Should your inbox be called the Emergency Department?
Meet Beth, she's someone like you and me; she's nothing special. She's a departmental manager, but she could just as well be running her own business, her husband would certainly like her to change jobs.
Beth is the Admissions Manager for a busy hospital. She has to make the best use of the hospital beds. She has a boss who steals her thunder when things go well and blames her when things go wrong. Her assistant thinks he should have got her job and constantly does his best to undermine her.
Sound like any corporate company or civil service department you know?
Press the 'play' button (sometimes twice) below to hear a short message from Russ about the book!
During the past two decades, an approach dubbed the "theory of constraints" has grown in popularity and success in industry. This approach began with Eliyahu Goldratt's particularly readable "business novel" entitled The Goal, which is currently in its third edition (North River Press, 2004). Several related books have been published since then. The newest book in that array, We All Fall Down, extends the principles and analytic approaches of the theory of constraints to health care systems. The story is set in a mid-sized academic hospital in the United Kingdom, and the characters and their foibles are so familiar as to be both comforting and frightening.New England Journal of Medicine 355:2 July 13, 2006
Beth has got 61 more patients than she has beds and there are a constant stream of patients coming in from doctor referrals and injured people via the Accident and Emergency Department.
Why does the really important stuff only hit you at the last minute?
By using a business process called the Theories of Constraints (TOC) Beth manages to get her colleagues on her side and together they find not only the core problem of health systems worldwide, but they also discover how to free up 10 to 30% of the hospital beds without significant investment.
Remember Beth is not special. She's like you and me.
Buy a signed copy now at a discount price of £15.99 including postage direct from us and see how it can help YOUR business! Alternatively it is also available on Amazon
Engagingly whisking its readers through Beth Segar's every-day digressively tedious life in combat with coworkers and happiness, We All Fall Down depicts the amusing tale of her introduction of Theory of Constraints in the workplace and its immediate effectiveness. We All Fall Down is unique and very highly recommended reading. MidWest Book Review
Many books start well, but few are able to sustain the pace of 'We All Fall Down' for a full 352 pages. You learn about the theory of constraints, and how and when to present discoveries made by using powerful analytical tools such as 'The Cloud'. These will enable you to identify the core problem of your organisation.
Moreover you learn easily, avoiding the bland literature of the classroom with it's jargon and techno-babble. This book is in English, not some business pundit's specialised tongue. What a delight it is to read.
No amount of book reading will solve management problems unless you can apply the knowledge within the book's covers. 'We All Fall Down' demonstrates how important it is to create powerful alliances before attempting to change your work-place.
I particularly enjoyed the frisson between Beth and John, a Professor of surgery. As Beth's relationship with Max, her husband, deteriorates one can't help wondering if she will succumb to the attractive bachelor's charms?
Stephen Bray: Principal, The Family Business School
Many business' and organisations are emotionally dead, they have become functional and dutiful. They lack passion, purpose and vision. Staff and suppliers, clients and even patients, will all know this, they will refer to the system as 'arrogant' or 'corporate' or 'uncaring'. The purpose and passion within this book is to ignite your spark and create a fire that glows bright, and can self sustain itself through challenges and threats, those that come into contact with you will want you to be successful, you can be like a magnet and your light can shine for all to see. As the book says: 'We all want to do a good job!' Penny Power, Founder of the networking site Ecademy, and co-author of A Friend in Every City,.
Brilliantly written with the addition of appropriate humour. Although based on resolving actual NHS issues, the content provides many insights for all managers and business owners. A recommended read. (*****) Mumkidsdotcom
I approached this book with some trepidation, with its unappealing subtitle and a subject matter I am not over familiar with. However, a record reading time later I put it down with my brain whirring. For the National Health Service, I was thinking about my own business and I am already looking for ways to use what I have learnt both in my interactions with colleagues and in moving our business forward.
Entertaining... and I learnt something. Wow! Andy Lopata. Managing Director of Business Referral Exchange Networking (BRE). Co-Author of And Death Came Third!
What's in this book for me?
Read this book and discover how to:
- Understand office politics and negate them
- Discover the core problem of your business or organisation. The one that is causing the symptoms that are giving you stress now
- Get your colleagues to help you, rather than trying to fight against them
- Discover how to communicate your solutions so other people buy into them
Buy a signed copy now at a discount price of £15.99 including postage direct from us and see how it can help YOUR business! Alternatively it is also available on Amazon
About the Authors
Julie Wright has held various management positions including that of Managing Director of a manufacturing company. More recently she has pursued the goal of introducing Eli Goldratt's Theory of Constraints to healthcare and other service industries by working in both primary and secondary care where she has gained first hand knowledge of the pressures and frustrations experienced by both the staff and patients. Since then she has also become involved with another not for profit organisation, TOC for Education.
Dr Russ King is a freelance writer who has had science-related magazine articles published around the world and has helped run a daily corporate news service for the pharmaceutical giant Pfizer. Russ' role in the project was to turn Julie's outline of the book into an exciting and funny novel that lets the reader forget they are reading a textbook.
Tell us what you thought about the book and how it changed your perspective on your working life. Email Russ here.
