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1 © 2013 TOCICO. All rights reserved.

TOCICO 2014 Webinars

The Little Prince Pediatric

Hospital

A TOC Study in U.S. Health Care

Presented By: Bill Taylor

Date: February 8, 2014

2

© 2014 TOCICO. All rights reserved.


Abstract

• The Little Prince Pediatric Hospital Study is a theoretical development from the TOC TP diagnosis of various Pediatric Healthcare institutions, conducted with senior executives with US Healthcare experience

• This study leads to the creation of the Generic Transition Strategy and Tactics Tree for LPPH and proposed action plans.

• This Solution can be modified using the 12 Questions Current Reality Branch Excel Apps and/or the Harmony Conflict Resolution Software, to customize for other Healthcare Providers.

• This Webinar will start with a summary "What is TOC for Healthcare?" outline.

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What is TOC for Healthcare?

• Started internationally, shortly after the publication of “The Goal”.

• Many Successful TOC Applications worldwide: South Africa, UK, Holland, Japan, USA, …

• Books on TOC in Healthcare include:

− “We All Fall Down: Goldratt's Theory of Constraints for Healthcare Systems” by Julie Wright and Russ King

− “Focused Operations Management for Health Services Organizations” by Boaz Ronen, Joseph S. Pliskin and Shimeon Pass

− “Performance Improvement for Healthcare: Leading Change with Lean, Six Sigma, and Constraints Management” by Bahadir Inozu, Dan Chauncey, Vickie Kamataris and Charles Mount

− New book in Publication by Alex Knight

• 34 TOCICO Presentations and Papers include

− Alex Knight, Gary Wahdwa, Roy Stratton, Lisa Ferguson, 17 others

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CHANGE MANAGEMENT Creative solutions executed

effectively, efficiently and ethically (win-win-win).

PROJECT MANAGEMENT Project delivery on time,

on scope, on budget.

INNOVATION MANAGEMENT Business ideas made tangible,

sustainable and profitable.

FLOW MANAGEMENT Focusing teams to increase flows of services,

goods, information and money.

TOC Applications in Healthcare

13 TOCICO Presentations 21 TOCICO Presentations

10 TOCICO Presentations 14 TOCICO Presentations

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STEP 1

PRIORITY

STEP 2

PIPELINE

STEP 3

CHECKLIST

STEP 4

MILESTONES

STEP 5

SCHEDULE

STEP 6

DASHBOARD

STEP 7

MANAGE

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STEP 1

GOAL

STEP 2

METRICS

STEP 3

FLOWS

STEP 4

CONSTRAINTS

STEP 5

SUBORDINATE

STEP 6

ELEVATE

STEP 7

LEAD

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STEP 1

SYMPTOMS

STEP 2

ROOTS

STEP 3

TARGETS

STEP 4

CONSENSI

STEP 5

INJECT

STEP 6

CHECK

STEP 7

IMPROVE

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STEP 1

IDEA

STEP 2

PROTOTYPE

STEP 3

STRATEGY

STEP 4

STARTUP

STEP 5

GROW

STEP 6

PROCEDURES

STEP 7

CAPITALIZE

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TOC Apps MultiProjects Leadership Improvement Entrepreneur

MANAGING Projects Flow Change Innovation

STEP 1 - Attune Priority Goal Symptoms Idea

STEP 2 - Assess Pipeline Metrics Roots Prototype

STEP 3 - Value Checklist Flows Targets Strategy

STEP 4 - Plan Milestones Constraints Consensi Startup

STEP 5 - Do Schedule Subordinate Inject Grow

STEP 6 - Monitor Dashboard Elevate Check Procedures

STEP 7 - Act Manage Lead Improve Capitalize

TOOLS/APPS/IT

Critical Chain

Project

Management

TOC, Lean and

6Sigma (TLS),

Global Metrics

TOC Thinking

Processes

Transition

Strategy and

Tactics

© BusinessRxConsulting.com

TOC Toolkit for Healthcare

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TOCICO 2014 Webinars 12 QUESTIONS

By Bill Taylor | On June 6th 2013 | At TOCICO 2013

Standardizing the Generic Current Reality Branch

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12



Agenda: 12 Questions

PART I

Building on the 3 Cloud Generic Process

PART II

12 Questions Generic Current Reality Branch

PART III

12 Questions Excel Tool

PART IV

The New 12 Questions Holistic Process

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Part I: Building on the 3 Cloud Generic

Process

PART I


PART II


PART III


PART IV



TOCICO 2014 Webinars PART I Building on the 3 Cloud Generic Process

15



Critical Organizational

Objective

A1

Critical Necessary Condition

B1

More Desirable Action

D’1

Less Desirable Action

D1


C1


Objective

A2


B2


D’2


D2


C2


Objective

A3


B3


D’1


D3


C3

Generic Critical

Organizational Objective

A

Generic Critical

Necessary Condition

B

Generic/Root More Desirable

Action

D’

Generic/Root Less Desirable

Action

D

Generic Critical

Necessary Condition

C

Our Giant: The 3 Cloud Generic Process

16



Undesirable Effects: Using the Giant to Help a Worried CEO

Get donors & unrestricted

funds

Government payments

dependency

“Superstar” professionals

needed Conflicting demands

Adapting to new

regulations

Money for new technology?

Medical staff

shortage

Progress versus vision?

Patient care or

profitability focus?

Adversarial relationships

Excessive and unreimbursed

diagnostic tests

Long E.R waits

Pervasive “silo"

mentality,

Increasing regulatory constraints

Government audits

Inefficient O.R.

utilization

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The Holistic Method

Find the system Generic/ Root Conflict

Verify that the Generic/Root Conflict is the cause of all/most problems (symptoms or UDEs)

Anticipate the obstacles to the Strategies and Tactics and assemble the Action Plan

List the Un-Desired Effects (Symptoms or UDEs)

of the system

Diagram the Conflicts

DE DE

DE DE DE

DE DE DE

DE

Program and Execute the Solution

START

Consensus Goal and Strategic

Objectives

Define a new strategic direction for the system

Break the Generic/Root Conflict

Define the “Targets” (Desired Effect or DEs) of the system and the Strategies and Tactics to reach them, with out causing new UDEs

Strategies and Tactics

GAP #1

12 Q CRB

GAP #2

Map Chronic Conflict

GAP

#3

12 Q CRT

GAP

#4

Gold

GAP

#5

TRT

18



Step 1 Identify a “giant” not a “chupchick”.

Step 2 Identify the enormity of the area not addressed by the giant.

Step 3 Get on the giant’s shoulders.

Step 4 Identify the conceptual difference between the improved reality and the area untouched.

Step 5 Identify the wrong assumption.

Step 6 Conduct the full analysis to determine the core problem, solution, etc.

6 Steps to Building on the Shoulders of

a Giant

19



Part II: 12 Questions Generic Current Reality Branch

PART I


PART II


PART III


PART IV



TOCICO 2014 Webinars PART II The 12 Questions Current Reality Branch

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The 12 Questions Entity Database

Entity Question01 Question02 Question03 Question04 Question05 Question06 Question07 Question08 Question09 Question10 Question11 Question12 Question12'A B C D D' AB1 AB2

Cell ReferenceQuestion1 Question2 Question3 Question4 Question5 Question6 Question7 Question8 Question9 Question10 Question11 Question12 Question12pA B Cp D Dp F G

Symptom 1 LPPH is not able to raise sufficient unrestricted funds LPPH is unable to support some necessary programsPatient care is compromised; LPPH goals are not metCuts in programs, people, services are madeRestricted funds are better than no funds at allPeople, corporations, governments and foundations are increasingly giving to specific, directed causesDonors want to control the use of money to achieve desired outcomesControl/management of hospital operations; Hospital goals and objectivesFocus on increasing throughput from operations; Create focus and incentives for raising unrestricted funds; New methodologies, strategies and programs for unrestricted fundraisingCurrent development compensation paradigms and structure; No throughput accounting; Negative PR/bias on unrestricted funding; Report of bad use of donationsPossible loss of restricted gifts; bad political/public response to fundraising incentives;Get money for the goals of the donorGet money for the goals of the organizationMeet hospital goals and objectivesGet as much money as you canManage hospital in line with goals and objectivesDon't try to channel money to unrestricted fundsTry to channel money to unrestricted fundsAttainment of hospital goals and objectives is chronically underfundedAvoid cutting people and programs

Symptom 2 LPPH is dependent on extremely unstable government paymentsCannot plan availabilty of LPPH services to needy childrenDifficult to make long term plays; difficul;t to find talent; emotional and mental exhaustionFrustration and exhaustion; Live without a sustainable business modelIt has to be a disaster before government will take action; I must keep focus on the mission; I am proud of the place we haveMisalignment between financial resource assignment and human needs; Out of sync.Federal, State and local officials have their own prioritiesAbility to take care of every child regardless of their ability to payMaximize efficiency and effectivenes of existing resources; try to influence the government - Business case outcomes vs. investment for politicians useContantly changing government players; Lack of standardized procedures and processes; Every "product" is customized; Pediatrics is not a priority (small chunk of the healthcare dollar >10%.); No long term thinking in government;Business case ourcomes are a double edged swordDo not plan for future patient needsPlan for future patient needsBuild a best practice system for children now and the futureMaintain Research, Teaching, Wellness and other strong LPPH best practice programsPlan the availability of services to needy childrenDo not map out the projected needs of all children and plan budget for themMap out the projected needs of all children and plan and budget for themIndividual performance and motivation relate strongly to feeling respected Individual priorities are extremely important to individuals and functions

