The Goal: a process of Ongoing Improvement

DW: Yours is a public hospital?
AV: Yes, we’re part of the state health system. In other words, not for profit.
Patients pay only a small amount for services. Later on, after I started
consulting with the Goldratt Institute in South Africa, we looked at a large
private hospital, 600 beds, a flagship hospital with neurosurgery and all the
high-tech stuff. The issue there was loss of capacity in the operating rooms.
The spin-off effect of that was that surgeons were leaving the hospital and
going to other private hospitals. It was a serious situation. We found that

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instead of focusing on local optima—making sure that my little department
comes first—the real question people should be asking is, what can I do to
achieve the larger goal of the hospital, which is to throughput new patients?
It’s a simple concept, but implementing it took about two months of meeting
with staff. Each person then developed an action plan aimed at making sure
more patients moved through the system more efficiently. In a period of a
year, this hospital moved from a 20% shortfall on its budget to where it began
showing a profit.
DW: So you’ve become a Goldratt consultant yourself?
AV: Yes. I presented the results from our hospital’s outpatient clinic at one of
the Goldratt symposia in the early 1990s. This was the first report of a
medical implementation of the Theory of Constraints. Eli Goldratt was there
to hear my presentation, and afterwards he invited me to join the Goldratt
Institute as an academic associate. I was based at the university but involved
in the implementations of his consulting company. I did quite a bit of work in
the mining industry—nothing to do with medicine! It was pure theory of
constraints, straight out of the book. It allowed me to develop my own skills.