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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
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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

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