Symptom 3 The various constituencies of LPPH create conflicting demandsI spend time working out compromisesI can't keep focus on the real priorities of the hospitalI am stressed: I work too hardI love my jobEach constituency focuses on its prioritiesThere is no consensus set of priorities for LPPHHave a great hospital; Provide great healthcare for children; Improve operations; Lead the hospital; Prioritize healthcareDevelop a consensus set of prioritiesDonor interests/focus/requests are prioritized; we do not generate sufficient money; Have no methodology to develop consensusSome constituencies may feel left out and no longer support LPPHContinue to work out compromises with diverse constituenciesDevelop and agree on consensus priorities of constituenciesSuccessfully lead LPPH to achieve its missionSatisfy the demands of the various LPPH Constituencies in the bext way possibleKeep focus on the real priorities of LPPHNot develop consensus between the LPPH constituencies nor agree on prioritiesDevelop consensus between the LPPH constituencies and agree on prioritiesAll constituencies can influence my image as a great leader for LPPHUnsatisfied demands of a constituency have a negative halo effect on this group's image of me

Symptom 4 LPPH is unable to adapt optimally to new regulationsLPPH has have increased exposure to fines and administrative actionContingent liabilities mount; the survival of LPPH could be threatenedFirefighting; emergencies; struggle to adapt to new regulationsDay to day activities consume most available time and attentionRegulations change frequently; there are contradictions in the rules; LPPH has difficulty changingLPPH does not have an effective change methodologyServe the needs of the LPPH contituencies now and in the futuresImplement a change methodology that creates consensus and updates the rules of the game (Holistic Workshops - Why Change, What to Change, What to Change to, How and When to make the ChangeWe don't know the methodology; We are very busy; It will take too longWe may create more problems than solutionsContinue to develop work-arounds to deal with new regulationsLeverage the opportunities from new regulations for positive changeEnsure the long term economic health and survival of LPPHEnsure the hospital's best practices are maintainedProtect the hospital from administrative actions, fines and contingenciesBe reactive in adapting to regulationsBe proactive in adapting to regulationsThe hospital has state of the art practices and proceduresThere is no guarantee that changes will be improvements

Symptom 5 Progress versus vision is not constantly reviewed and updatedThe vision becomes obsoleteThe vision becomes irrelevantPeople give lip service to the vision; It is not remembered day to dayPeople are busy; The hospital is doing wellThere are other prioritiesVision does not motivate constituencies behaviorAttainment of the visionUpdate the vision in a way that inspires constituencies to higher levelsWe don't have time; We have done it before; It is not importantAnother "forgotten" vision will further undermine the processDo not update the visionUpdate the visionManage the hospital wellFocus on day to day short term needs of the hospitalMaintain team awareness of the major objectives of the hospitalDo not prioritize updating the vision for the hospitalKeep the vision current and updatedExcellence is achieved in day-to-day activityLoss of focus can jeopardize day-to-day priorities

Symptom 6 The relationship between hospital management, staff and physician communities is adversarialAs far as possible, they act independently of each other's needsThe hospital functions far less effectively than possibleThere are mistakes, rework; management, staff and doctors complain about each otherThe priority is to make things work, somehowEach community has its own goalsLack of common goalsHospital's financial health; Teamwork; Quality patient care; Develop common goals for staff, doctors and managers; Holistic workshopsIt is difficult to create common goals; People may not see value in the activitiesPeople will revert to old habits; the change may not be sustainableDo not develop common goalsDevelop common goalsHave a well run hospitalAccomplish the day-to-day activities for which each is responsibleRun the hospital effectively, with best utilization of resources in line with common goalsDo not set common goals and focus for doctors, staff and administratorsSet common goals and focus for doctors, staff and administratorsWe must meet individual objectives and goalsAll team members must contribute to team goals

Symptom 7 LPPH cannot afford improvements in new technology and devicesHospital care quality is less than possible;Hospital loses competitiveness; Costs go upComplaints, frustration of professionals; patient insatisfactionThe hospital is quite modern and advancedThe hospital does not generate enough cashThe hospital is inefficient and bureaucraticBecome the leading hospital of the region; Give patients the best care possibleThe hospital applies TLS (TOC-Lean -Six Sigma) to improve processes, reduce costs and increase throughput (outcomes) with new technology and devicesLean has been applied with variable results, no proof that new methodology better; Donations are available for technology and devicesPossible credibility loss if TLS results fall shortFund technology and devices from donationsFund technology and devices from cost reductionFund technology and devices from cost reductionUse existing and proven resources wellKeep hospital up to date and competitiveFund improvements in technology and devices from budget and donationsFund improved technology and devices from cost reduction and productivityThe hospital has an inventory of excellent resources and proceduresOur results will be less than possible

Symptom 8 LPPH is not able to maintain an effective residency program and medical staffThere are insufficient doctorsDoctors are overworkedQuality of healthcare suffers; mistakes are madeIt's a general problemThere is insufficient budget for resident and staff servicesHospital operations do no generate sufficent cashProvide high quality healthcareGenerate cash reducing inefficienciences and waste with TLS; Increase funding for residency programWe don't know how to reduce inefficiencies sufficiently; We don't have TLS know-howTLS may not work and we will have disrupted good hospital proceduresFund residency program within budgetIncrease residency program funding with TLS cost and waste reductionIncrease residency program funding with TLS cost and waste reductionLive within financial means and preserve hospital strengthsHave sufficient high quality health providers and staffHire staff within allocationGenerate sufficient financial resources to pay high quality medical staffThe hospital budget and plan allocates resources fairly and intelligentlyBudget overruns lead to cuts which may have negative effects

Generic LPPH CEO is constrained by strength/structure of constituencies/managementLPPH CEO lacks the support to achieve the organizational goalsLPPH does not deliver superior healthcare; LPPH is at risk; CEO job is at mid/long term riskLPPH has Insufficient funds; Management instability; Internal conflict; Emergencies; StressProblems are common to most healthcare providers; Patients are generally well served; LPPH is one of the best in the regionMost professionals associated with the hospital focus on local and individual goals and measurementsThere is insufficient consensus and knowledge of global LPPH goals, vision and priorities; We are unable to make rapid, consensual change.Provide ever-improving healthcare to patients; Align LPPH constituencies behind current vision; Improve operations and technologyImplement a Holistic Integrated Strategy and Tactic of Continuous Improvement for LPPH; Use the TOC tools to decide what to change, what to change to and how and when to make the change rapidly.Other improvement methods did not work in the past at LPPH; LPPH has no knowledge of or experience with any Integrated, Holistic methodology for focus and consensus; There is not enough C Level time; Vision, Priority and Strategic Discussions cannot be delegated; Significant change should be lead/monitored by C-LevelChange may not be sustainable; Loss of good existing practices and procedures; Loss of CEO credibilityDo not undertake strategic, cultural or structural change initiatives at this timeCommit to, and implement, a holistic integrated Strategy and Tactic of Continuous Improvement for LPPHLead LPPH in providing ever improving healthcare to the community it serves.Respect and consider individual and functional priorities, practices and experienceAlign all the LPPH constituencies behind a single LPPH Vision, Strategy and PlanDo not undertake strategic, cultural or structural change initiatives at this timeCommit to, and implement, a Holistic Integrated Strategy and Tactic of Continuous Improvement for LPPHIndividual performance and motivation relate strongly to feeling respected Individual priorities are extremely important to individuals and functions

Defaults q01q01 q02q02 q03q03 q04q04 q05q05 q06q06 q07q07 q08q08 q09q09 q10q10 q11q11 q12q12 q12'q12' q12'q12' BBBB CCCC DDDD DDDD' FFFF GGGG

2 3 4 5 6 7 8 9 10 11 12 13 14 14 16 17 18 19 20 21

Entity Question01 Question02 Question03 Question04 Question05

Cell ReferenceQuestion1 Question2 Question3 Question4 Question5

Symptom 1 LPPH is not able to raise sufficient unrestricted funds LPPH is unable to support some necessary programsPatient care is compromised; LPPH goals are not metCuts in programs, people, services are madeRestricted funds are better than no funds at all

Symptom 2 LPPH is dependent on extremely unstable government paymentsCannot plan availabilty of LPPH services to needy childrenDifficult to make long term plays; difficul;t to find talent; emotional and mental exhaustionFrustration and exhaustion; Live without a sustainable business modelIt has to be a disaster before government will take action; I must keep focus on the mission; I am proud of the place we have

Entity Question01 Question02 Question03 Question04 Question05 Question06 Question07 Question08 Question09 Question10 Question11 Question12 Question12'A B C D D' AB1 AB2 AC1 AC2 CD'1 CD'2 BD1 BD2 BD-C1 BD-C2 CD'-B1 CD'-B2 DD'1 DD'2 Assumptions AB Assumptions AC Assumptions CD' Assumptions BD Assumptions DD' Jeop.Ass.CD'-B Jeop.Ass. BD-C

Cell ReferenceQuestion1 Question2 Question3 Question4 Question5 Question6 Question7 Question8 Question9 Question10 Question11 Question12 Question12pA B Cp D Dp F G H I J K L M N O P Q RR S assAB assAC assCDp assBD assDDp assDpB assDC

