Improving the productivity and efficiency of an integrated mental and addiction care – an application of the theory of constraints and five-focusing step to evaluation of adult ADHD patients
An application of the theory of constraints and the five-focusing step to evaluation of the adult ADHD patients
Avainsanat:
Clinical decision support system, social and health care, mental and addiction health care, theory of constraints, five-focusing step, productivity, efficiency, TOC, 5FS, CDSS, design research, action researchAbstrakti
This paper suggests that the productivity and the efficiency of social and health care services can be improved considerably by redesigning and streamlining the processes of an integrated mental health and addiction services. The paper presents the theory of constraint (TOC) and five-focusing step (5FS) solution to the productivity and efficiency problems of an integrated mental and addiction care outpatient clinic (MTPA-model) team. The MTPA was in 2010 established integrated walk-in clinic (24/7/365) for both mental health and addiction care, patients, where clinical decisions of some key patient groups supported by a designed software artifact - Clinical Decision Support System (CDSS). One of the critical service processes of the MTPA is a CDSS-assisted adult-ADHD diagnostics process, which had typical multidiscipline team´s inefficiencies and process constraints, which eliminated by applying the Five-Focusing Step (5FS) system methodology of the theory of constraints (TOC). 5FS provide a generic method to focus on solving the problems of system constraints of the multidiscipline team that is hindering the system achieving its goal.
The aim of the paper is to describe the improvement of productivity and efficiency of a typical multi-disciple team of an integrated mental health and addiction care outpatient clinic (MTPA-model) in southeast Finland. The combination of the action research approach and the design science research applied to solving the emerging service process problems and creating the solution artifact, clinical decision support system (CDSS). The paper outlines the principles of the theory of constraints (TOC) applied for established CDSS-assisted adult-ADHD diagnostics process, which is one of the key service processes at the MTPA-model. TOC is a theory, which assumes that every system has at least one constraint, which is precluding the system to achieve its strategic and operational goals. The Five-Step Focusing (5SF) Process of the TOC is to identify, exploit and remove the key constraints in any systems or processes. The bottlenecks or constraints of an adult-ADHD process defined. The data from the designed software artifact- the adult-ADHD CDSS – and currently used electronic health record (EHR, Effica)- provided material applying the 5FS methodology for improving productivity and efficiency of the adult-ADHD process.
We suggest that applying the 5FS-process of the TOC to mental and addiction care processes generally and to the multi-professional team especially is an effective way to negotiate constructively about the bottlenecks or constraints of the process and improve the productivity and the efficiency of an integrated mental health and addiction care services and operations.
Based on the results, a general framework for improving productivity and efficiency of a multi-professional team and health care services organization by applying the 5FS logic and methodology proposed.
Keywords: Clinical decision support system, social and health care, mental and addiction health care mental and addiction health care, theory of constraints, five-focusing step, productivity, efficiency, TOC, 5FS, CDSS, design research, action research
