I recently heard about a classic book from the eighties that apparently was all the rage among business students and aficionados back in the day, but that somehow slipped by me. Since it was about operations management, and presented in an unusual format — a novel — I felt compelled to check it out.

Now that I have, I think medical practice managers should, too.  It’s called The Goal, by Eli Goldratt, and it tells the story of a plant manager named Alex Rogo who must turn around abysmal performance in his manufacturing plant.  Despite achieving ‘efficiencies’ in many steps of production, the plant’s productivity overall has deteriorated to the point where orders are backed up for weeks, and the company’s salespeople can’t reliably forecast when orders can be delivered (and so can’t really sell any new orders, either).  If Alex can’t fix the plant, it will be shut down.

Alex is mentored in the book by a professor named Jonah, who guides him in the process of understanding the plant’s constraints — bottlenecks — and how to increase their throughput.  By analyzing what really drives (or holds back) production in his plant, Alex learns that many of his most relied-upon assumptions aren’t correct — and develops a better way to improve his plant’s productivity.

I happened to be reading this book while working with a medical practice that was having workflow problems, and the parallels were striking.  This practice was proud of its wonderful system for triaging patients — but, the system was so efficient, patients were waiting for ages in exam rooms for their providers.  The practice had over-optimized in triage, creating huge bottlenecks down the line at the exam rooms — and, no benefit whatsoever to patients and no improvement at all in the number of patients seen!  They needed to look at their “plant” with fresh eyes, just like Alex did, to see that overall process efficiency is dependent on the performance of the slowest link in the chain.

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