Symptom 1 LPPH is not able to raise sufficient unrestricted funds LPPH is unable to support some necessary programsPatient care is compromised; LPPH goals are not metCuts in programs, people, services are madeRestricted funds are better than no funds at allPeople, corporations, governments and foundations are increasingly giving to specific, directed causesDonors want to control the use of money to achieve desired outcomesControl/management of hospital operations; Hospital goals and objectivesFocus on increasing throughput from operations; Create focus and incentives for raising unrestricted funds; New methodologies, strategies and programs for unrestricted fundraisingCurrent development compensation paradigms and structure; No throughput accounting; Negative PR/bias on unrestricted funding; Report of bad use of donationsPossible loss of restricted gifts; bad political/public response to fundraising incentives;Get money for the goals of the donorGet money for the goals of the organizationMeet hospital goals and objectivesGet as much money as you canManage hospital in line with goals and objectivesDon't try to channel money to unrestricted fundsTry to channel money to unrestricted fundsAttainment of hospital goals and objectives is chronically underfundedAvoid cutting people and programsDonation funding is not always aligned with goals and objectivesImportant hospital goals and objectives may suffer from underfundingAllow funds to be assigned in line with hospital prioritiesRestricted fund earmarking is reducedFacilitate fundraisingDirected funding is and easier sellThere is funding shortage for certain hospital prioritiesMany funds are earmarked for non-priority hospital activitiesDonors may be unwilling to make unrestricted donations (bureaucracy, etc.)Donors have a large variety of objectives and motivationsRestricted and unrestricted funding are oppositeThere are limits to donation fundsaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Symptom 2 LPPH is dependent on extremely unstable government paymentsCannot plan availabilty of LPPH services to needy childrenDifficult to make long term plays; difficul;t to find talent; emotional and mental exhaustionFrustration and exhaustion; Live without a sustainable business modelIt has to be a disaster before government will take action; I must keep focus on the mission; I am proud of the place we haveMisalignment between financial resource assignment and human needs; Out of sync.Federal, State and local officials have their own prioritiesAbility to take care of every child regardless of their ability to payMaximize efficiency and effectivenes of existing resources; try to influence the government - Business case outcomes vs. investment for politicians useContantly changing government players; Lack of standardized procedures and processes; Every "product" is customized; Pediatrics is not a priority (small chunk of the healthcare dollar >10%.); No long term thinking in government;Business case ourcomes are a double edged swordDo not plan for future patient needsPlan for future patient needsBuild a best practice system for children now and the futureMaintain Research, Teaching, Wellness and other strong LPPH best practice programsPlan the availability of services to needy childrenDo not map out the projected needs of all children and plan budget for themMap out the projected needs of all children and plan and budget for themIndividual performance and motivation relate strongly to feeling respected Individual priorities are extremely important to individuals and functionsLack of alignment and consensus creates excessive conflict and a culture of blameAn integrated consensus plan is vital to enhance collaboration, communication, commitment and continuous improvementsAn integrated community, with common goals and priorities, enhances organizational harmony, performance and improvementLack of integration causes inefficiencies, creates error and waste, and increases bureaucracy and expensesLPPH has a large staff with many years of successful accumulated practice and experience who work independently and well.Many past improvement initiatives have been disappointing, requiring a lot of effort is required and there is no guarantee that the next one will be differentThere are too many divergent points of view; People hang on tightly to their experience and beliefsChange is needed; Change requires effortPeople are afraid to commit to change; "If it aint broke, don't fix it" It is very difficult to get consensus on priorities involving very diverse constituenciesCommit and not commit are opposites; Implement and Do not implement are oppositesTime, Resources and Management Focus are limitedaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Symptom 3 The various constituencies of LPPH create conflicting demandsI spend time working out compromisesI can't keep focus on the real priorities of the hospitalI am stressed: I work too hardI love my jobEach constituency focuses on its prioritiesThere is no consensus set of priorities for LPPHHave a great hospital; Provide great healthcare for children; Improve operations; Lead the hospital; Prioritize healthcareDevelop a consensus set of prioritiesDonor interests/focus/requests are prioritized; we do not generate sufficient money; Have no methodology to develop consensusSome constituencies may feel left out and no longer support LPPHContinue to work out compromises with diverse constituenciesDevelop and agree on consensus priorities of constituenciesSuccessfully lead LPPH to achieve its missionSatisfy the demands of the various LPPH Constituencies in the bext way possibleKeep focus on the real priorities of LPPHNot develop consensus between the LPPH constituencies nor agree on prioritiesDevelop consensus between the LPPH constituencies and agree on prioritiesAll constituencies can influence my image as a great leader for LPPHUnsatisfied demands of a constituency have a negative halo effect on this group's image of meA good leader impacts the enterprise by keeping it focused on its real prioritiesManagement focus on the right priorities is the ultimate constraint of an organizationAgreement on priorities empowers the organization to achieve its common important objectivesLack of consensus leads to disharmony and waste from unaligned effortsA satisfactory workable network of compromises within the system has been worked out over timeConsensus development is extremely difficult and takes the time of valuable resourcesEach constituency has its own, different, prioritiesEach constituency places different demands on the CEOConstituencies do not want to give up priority on the things they each view as importantMany constituencies are satisfied with the way things are, and see no need to changeAgree and Disagree are OppositesAgree and Diasgree are the only alternativesaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Symptom 4 LPPH is unable to adapt optimally to new regulationsLPPH has have increased exposure to fines and administrative actionContingent liabilities mount; the survival of LPPH could be threatenedFirefighting; emergencies; struggle to adapt to new regulationsDay to day activities consume most available time and attentionRegulations change frequently; there are contradictions in the rules; LPPH has difficulty changingLPPH does not have an effective change methodologyServe the needs of the LPPH contituencies now and in the futuresImplement a change methodology that creates consensus and updates the rules of the game (Holistic Workshops - Why Change, What to Change, What to Change to, How and When to make the ChangeWe don't know the methodology; We are very busy; It will take too longWe may create more problems than solutionsContinue to develop work-arounds to deal with new regulationsLeverage the opportunities from new regulations for positive changeEnsure the long term economic health and survival of LPPHEnsure the hospital's best practices are maintainedProtect the hospital from administrative actions, fines and contingenciesBe reactive in adapting to regulationsBe proactive in adapting to regulationsThe hospital has state of the art practices and proceduresThere is no guarantee that changes will be improvementsThe government is seeking funding from fraud reduction and fines via RACsFines and non-reimbursement can bankrupt the hospitalNew procedures can facilitate positive changeMany regulation are intended to improve healthcare procedures and administrationThe hospital's current procedures are excellentChanges can be disruptive; Many regulations are impracticalMany procedures have regulatory flawsRACs will accelerate government administrative actionWork-arounds are requiredRegulations may be misguided or downright wrongProactivity and reactivity are opposite attitudesProactivity and reactivity require different culturesaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Symptom 5 Progress versus vision is not constantly reviewed and updatedThe vision becomes obsoleteThe vision becomes irrelevantPeople give lip service to the vision; It is not remembered day to dayPeople are busy; The hospital is doing wellThere are other prioritiesVision does not motivate constituencies behaviorAttainment of the visionUpdate the vision in a way that inspires constituencies to higher levelsWe don't have time; We have done it before; It is not importantAnother "forgotten" vision will further undermine the processDo not update the visionUpdate the visionManage the hospital wellFocus on day to day short term needs of the hospitalMaintain team awareness of the major objectives of the hospitalDo not prioritize updating the vision for the hospitalKeep the vision current and updatedExcellence is achieved in day-to-day activityLoss of focus can jeopardize day-to-day prioritiesManagement is responsible for achieving the major objectives of the hospitalThe major objectives can be forgotten in the day to day crises and firefightinngAn updated vision continues to motivate and inspire the constituencies of the hospitalThe vision must stay relevantThere are many issues that need immediate attentionDo not waste valuable time on reworkThe major objectives of the hospital do not come up in day-to-dayThe vision relates to a changing environmentDay to day focus and vision are mutually exclusiveProcedures and practices should not be changed too frequentlyUppdate and not update are mutually exclusiveThere is not enough management time, nor subordinate time for re-educationaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Symptom 6 The relationship between hospital management, staff and physician communities is adversarialAs far as possible, they act independently of each other's needsThe hospital functions far less effectively than possibleThere are mistakes, rework; management, staff and doctors complain about each otherThe priority is to make things work, somehowEach community has its own goalsLack of common goalsHospital's financial health; Teamwork; Quality patient care; Develop common goals for staff, doctors and managers; Holistic workshopsIt is difficult to create common goals; People may not see value in the activitiesPeople will revert to old habits; the change may not be sustainableDo not develop common goalsDevelop common goalsHave a well run hospitalAccomplish the day-to-day activities for which each is responsibleRun the hospital effectively, with best utilization of resources in line with common goalsDo not set common goals and focus for doctors, staff and administratorsSet common goals and focus for doctors, staff and administratorsWe must meet individual objectives and goalsAll team members must contribute to team goalsEffective use of resources maximizes resultsBadly utilized resources create ineffective costs and expensesCommon goals and objectives create highly motivated, effective teamsA positive work environment facilitates caring of patients and fosters healthPeople are increasingly overworked and can't be further burdenedWe must avoid disruptive changesThere is rework, waste and also critical shortagesEach prioritizes his/her needs and the total effort is suboptimizedSometimes individual priorities and goals must be subordinatedPeople are judged on the accomplishment of individual goalsSetting and not setting goals are mutually exclusiveThere is not enough time or mutual interestaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Symptom 7 LPPH cannot afford improvements in new technology and devicesHospital care quality is less than possible;Hospital loses competitiveness; Costs go upComplaints, frustration of professionals; patient insatisfactionThe hospital is quite modern and advancedThe hospital does not generate enough cashThe hospital is inefficient and bureaucraticBecome the leading hospital of the region; Give patients the best care possibleThe hospital applies TLS (TOC-Lean -Six Sigma) to improve processes, reduce costs and increase throughput (outcomes) with new technology and devicesLean has been applied with variable results, no proof that new methodology better; Donations are available for technology and devicesPossible credibility loss if TLS results fall shortFund technology and devices from donationsFund technology and devices from cost reductionFund technology and devices from cost reductionUse existing and proven resources wellKeep hospital up to date and competitiveFund improvements in technology and devices from budget and donationsFund improved technology and devices from cost reduction and productivityThe hospital has an inventory of excellent resources and proceduresOur results will be less than possibleHealth care resources and equipment continuously improveWe may lose revenue generating patients to other hospitals, impacting reinvestmentHigh productivity resources improve reinvestment capacityWe want to have unlimited upside potential for improvementAdministrators and donors must have a major say in investment in proven medical improvement investmentsIt is not good to depend on operational profitability for investmentWe don't change procedures to leverage the technologyTechnology advances faster than the budget (and donations) processExisting and proven resources may need to be replaced or changedExisting and proven resources are demonstrably valid and must be provided forDonations, budgets and operations compete for C level attention and timeImprovement and radical change are mutually incompatible; Fight for resources vs. fight for thoughputaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Symptom 8 LPPH is not able to maintain an effective residency program and medical staffThere are insufficient doctorsDoctors are overworkedQuality of healthcare suffers; mistakes are madeIt's a general problemThere is insufficient budget for resident and staff servicesHospital operations do no generate sufficent cashProvide high quality healthcareGenerate cash reducing inefficienciences and waste with TLS; Increase funding for residency programWe don't know how to reduce inefficiencies sufficiently; We don't have TLS know-howTLS may not work and we will have disrupted good hospital proceduresFund residency program within budgetIncrease residency program funding with TLS cost and waste reductionIncrease residency program funding with TLS cost and waste reductionLive within financial means and preserve hospital strengthsHave sufficient high quality health providers and staffHire staff within allocationGenerate sufficient financial resources to pay high quality medical staffThe hospital budget and plan allocates resources fairly and intelligentlyBudget overruns lead to cuts which may have negative effectsPeople are at the heart of excellent healthcareStaff shortages create overwork, stress, rework and errorsWell motivated and remunerated staff provide better patient careOverworked and tired healthcare workers undermine heathcare qualityThe budget process correctly allocates scarce resources within priority and need Change is riskyThe budget allocation assumes current levels are sufficient to work withAllocation is insufficientBudget allocations represent current best practices to maintain hospital strengthsChange workshops cost time and moneyUnbudgeted activities and expenses must be paid for with cuts in other areasPeople are busy; There is not enough time; There is no budgetaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Generic LPPH CEO is constrained by strength/structure of constituencies/managementLPPH CEO lacks the support to achieve the organizational goalsLPPH does not deliver superior healthcare; LPPH is at risk; CEO job is at mid/long term riskLPPH has Insufficient funds; Management instability; Internal conflict; Emergencies; StressProblems are common to most healthcare providers; Patients are generally well served; LPPH is one of the best in the regionMost professionals associated with the hospital focus on local and individual goals and measurementsThere is insufficient consensus and knowledge of global LPPH goals, vision and priorities; We are unable to make rapid, consensual change.Provide ever-improving healthcare to patients; Align LPPH constituencies behind current vision; Improve operations and technologyImplement a Holistic Integrated Strategy and Tactic of Continuous Improvement for LPPH; Use the TOC tools to decide what to change, what to change to and how and when to make the change rapidly.Other improvement methods did not work in the past at LPPH; LPPH has no knowledge of or experience with any Integrated, Holistic methodology for focus and consensus; There is not enough C Level time; Vision, Priority and Strategic Discussions cannot be delegated; Significant change should be lead/monitored by C-LevelChange may not be sustainable; Loss of good existing practices and procedures; Loss of CEO credibilityDo not undertake strategic, cultural or structural change initiatives at this timeCommit to, and implement, a holistic integrated Strategy and Tactic of Continuous Improvement for LPPHLead LPPH in providing ever improving healthcare to the community it serves.Respect and consider individual and functional priorities, practices and experienceAlign all the LPPH constituencies behind a single LPPH Vision, Strategy and PlanDo not undertake strategic, cultural or structural change initiatives at this timeCommit to, and implement, a Holistic Integrated Strategy and Tactic of Continuous Improvement for LPPHIndividual performance and motivation relate strongly to feeling respected Individual priorities are extremely important to individuals and functionsLack of alignment and consensus creates excessive conflict and a culture of blameAn integrated consensus plan is vital to enhance collaboration, communication, commitment and continuous improvementsAn integrated community, with common goals and priorities, enhances organizational harmony, performance and improvementLack of integration causes inefficiencies, creates error and waste, and increases bureaucracy and expensesLPPH has a large staff with many years of successful accumulated practice and experience who work independently and well.Many past improvement initiatives have been disappointing, requiring a lot of effort is required and there is no guarantee that the next one will be differentThere are too many divergent points of view; People hang on tightly to their experience and beliefsChange is needed; Change requires effortPeople are afraid to commit to change; "If it aint broke, don't fix it" It is very difficult to get consensus on priorities involving very diverse constituenciesCommit and not commit are opposites; Implement and Do not implement are oppositesTime, Resources and Management Focus are limitedaba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

