2000. Accessed July 12
Keyes WN. 1990. Government contracts: In a nut shell. St. Paul: West Publishing Co;
Lavis JN, Ross S, Hurley JE, et al. 2002 Examining the role of health services research in public policymaking. Milbank Q. 80: 125– 154.Google Scholar
Lavis JN, Robertson D, Woodside JM, et al. 2003 How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q. 2: 221– 248.Google Scholar
Martin MG. 2002. Delivering project excellence with the statement of work. Vienna: Management Concepts;
National Aeronautics and Space Administration. 2005. Statement of work (SOW): Guidance for writing work statements. Available at: http://www.hq.nasa.gov/office/procurement/newreq1.htm. Updated 1997. Accessed July 12
NHS Learning Network. Focusing on ophthalmology waiting lists: Using the ‘theory of constraints’ methodology to increase improve services to patients. “ImpAct.” Available at: http://www.jr2.ox.ac.uk/bandolier/painres/download/ImpAct6.pdf. Updated 2000. Accessed July 12, 2005.
Ontario Ministry of Health and Long-term Care. 2005. The Canadian Health Services Research Foundation. Building research transfer relationships: Proceedings of the Ontario Ministry of Health and Long-term Care Workshop. Available at: http://www.chsrf.ca/knowledge_transfer/brtr_e.php. Updated 2000. Accessed July 12
Project Management Institute. 2000. A guide to the project management body of knowledge. Newton Square: Project Management Institute, Inc.;
Roybal H, Baxendale SJ, Gupta M. 1999 Using activity-based costing and theory of constraints to guide continuous improvement in managed care. Manag Care Q. 7: 1– 10.Google Scholar
Womack DE, Flowers S. 1999 Improving system performance: A case study in the application of the theory of constraints. J Healthc Manag. 44: 397– 405.Google Scholar