Defaults q01q01 q02q02 q03q03 q04q04 q05q05 q06q06 q07q07 q08q08 q09q09 q10q10 q11q11 q12q12 q12'q12' q12'q12' BBBB CCCC DDDD DDDD' FFFF GGGG HHHH IIII JJJJ KKKK LLLL MMMM NNNN OOOO PPPP QQQQ RRRR SSSS aba;abb;abc;abd aca;acb;acc;acd ce1;ceb;cec;ced bda;bdb;bdc;bdd dea;deb;dec;ded eba;ebb;ebc;ebd dca;dcb;dcc;dcd

2 3 4 5 6 7 8 9 10 11 12 13 14 14 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

22
















2 3 4 5 6 7 8 9 10 11 12 13 14 14 16 17 18 19 20 21

















2 3 4 5 6 7 8 9 10 11 12 13 14 14 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

23



Thermometer: Symptom

Q1 What is the problem from your point of view?

Symptom 1 LPPH is not able to raise sufficient unrestricted funds

Symptom 2 LPPH is dependent on extremely unstable government payments

Symptom 3 The various constituencies of LPPH create conflicting demands

Symptom 4 LPPH is unable to adapt optimally to new regulations

Symptom 5 Progress versus vision is not constantly reviewed and updated

Symptom 6 The relationship between hospital management, staff and physician communities is adversarial

Symptom 7 LPPH cannot afford improvements in new technology and devices

Symptom 8 LPPH is not able to maintain an effective residency

program and medical staff

Generic LPPH CEO is constrained by strength/structure of constituencies/management

24



Q2 How is the problem undesirable or bad in the present?

Symptom 1 LPPH is unable to support some necessary programs

Symptom 2 Cannot plan availabilty of LPPH services to needy children

Symptom 2 I spend time working out compromises

Symptom 2 LPPH has have increased exposure to fines and administrative action

Symptom 2 The vision becomes obsolete

Symptom 2 As far as possible, they act independently of each other's needs

Symptom 2 Hospital care quality is less than possible;

Symptom 2 There are insufficient doctors

Generic LPPH CEO lacks the support to achieve the organizational goals

Domino: Impact

25



Q3 In what way is the problem undesirable in the longer term?

Symptom 1 Patient care is compromised; LPPH goals are not met

Symptom 2 Difficult to make long term plays; difficult to find talent;

emotional and mental exhaustion

Symptom 3 I can't keep focus on the real priorities of the hospital

Symptom 4 Contingent liabilities mount; the survival of LPPH could be threatened

Symptom 5 The vision becomes irrelevant

Symptom 6 The hospital functions far less effectively than possible

Symptom 7 Hospital loses competitiveness; Costs go up

Symptom 8 Doctors are overworked

Generic LPPH does not deliver superior healthcare; LPPH is at risk; CEO job is at mid/long term risk

Binoculars: Implication

26



Q4 What are specific actions, situations or emotions that arise from the problem in current reality?

Symptom 1 Cuts in programs, people, services are made

Symptom 2 Frustration and exhaustion; Live without a sustainable

business model

Symptom 3 I am stressed: I work too hard

Symptom 4 Firefighting; emergencies; struggle to adapt to new regulations

Symptom 5 People give lip service to the vision; It is not remembered day to day

Symptom 6 There are mistakes, rework; management, staff and doctors complain about each other

Symptom 7 Complaints, frustration of professionals; patient insatisfaction

Symptom 8 Quality of healthcare suffers; mistakes are made

Generic LPPH has Insufficient funds; Management instability; Internal conflict; Emergencies; Stress

Alligator: Side Effect

27



Q5 Why do you put up with the problem? What is the benefit of not changing?

Symptom 1 Restricted funds are better than no funds at all

Symptom 2 It has to be a disaster before government will take action; I must keep focus on the mission; I am proud of

the place we have

Symptom 3 I love my job

Symptom 4 Day to day activities consume most available time and attention

Symptom 5 People are busy; The hospital is doing well

Symptom 6 The priority is to make things work, somehow

Symptom 7 The hospital is quite modern and advanced

Symptom 8 It's a general problem

Generic Problems are common to most healthcare providers; Patients are generally well served; LPPH is one of the best in the region

Mermaid: Inertia Benefit

28



Q6 What actions and situations are causing the problem?

Symptom 1 People, corporations, governments and foundations are

increasingly giving to specific, directed causes

Symptom 2 Misalignment between financial resource assignment and human needs; Out of sync.

Symptom 3 Each constituency focuses on its priorities

Symptom 4 Regulations change frequently; there are contradictions in the rules; LPPH has difficulty changing

Symptom 5 There are other priorities

Symptom 6 Each community has its own goals

Symptom 7 The hospital does not generate enough cash

Symptom 8 There is insufficient budget for resident and staff services

Generic Most professionals associated with the hospital focus on local and individual goals and measurements

Germ: Direct Cause

29



Q7 Why do those actions or situations exist?

Symptom 1 Donors want to control the use of money to achieve

desired outcomes

Symptom 2 Federal, State and local officials have their own priorities

Symptom 3 There is no consensus set of priorities for LPPH

Symptom 4 LPPH does not have an effective change methodology

Symptom 5 Vision does not motivate constituencies behavior

Symptom 6 Lack of common goals

Symptom 7 The hospital is inefficient and bureaucratic

Symptom 8 Hospital operations do no generate sufficent cash

Generic There is insufficient consensus and knowledge of global LPPH goals, vision and priorities; We are unable to make rapid, consensual change.

Root: Root Cause

30



Q8 What objectives, yours or others’, are directly threatened or jeopardized by the problem?

Symptom 1 Control/management of hospital operations; Hospital goals

and objectives

Symptom 2 Ability to take care of every child regardless of their ability to

pay

Symptom 3 Have a great hospital; Provide great healthcare for children; Improve operations; Lead the hospital; Prioritize healthcare

Symptom 4 Serve the needs of the LPPH constituencies now and in the future

Symptom 5 Attainment of the vision

Symptom 6 Hospital's financial health; Teamwork; Quality patient care;

Symptom 7 Become the leading hospital of the region; Give patients the best care possible

Symptom 8 Provide high quality healthcare

Generic Provide ever-improving healthcare to patients; Align LPPH constituencies behind current vision; Improve operations and technology

Gold: Blocked Objective

31



The Current Reality Branch Template

= = =

32



Questions 1 8: CRB Logic Check

33



Q9 What actions or conditions should be injected into current reality in order to attain the jeopardized objectives?

Symptom 1 Focus on increasing throughput from operations; Create focus and incentives for raising unrestricted funds; New methodologies, strategies and programs for unrestricted fundraising

Symptom 2 Maximize efficiency and effectivenes of existing resources; try to influence the government - Business case outcomes vs. investment for politicians use

Symptom 3 Develop a consensus set of priorities

Symptom 4 Implement a change methodology that creates consensus and updates the rules of the game (Holistic Workshops - Why Change, What to Change, What to Change to, How and When to make the Change

Symptom 5 Update the vision in a way that inspires constituencies to higher levels

Symptom 6 Develop common goals for staff, doctors and managers; Holistic workshops

Symptom 7 The hospital applies TLS (TOC-Lean -Six Sigma) to improve processes, reduce costs and increase throughput (outcomes) with new technology and devices

Symptom 8 Generate cash reducing inefficienciences and waste with TLS; Increase funding for residency program

Generic Implement a Holistic Integrated Strategy and Tactic of Continuous Improvement for LPPH; Use the TOC tools to decide what to change, what to change to and how and when to make the change rapidly.

Syringe: Injection

34



Q10 What obstacles must be overcome in order to make the proposed injections exist in reality?

Symptom 1 Current development compensation paradigms and structure; No throughput

accounting; Negative PR/bias on unrestricted funding; Report of bad use of

donations

Symptom 2 Contantly changing government players; Lack of standardized procedures and

processes; Every "product" is customized; Pediatrics is not a priority (small chunk of

the healthcare dollar >10%.); No long term thinking in government;

Symptom 3 Donor interests/focus/requests are prioritized; we do not generate sufficient money;

Have no methodology to develop consensus

Symptom 4 We don't know the methodology; We are very busy; It will take too long

Symptom 5 We don't have time; We have done it before; It is not important

Symptom 6 It is difficult to create common goals; People may not see value in the activities

Symptom 7 Lean has been applied with variable results, no proof that new methodology better;

Donations are available for technology and devices

Symptom 8 We don't know how to reduce inefficiencies sufficiently; We don't have TLS know-

how

Generic

Other improvement methods did not work in the past at LPPH; LPPH has no

knowledge of or experience with any Integrated, Holistic methodology for focus and

consensus; There is not enough C Level time; Vision, Priority and Strategic

Discussions cannot be delegated; Significant change should be lead/monitored by

C-Level

Hurdle: Obstacles

35



Q11 What potential negative consequences/undesirable effects could emerge from the proposed injections?

Symptom 1 Possible loss of restricted gifts; bad political/public response

to fundraising incentives;

Symptom 2 Business case ourcomes are a double edged sword

Symptom 3 Some constituencies may feel left out and no longer support LPPH

Symptom 4 We may create more problems than solutions

Symptom 5 Another "forgotten" vision will further undermine the process

Symptom 6 People will revert to old habits; the change may not be sustainable

Symptom 7 Possible credibility loss if TLS results fall short

Symptom 8 TLS may not work and we will have disrupted good hospital procedures

Generic Change may not be sustainable; Loss of good existing practices and procedures; Loss of CEO credibility

Crutches: Risks

36



Q12 Is the problem in Question 1 related to some conflict or dilemma? What is the conflict or dilemma?

Symptom 1 Get money for the goals of the donor

Symptom 2 Do not plan for future patient needs

Symptom 3 Continue to work out compromises with diverse constituencies

Symptom 4 Continue to develop work-arounds to deal with new regulations

Symptom 5 Do not update the vision

Symptom 6 Do not develop common goals

Symptom 7 Fund technology and devices from donations

Symptom 8 Fund residency program within budget

Generic Do not undertake strategic, cultural or structural change initiatives at this time

Dilemma: Conflict Don’t Change

37



Q12 Is the problem in Question 1 related to some conflict or dilemma? What is the conflict or dilemma?

Symptom 1 Get money for the goals of the organization

Symptom 2 Plan for future patient needs

Symptom 3 Develop and agree on consensus priorities of constituencies

Symptom 4 Leverage the opportunities from new regulations for positive

change

Symptom 5 Update the vision

Symptom 6 Develop common goals

Symptom 7 Fund technology and devices from cost reduction

Symptom 8 Increase residency program funding with TLS cost and waste

reduction

Generic Commit to and implement, a holistic integrated Strategy and Tactic of Continuous Improvement for LPPH

Dilemma: Conflict Change

38



Part IV: The New 12 Questions Holistic Process

PART I


PART II


PART III


PART IV



TOCICO 2014 Webinars PART IV The New 12 Questions Holistic Process

40



The Holistic Process

Find the system Generic/ Root Conflict

Verify that the Generic/Root Conflict is the cause of all/most problems (symptoms or UDEs)


List the Un-Desired Effects (Symptoms or UDEs)

of the system


DE DE

DE DE DE

DE DE DE

DE


START

Consensus, Goal and Strategic

Objectives



Define the “Targets” (Desired Effect or DEs) of the system and the Strategies and Tactics to reach them, with out causing new UDEs


GAP #1

12 Q CRB

GAP #2


GAP

#3

12 Q CRT

GAP

#4

Gold

GAP

#5

TRT

41



Filling the Gaps in the Holistic Process

Find the system Generic/Root Conflict

Verify that the Generic/Root Conflict is the cause of all/most problems(symptoms or UDEs)


List the Un-Desired Effects (Symptoms or UDEs) of the system


DEDE

DEDEDE

DEDE

DEDE


Start

ConsensusGoal and Strategic Objectives

Current Reality

Future Reality



Define the “Targets”(Desired Effect or DEs) of the system and the Strategies and Tactics to reach them, with out causing new UDEs


GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT

GAP #1

12 Q CRB

42



UDE Hierarchy

GAP #1

12 Q CRB

43



The Current Reality Branch Template

= = =

GAP #1

12 Q CRB

44



The “Restricted Funds” CRB

=

=

GAP #1

12 Q CRB

45



The “Government Interference” CRB

=

=

GAP #1

12 Q CRB

46



The “Conflicting Demands” CRB

=

=

GAP #1

12 Q CRB

47



The “New Regulations” CRB

= =

GAP #1

12 Q CRB

48



The “Current Vision” CRB

= =

GAP #1

12 Q CRB

49



The “Adversarial Silos” CRB

=

=

GAP #1

12 Q CRB

50



The “New Technology” CRB

= =

GAP #1

12 Q CRB

51



The “Residency and Medical Staffing” CRB

= =

GAP #1

12 Q CRB

52



The “Generic” CRB

=

=

GAP #1

12 Q CRB

53




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7






DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC

CRB

CRB CLR TEMPLATE

GAP #1

12 Q CRB

54



By Bill Taylor | On June 6th 2013 | At TOCICO 2013

The UDE Conflicts

(1Q01) We are not able to raise sufficient unrestricted funds

(2Q01) We don't have any impact or influence on the end result of political decisions

(4Q01) We are unable to adapt optimally to new regulations

(5Q01) Progress versus vision is not constantly reviewed and updated

(6Q01) The relationship between hospital management, staff and physician communities is adversarial

(8Q01) LPPH is not able to maintain an effective residency program and medical staff

(3Q01) The various constituencies of LPPH create conflicting demands

(7Q01) LPPH cannot afford improvements in new technology and devices

Lead the HealthCare Provider

(7D) Fund improvements in technology and devices from budget and donations

(7D') Fund improved technology and devices from cost reduction and productivity

(8D) Hire staff within allocation

(8D') Generate sufficient financial resources to pay high quality medical staff

(6D) Do not set common goals and focus for doctors, staff and administrators

(6D') Set common goals and focus for doctors, staff and administrators

(7B) Use existing and proven resources well

(7C) Keep hospital up to date and competitive

(6B) Accomplish the day-to-day activities for which each is responsible

(6C) Run the hospital effectively, with best utilization of resources in line with common goals

(8B) Live within financial means and preserve hospital strengths

(8C) Have sufficient high quality health providers and staff

(3D') Develop consensus between the LPPH constituencies and agree on priorities

(3D) Not develop consensus between the LPPH constituencies nor agree on priorities

(2D') Initiate important improvements despite in regulatory uncertainty

(2D) Do not initiate important improvements in regulatory uncertainty

(4D') Be proactive in adapting to regulations

(3C) Keep focus on the real priorities of LPPH

(3B) Satisfy the demands of the various LPPH Constituencies in the bext way possible

(4C) Protect the hospital from administrative actions, fines and contingencies

(2C) Make necessary improvements in LPPH in time

(2B) Avoid costly mistakes

(5D) Do not prioritize updating the vision for the hospital

(5D') Keep the vision current and updated

(1D') Try to channel money to unrestricted funds

(1D) Don't try to channel money to unrestricted funds

(1C) Manage hospital in line with goals and objectives

(1B) Get as much money as you can

(5B) Focus on day to day short term needs of the hospital

(5C) Maintain team awareness of the major objectives of the hospital

(4D) Be reactive in adapting to regulations

(4B) Ensure the hospital's best practices are maintained

55




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7






DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

CRB CLR TEMPLATE

Manage LPPH well

































Conflict

(A) Lead LPPH in providing ever improving healthcare to the community it serves

(B) Respect and consider

individual and functional

priorities, practices and

experience

(D') Commit to, and implement, a

Holistic Integrated Strategy and

Tactic of Continuous Improvement

for LPPH

(D) Do not undertake

strategic, cultural or

structural change initiatives

at this time

(C) Align all the LPPH

constituencies behind the

execution of an ever improving

integrated LPPH Vision,

Strategy and Plan

Connect Generic Cloud to all UDEs

GAP #1

12 Q CRB

56



Check the Generic Conflict

GAP

#1

12 Q CRB

Requisite or Necessary Condition

Prerequisite

Generic/Root Conflict We need to... (B) Respect and consider individual and

functional priorities, practices and experience

We need to... (C) Align all the LPPH constituencies behind the execution of an ever improving integrated LPPH Vision, Strategy and Plan

Critical Organizational Objective

We feel pressure to... (D') Commit to, and implement,

a Holistic Integrated Strategy and Tactic of

Continuous Improvement for LPPH

We feel pressure to... (D) Do not undertake strategic,

cultural or structural change initiatives at this time

(3Q01) The various constituencies of LPPH

create conflicting demands

(2Q01) We don't have any impact or influence on the end result of political decisions

(1Q01) We are not able to raise sufficient unrestricted

funds

(4Q01) We are unable to

adapt optimally to new

regulations

(5Q01) Progress versus

vision is not constantly

reviewed and updated

(8Q01) LPPH is not able to maintain an effective residency program and medical staff

(7Q01) LPPH cannot afford improvements in new technology and devices

Despite the pressure to...(D') Commit to, and implement, a Holistic Integrated Strategy and Tactic of Continuous Improvement for LPPH, we sometimes decide to... (D) Do not undertake strategic, cultural or structural change initiatives at this time

(6Q01) The relationship between

hospital management, staff and

physician communities is adversarial

We want to... (A) Lead LPPH in providing ever improving healthcare to the community it serves

57



Check the Root Conflict

58




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7






DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

CRB CLR TEMPLATE

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan


Generic/Root Conflict


We need to... (B) Respect and consider individual

and functional priorities, practices and

experience


We feel pressure to... (D') Commit to, and

implement, a Holistic Integrated Strategy and

Tactic of Continuous Improvement for LPPH

We feel pressure to... (D) Do not undertake

strategic, cultural or structural change initiatives

at this time

(3Q01) The various

constituencies of LPPH create

conflicting demands

(2Q01) We don't have any

impact or influence on the end

result of political decisions

(1Q01) We are not able to raise

sufficient unrestricted funds


adapt optimally to new regulations


vision is not constantly reviewed and updated

(8Q01) LPPH is not able to

maintain an effective residency


(7Q01) LPPH cannot afford

improvements in new

technology and devices

Despite the pressure to...(D') Commit to, and implement, a

Holistic Integrated Strategy and Tactic of Continuous

Improvement for LPPH, we sometimes decide to... (D) Do not

undertake strategic, cultural or structural change initiatives at

this time



physician communities is

adversarial

CHRONIC CONFLICT

GAP #2


59



Mapping The Chronic Conflict

GAP #2


60




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7






DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

CRB CLR TEMPLATE

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan






experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

CHRONIC CONFLICT

CRT Map GAP #3

12 Q CRT

61



Mapping The Current Reality Branch/Tree

GAP #3

12 Q CRT

http://www.youtube.com/watch?v=hcz1aZ60k7w

62




CRT Map

CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7







DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT





experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan

CHRONIC CONFLICT

CRB CLR TEMPLATE

Current Reality

Tree

GAP #3

12 Q CRT


63



Generic Current Reality Tree

GAP #3

12 Q CRT

64




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7







DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT





experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan

CHRONIC CONFLICT

CRB CLR TEMPLATE

CRT Map

Current Reality

Tree

Constraints

Analysis

GAP #3

12 Q CRT


65



CRT Root Causes and Constraints

Constraint Constraint

Assumptions?? Assumptions?? Assumptions??

Root Causes Root Causes

Assumptions??

Yes, but..

Oyes, but..

Root Causes

Root Causes GAP #3

12 Q CRT

66



HARMONY* Conflict Resolution

GAP #3

12 Q CRT

* © Goldratt Research Labs.

67




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7







DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT





experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan

CHRONIC CONFLICT

CRB CLR TEMPLATE

CRT Map

Current Reality

Tree

TRANSITION TARGETS

(GOLD)

GAP #4

Gold


Assumptions?? Assumptions??Assumptions??

Root CausesRoot Causes

Assumptions??

Yes, but..

Oyes, but..

Root Causes

Root Causes


68



Transition Targets (Gold)

GAP #4

Gold

69




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7







DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT





experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan

CHRONIC CONFLICT

CRB CLR TEMPLATE

CRT Map

Current Reality

Tree

TRANSITION OBJECTIVES

(GOLD)

TRANSITION TREE

ACTIONS MAP

CCPM PLAN

STRATEGY & TACTICS

TRANSITION TREE

GAP #5

TRT




Assumptions??

Yes, but..

Oyes, but..

Root Causes

Root Causes


70



LPPH Transition Tree

GAP #5

TRT

Actions (Injections to Achieve the “Gold”)

http://www.exepron.com/tour/critical-chain





























71




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7







DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT





experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan

CHRONIC CONFLICT

CRB CLR TEMPLATE

CRT Map

Current Reality

Tree


(GOLD)

TRANSITION TREE

ACTIONS MAP

CCPM PLAN

STRATEGY & TACTICS

TRANSITION TREE

GAP #5

TRT




Assumptions??

Yes, but..

Oyes, but..

Root Causes

Root Causes


72



Action (Injection) Map

73



Strategy and Tactics Tree

74




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7







DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT





experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan

CHRONIC CONFLICT

CRB CLR TEMPLATE

CRT Map

Current Reality

Tree


(GOLD)

TRANSITION TREE

ACTIONS MAP

CCPM PLAN

STRATEGY & TACTICS

TRANSITION TREE




Assumptions??

Yes, but..

Oyes, but..

Root Causes

Root Causes


75



Exepron* CCPM

* © Exepron

76




CRB 1

CRB 2

CRB 3

CRB 4

CRB 6

CRB 8

CRB 5

CRB 7







DEDE

DEDEDE

DEDE

DEDE


Start


Current Reality

Future Reality





GAP #1

12 Q CRB

GAP #2


GAP #3

12 Q CRT

GAP #4

Gold

GAP #4

TRT





experience







at this time

(3Q01) The various


conflicting demands














improvements in new






this time




adversarial

UDE MAP

UDE CLOUDS

GENERIC CLOUD

GENERIC CRB

Manage LPPH well

































Conflict





experience




for LPPH




at this time





Strategy and Plan

CHRONIC CONFLICT

CRB CLR TEMPLATE

CRT Map

Current Reality

Tree


(GOLD)

TRANSITION TREE

ACTIONS MAP

CCPM PLAN

STRATEGY & TACTICS

TRANSITION TREE




Assumptions??

Yes, but..

Oyes, but..

Root Causes

Root Causes


77



TOC Applications In The LPPH Action Plan

12 TOC TP Workshops

.

.

. .

.

.

.

. .

.

.

.


78




9 CCPM Planning and Execution



79




6 HARMONY* Strategy and Tactics

80




3 Throughput Accounting 3 TOC SCL

81



Part III: 12 Questions Excel Tool

PART I


PART II


PART III


PART IV



TOCICO 2014 Webinars PART III The 12 Questions Excel Tool

83



Excel Menu: The 12 Questions

Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to

change; "If it aint broke,

don't fix it"

CD'-B2 - It is very difficult

to get consensus on

priorities involving very

diverse constituencies

BD-C1 - There are too

many divergent points

of view; People hang on

tightly to their

experience and beliefs

BD-C2 - Change is

needed; Change

requires effort

And If… And If… And If… And If…

If… If…Q12: Do not undertake


structural change

initiatives at this time

Q12': Commit to, and

implement, a holistic

integrated Strategy and

Tactic of Continuous

Improvement for LPPHThen… Then… Then… Then…

BD1 - LPPH has a large

staff with many years of

successful accumulated

practice and experience

who work independently

and well.

BD2 - Many past improvement

initiatives have been

disappointing, requiring a lot of

effort is required and there is no

guarantee that the next one will

be different

DD'1 - Commit and not

commit are opposites;

Implement and Do not

implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited

CD'1 - An integrated

community, with common

goals and priorities,

enhances organizational

harmony, performance

and improvement

CD' 2 -Lack of

integration causes

inefficiencies, creates

error and waste, and

increases bureaucracy

and expensesAnd If… And If… If… If… And If… And If…

If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual

priorities are extremely

important to individuals

and functions

AC1 - Lack of alignment

and consensus creates

excessive conflict and a

culture of blame

AC2 - An integrated consensus

plan is vital to enhance

collaboration, communication,

commitment and continuous

improvements

And If… And If… And If…

If…

Q08: Provide ever-improving healthcare to patients;

Align LPPH constituencies behind current vision;

Improve operations and technology

Q04: LPPH has Insufficient funds;

Management instability; Internal

conflict; Emergencies; Stress

Q03: LPPH does not deliver superior

healthcare; LPPH is at risk; CEO job is at

mid/long term risk

Q02: LPPH CEO lacks the support to

achieve the organizational goals

We are facing a losing battle to (A) Lead LPPH in

providing ever improving healthcare to the

community it serves.

We struggle to (B) Respect and consider individual and


We struggle to (C) Align all the LPPH constituencies

behind a single LPPH Vision, Strategy and Plan

DD' - Despite the pressure to (D') Commit to, and


Tactic of Continuous Improvement for LPPH, we

feel pressure to (D) Do not undertake strategic,

cultural or structural change initiatives at this

time

We feel pressure to (D) Do not undertake strategic,


We feel pressure to (D') Commit to, and implement, a Holistic

Integrated Strategy and Tactic of Continuous Improvement

for LPPH

The NBR to Injecting Q09 are Q11: Change

may not be sustainable; Loss of good

existing practices and procedures; Loss of

CEO credibility

Q06: Most professionals associated with

the hospital focus on local and

individual goals and measurements

Q07: There is insufficient consensus and

knowledge of global LPPH goals, vision and

priorities; We are unable to make rapid,

consensual change.

We want to (A): Lead LPPH in providing

ever improving healthcare to the


Q05: Problems are common to

most healthcare providers;

Patients are generally well served;

LPPH is one of the best in the

region

We feel pressure to Q09: Implement a Holistic

Integrated Strategy and Tactic of Continuous

Improvement for LPPH; Use the TOC tools to decide

what to change, what to change to and how and when

to make the change rapidly.

The obstacles to injecting Q09 are Q010: Other improvement

methods did not work in the past at LPPH; LPPH has no

knowledge of or experience with any Integrated, Holistic

methodology for focus and consensus; There is not enough C

Level time; Vision, Priority and Strategic Discussions cannot be

delegated; Significant change should be lead/monitored by C-

Level

And If…

Q01: LPPH CEO is constrained by

strength/structure of

constituencies/management

It is necessary to( B) Respect and consider

individual and functional priorities,

practices and experience

It is necessary to (C) Align all the LPPH

constituencies behind a single LPPH

Vision, Strategy and Plan

CONFLICT

UDE CONFLICT

Then…If… And If…

Then… Then…CD'-B1 - People are afraid

to commit to change; "If it

aint broke, don't fix it"


to get consensus on




many divergent points of

view; People hang on

tightly to their experience

and beliefs

BD-C2 - Change is needed;

Change requires effort


If… If…

Then… Then… Then… Then…






and well.






be different




implement are

opposites

DD'2 - Time, Resources

and Management Focus

are limited



goals and priorities, enhances

organizational harmony,

performance and

improvement

CD' 2 -Lack of integration

causes inefficiencies,

creates error and waste,

and increases bureaucracy

and expenses

And If… And If… If… If… And If… And If…

If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated

consensus plan is vital to

enhance collaboration,

communication,

commitment and

continuous improvements


If…

It is necessary to( B) Respect and

consider individual and functional

priorities, practices and experience







Chronic Conflict from: <LPPH CEO is constrained by strength/structure of constituencies/management>

We are facing a losing battle to (A) Lead

LPPH in providing ever improving

healthcare to the community it serves.

We struggle to (B) Respect and consider

individual and functional priorities, practices

and experience

We struggle to (C) Align all the LPPH

constituencies behind a single LPPH Vision,

Strategy and Plan



We feel pressure to (D') Commit to, and implement, a


Improvement for LPPHCONFLICT

Root Cause(s) Direct Cause(s) or UDE (Undesired Effect) Immediate Impacts Longer Term Implications

Q01: LPPH CEO is

constrained by


constituencies/managem

ent

Q02: LPPH CEO lacks the

support to achieve the

organizational goals

Consequences

CURRENT REALITY BRANCH OUTLINE

Q04: LPPH has

Insufficient funds;

Management

instability; Internal

conflict;

Emergencies;

Stress

Q05: Problems are common to most healthcare providers;

Patients are generally well served; LPPH is one of the best

in the region

Why do you put up with the problem? Why not change? The Objective(s) that is (are) threatened by the Problem:

Q08: Provide ever-improving healthcare to patients; Align LPPH

constituencies behind current vision; Improve operations and

technology

Main Problem or Symptom

Q03: LPPH does not

deliver superior

healthcare; LPPH is at

risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the

hospital focus on local

and individual goals

and measurements

Q07: There is insufficient

consensus and knowledge

of global LPPH goals,

vision and priorities; We

are unable to make rapid,

consensual change.

Return to Main Menu

Return to 12 Q

Save Answers

Shrink FontSelect AllView/Change 12Qs

12 Questions

CRB Outline

Conflict Cloud Develop

Assumptions

Cloud to 12Q

Chronic Conflict Current Reality

Branch/Tree Direction for

Solution Change

Matrix

Harmony™* Conflict

Resolution Entity Database Generic Maker

*®© Goldratt Research Labs

UDE Conflict

84



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

Return to 12 Q

Save Answers


12 Questions

CRB Outline

Conflict CloudDevelop

Assumptions

Cloud to 12Q

Chronic ConflictCurrent Reality

Branch/TreeDirection for

SolutionChange

Matrix

Harmony™*Conflict

Resolution Entity DatabaseGenericMaker


UDE Conflict

Answer the 12 Questions

12 Questions

85



Answer the 12 Questions

86



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

Return to 12 Q

Save Answers


12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

Check The Current Reality Branch Outline

CRB Outline

87



Check The Current Reality Branch Outline

88



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

Return to 12 Q

Save Answers


12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

Check The UDE Conflict

UDE Conflict

89


TOCICO 2014 Webinars Check The UDE Conflict

90



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

Return to 12 Q

Save Answers


12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

Conflict Cloud: Build the UDE Cloud

Conflict Cloud

91



B D - Less desired condition/action

Respect and consider



experience

Do not undertake strategic,

cultural or structural change


UDE: LPPH CEO is

constrained by


constituencies/manage

ment

A - THE COMMON GOAL/OBJECTIVE

Lead LPPH in providing

ever improving

healthcare to the


C D' - More-desired condition / Action

Align all the LPPH

constituencies behind a

single LPPH Vision, Strategy

and Plan

Commit to, and implement, a



Improvement for LPPH

Needs/Requisites / Necessary Conditions Pre-Requisites in Conflict

CONFLICT RESOLUTION DIAGRAM RELATED TO UNDESIRABLE EFFECT: <LPPH CEO is constrained by strength/structure of constituencies/management>

CONFLICTANSWER USING 12 QUESTIONS

Hints for D

Hints for D'

"S" - Conflict Save Cloud Return to Main MenuReturn to 12Q

Hints for B

Hints for C

Hints for A

Select All Shrink Font

Add to Holistic Change 12Qs

Surface

Assumptions

Conflict Cloud: Build the UDE Cloud

92



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

Return to 12 Q

Save Answers


12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

Tool To Retrofit Cloud To 12 Questions

Cloud to 12Q

93



Tool To Retrofit Cloud To 12 Questions

ANSWERING THE 12 QUESTIONS FROM THE CONFLICT RESOLUTION DIAGRAM RELATED TO QUESTION 01 : LPPH CEO is constrained by strength/structure of constituencies/management

Q01: LPPH CEO is constrained by strength/structure of constituencies/management

B: Respect and consider individual

and functional priorities, practices

and experience

D: Do not undertake strategic,



Q012: Do not undertake strategic, cultural or structural

change initiatives at this time

Q11 (NBR of D'): Change may not be sustainable; Loss of good existing practices and procedures; Loss of CEO credibility

A: Lead LPPH in providing ever

improving healthcare to the


C: Align all the LPPH

constituencies behind a single

LPPH Vision, Strategy and Plan

D': Commit to, and implement, a



for LPPH

Q012': Commit to, and implement, a holistic integrated

Strategy and Tactic of Continuous Improvement for LPPH

Q02: LPPH CEO lacks the support to achieve the organizational goals

Q03: LPPH does not deliver superior healthcare; LPPH is at risk; CEO job is at mid/long term risk t

Q08: Provide ever-improving healthcare to patients; Align

LPPH constituencies behind current vision; Improve

operations and technology

Q07: There is insufficient consensus and knowledge of global LPPH goals, vision and priorities; We are unable to make rapid, consensual

change.

Q09: Implement a Holistic Integrated Strategy and Tactic of Continuous Improvement for LPPH; Use the TOC tools to decide what

to change, what to change to and how and when to make the change rapidly.

Q10 (Cause of D): Other improvement methods did not work in the past at LPPH; LPPH has no knowledge of or experience with any

Integrated, Holistic methodology for focus and consensus; There is not enough C Level time; Vision, Priority and Strategic Discussions

cannot be delegated; Significant change should be lead/monitored by C-Level

Effects of Q04 (Effect of D): LPPH has Insufficient funds;

Management instability; Internal conflict; Emergencies; Stress

Q05: Problems are common to most healthcare providers; Patients are

generally well served; LPPH is one of the best in the region

Q06: Most professionals associated with the hospital focus on local and individual goals and measurements

CONFLICT

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12Qs

94



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

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12 Questions

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SolutionChange

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UDE Conflict Surface Assumptions

Surfacing The Assumptions Within The Cloud

95



B - What for? D - Less desired Condition/action

aba;abb;abc;abd B: Respect and consider individual

and functional priorities, practices

and experience

D: Do not undertake strategic,



bda;bdb;bdc;bdd

A - THE COMMON GOAL

A: Lead LPPH in providing ever

improving healthcare to the


dea;deb;dec;ded

C

aca;acb;acc;acd C: Align all the LPPH

constituencies behind a single

LPPH Vision, Strategy and Plan

D': Commit to, and implement, a Holistic


Improvement for LPPH

ce1;ceb;cec;ced

Needs / Requisites / Necessary Conditions Wants/Pre-Requisites in Conflict t

SURFACING THE ASSUMPTIONS FOR CONFLICT RESOLUTION DIAGRAM RELATED TO QUESTION 01 : LPPH CEO is constrained by strength/structure of constituencies/management

D' -More-desired condition/action

CONFLICT

CD'

BDAB

AC

DD'

Save Assmpt.

Assumptions

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Add to Holistic


View ABCDD'Change

12Qs

Summarize

Assumptions

Shrink Font

Surfacing The Assumptions Within The Cloud

96



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

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Save Answers


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UDE Conflict Summarize Assumptions

Summarizing The Assumptions Within the Cloud

97



11

K

Reference

A

B

B - What for?

D - Less desired condition/action Do not

Change Cp

B: Respect and consider



experience

D: Do not undertake


structural change

initiatives at this timeD

A - THE COMMON GOAL Dp

A: Lead LPPH in

providing ever

improving healthcare to

the community it serves.AB

C AC

C: Align all the LPPH

constituencies behind a

single LPPH Vision,

Strategy and Plan

D': Commit to, and

implement, a Holistic

Integrated Strategy and


Improvement for LPPHCDp

Needs / Requisites / Necessary Conditions Pre-Requisites in Conflict t BDDpB

CONFLICT RESOLUTION DIAGRAM RELATED TO QUESTION 01 : <LPPH CEO is constrained by strength/structure of constituencies/management>

D' Opposite/

more-desired condition

Change

CONFLICT

SUMMARIZE THE ASSUMPTIONS

Save Assumptions Return to Main MenuReturn to Twelve

Questions

In order to A, B is necessary

because...

In order to A, C is

necessary because…

For C, D' is wanted

because...

For B, D is wanted

because…

D and D' are in conflict

because...

B and D jeopardize C

because...

C and D' jeopardize B

because...

Assumption BD2

Assumption AB1

Assumption CD'1

Assumption D-C2

Assumption AC2

Assumption D'-B1

Assumption AB2

Assumption AC1

Assumption D'-B2

Assumption DD'2

Assumption CD'2

Assumption BD1

Assumption D-C1

Assumption DD'1

Add to Holistic


View/Change 12Qs

COMMUNICATION. CURRENT REALITY TREE

View/Change Assumptions

The Positives of Retaining A and B The Negatives of Not Retaining B The Positives of Retaining A and C The Negatives of Not Retaining C The Positives of the Change to C and D’ (Pot of Gold) The Benefits of Not Retaining the Negatives of D (Alligator)) The Positives of Retaining B and D (Mermaid) The Benefit of Avoiding the Negatives of the Change to D’ (Crutches) Why are D and D’ Mutually Exclusive or in Conflict? Why is it that D and D’ Cannot be Done Together? Why do B and D Jeopardize C? Why for C is it Necessary Not to D? Why do C and D’ Jeopardize B? Why for B is it Necessary Not to D’?

Summarizing The Assumptions Within the Cloud

98



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

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12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

The Chronic Conflict Within The Cloud

Chronic Conflict

99



The

Ch

ron

ic C

on

flic

t W

ith

in T

he

Clo

ud






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan






100



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

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Save Answers


12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

Complete Current Reality Branch/Tree

Current Reality Branch/Tree

101



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT

Complete Current Reality Branch/Tree

102



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

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CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict


Entity Database

103
















2 3 4 5 6 7 8 9 10 11 12 13 14 14 16 17 18 19 20 21

















2 3 4 5 6 7 8 9 10 11 12 13 14 14 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

104



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

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CRB Outline


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Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

The Generic Maker Tool

Generic Maker

105



The Generic Maker Tool

Entity Question

Question07 Q07. Why do the actions or situations described in Question 6 exist?

Symptom 1 Donors want to control the use of money to achieve desired outcomes

Symptom 2 Federal, State and local officials have their own priorities

Symptom 3 There is no consensus set of priorities for LPPH

Symptom 4 LPPH does not have an effective change methodology

Symptom 5 Vision does not motivate constituencies behavior

Symptom 6 Lack of common goals

Symptom 7 The hospital is inefficient and bureaucratic

Symptom 8 Hospital operations do not generate sufficent cash

Generic

8

There is insufficient consensus and knowledge of global LPPH goals, vision and

priorities; We are unable to make rapid, consensual change.

106



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

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CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

Analyzing the Direction of the Solution

Direction for Solution

107



Analyzing the Direction of the Solution

108



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

Return to 12 Q

Save Answers


12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

HARMONY* Conflict Analysis and

Resolution


Harmony Conflict

109



HARMONY* Conflict Analysis


110



HARMONY* Conflict Analysis - LPPH


111



HARMONY* Conflict Analysis and Resolution


112



Then…

If…

Then… Then…

CD'-B1 - People are

afraid to commit to


don't fix it"


to get consensus on






tightly to their


BD-C2 - Change is

needed; Change

requires effort




structural change












and well.






be different




implement are

opposites

DD'2 - Time,

Resources and

Management Focus

are limited






and improvement

CD' 2 -Lack of

integration causes





If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame





improvements


If…









mid/long term risk















time





for LPPH




CEO credibility







consensual change.








region












Level

And If…










CONFLICT

UDE CONFLICT






to get consensus on







and beliefs




If… If…







and well.






be different




implement are

opposites



are limited





performance and

improvement





and expenses


If… If…

Then… Then…

AB1 - Individual

performance and

motivation relate

strongly to feeling

respected

AB2 - Individual



and functions




culture of blame

AC2 - An integrated



communication,

commitment and



If…
















and experience



Strategy and Plan







Q01: LPPH CEO is

constrained by



ent




Consequences


Q04: LPPH has

Insufficient funds;

Management


conflict;

Emergencies;

Stress



in the region




technology


Q03: LPPH does not

deliver superior


risk; CEO job is at

mid/long term risk

Q06: Most

professionals

associated with the



and measurements






consensual change.

Return to Main Menu

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Save Answers


12 Questions

CRB Outline


Assumptions

Cloud to 12Q



SolutionChange

Matrix

Harmony™*Conflict



UDE Conflict

Mapping the 12 Questions to the Change Matrix

Change Matrix

113



Mapping the 12 Questions to the Change Matrix

114



Mapping the Change Matrix to Other Icons

♦ ♣

♠ ♥

115



LPPH Conclusions

• The TOC Thinking Processes clearly indicate that the key constraint facing the Hospital is the inability to effectively manage rapid change required by the state and the rate of change in the industry

• This leads to the majority of challenges faced by the Hospital.

• The TOC solution for dealing with this is a systematic logical process that creates consensus on what to change, what to change to and how to make the change without jeopardizing the existing strengths

• TOC applications have been adapted to Healthcare around the world over the last 20 years

116



LPPH Strategy Document

117



THANK YOU

Bill Taylor has been associated with Coca-Cola for over 40 years, as a flavor chemist, product development manager, marketing manager, general

manager, Regional Manager, International VP, Bottling Company CEO and consultant, living in Argentina, USA, Colombia, Turkey, Mexico and Brazil, and has managed companies and executed projects in over 30 countries.

His last executive assignment with Coca-Cola was as CEO of SPAIPA, a 1billion dollar Coca-Cola bottling, sales and distribution company based in

Curitiba, Brazil. Bill created SPAIPA In 1994 by leading a merger of four independent Coca-Cola bottling groups, and ran this company for 8 years.

After retiring from SPAIPA in 2002, Bill joined TOCICO and created Taylors Of Curitiba, a business strategy and change management consulting

company, working projects in education, wood, paper, banking, insurance, logistics, transportation, heavy machinery, agricultural products,

construction, energy, retail and consumer products in Brazil. He has also lectured frequently in various universities and organizations and been a member of the Board of Directors of various Brazilian and International

companies and organizations Bill has been on the TOCICO Board since 2009 and was the 2011/2012 Chairman of the Board of TOCICO.

Bill has a degree in Chemical Engineering from the Universidad de Buenos Aires and a Masters of Business Administration from Florida International University. After 18 years in Brazil, Bill moved to Atlanta in 2012, where he

has established his new base of operations, focusing his work on Healthcare and the development of TOC.

You can get in touch with Bill Taylor at [email protected]

the little prince pediatric hospital a toc study in u.s ...tocico.net/the little prince pediatric...

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