Bought and read your book "We All Fall Down". Very good. I started it at 7.30pm and finished at 2am. Straight through! It was a good story and the ToC stuff was nicely woven in. Definitely up to the standard of The Goal. Well done. Rob Worth Worth Solutions
This book highlights the need to start where you are and makes the point that you don't have to be the CEO to make positive changes. I believe that there are far too many people in business who see themselves as victims of a system they're powerless to influence. It's a disease that is passed from one person to another and we need a vaccine for it. Part of that vaccine is in We All Fall Down. Steven Holt (Amazon review)
Buy a signed copy now at a discount price of £15.99 including postage direct from us and see how it can help YOUR business! Alternatively it is also available on Amazon
So why would I want to read a book about the Healthcare system? Isn't it just a huge complicated mess?
It's complex, yes, but it's not complicated. You just need to break it down to discover what the core problem is - the cause that is producing the symptoms. It is amazing how everything looks like common sense once you've discovered what the real problem is!
Once you learn how to do this you can find the core problem of your own workplace.
SCROLL DOWN TO READ THE FIRST CHAPTER – FREE!
So what is this Theories of Constraints all about?
The full title of the book is We All Fall Down - Goldratt's Theory of Constraints for Healthcare Systems. Eli Goldratt's Theories of Constraints or TOC has become popular in manufacturing industries since the publication of The Goal - a textbook written in the style of a thriller novel set in a struggling factory - that has now sold over 3 million copies.
After many years of success Goldratt has created the The Avraham Y. Goldratt Institute - a global enterprise devoted to delivering improved bottom line results through the successful implementation of the Theory of Constraints (TOC). The Institute is led by a team of highly acclaimed TOC Experts, each of whom has played a significant role in the creation and ongoing development of the TOC body of knowledge. A list of some of their impressive success stories can be found here.
However, until We All Fall Down there has not been a book that applies TOC to the service industries and office politics.
Buy a signed copy now at a discount price of £15 direct from us and see how it can help YOUR business! That's currently £1.99 cheaper than Amazon!
Wright and King's book provides useful approaches to managing change and overcoming resistance to change… We All Fall Down should be a respected addition to the libraries of clinicians who practise in a health care system and of managers of clinical enterprises. New England Journal of Medicine 355:2 July 13, 2006
Having researched using TOC in service industries I was delighted to find out that this book was coming out. The business novel style, as per Goldratt's original "The Goal", is just so much more fun to learn from than a textbook! Julie & Russ' story definitely hits the spot! I read it in little over a day, marking up choice passages and new distinctions as I went along.
So if you're tired of being a witch-doctor with sticking plaster solutions, pick this up and learn how to be a decision-making surgeon! Neil Jamieson Change NRJ
It's a good read and well-written so that the reader really feels Beth's pain as she struggles with learning how to use TOC and implementing a TOC solution in a high-stakes, politically-charged environment. This is a great addition to the three core TOC novels – The Goal. It's Not Luck and Critical Chain.
What I liked especially about this book is that it demonstrates how TOC can be implemented in a government setting and that TOC can be used in a less-controlled environment. When I first discovered The Goal back in 1994, I immediately took to its message but I had trouble applying it to the state government law office that I worked at.
Unlike a factory where inputs and processes can be planned in advance and optimized for maximum efficiency, work is more chaotic and not easy to schedule. I often thought that TOC could not handle the repair-shop model but Wright and King demonstrate how TOC can work in such an environment. Eclectic Bill Blog (See here for the full review)
Buy a signed copy now at a discount price of £15.99 including postage direct from us and see how it can help YOUR business! Alternatively it is also available on Amazon
So what's We All Fall Down all about?
For Beth Seager, dealing with 'fearsome' work colleagues and 'fighting fires' has inadvertently become a part of her job description. As a Manager of Admissions for the British National Health Service, Beth is desperate to find a way to free up more beds for sick patients while maintaining her sanity in a volatile work environment.
While management continues to implement one faulty plan after another and with no investment funds in sight, Beth searches for an effective way to improve patient services throughout the healthcare system. Over a series of secret tutoring sessions from her brother in law in the US, and with the help of a tenacious professor and her sceptical husband (a self described venture capitalist with a heart) Beth discovers that not only does everyone want to do a good job, but through understanding the core problem of the system, they can work together to treat the cause and not the symptoms.
We All Fall Down is destined to revolutionise the service industry and not-for-profit sector in the same way that Eli Goldratt's book The Goal
Buy a signed copy now at a discount price of £15.99 including postage direct from us and see how it can help YOUR business! Alternatively it is also available on Amazon
We All Fall Down: Goldratt's Theory of Constraints for Healthcare Systems
by Julie Wright & Russ King
Chapter 1
Three little words! Just three words were capable of igniting the wrath of Fran the Fearsome. It was strange, I didn't regret saying them. I don't even remember allowing my mouth to let them out into the open. Sure, they were buzzing round my head like a flatulent bumblebee, but they should have been for my ears only.
Perhaps I had better explain. It was Monday, a day despised by nine-to-fivers around the world and dreaded by the Health Service. The family doctors get it first, the wave of patients dragging themselves in after a weekend of sickness. This delay in seeking medical attention results in many of them being so poorly that the overrun doctors have to admit them to hospital. The result? Their Monday morning rush becomes our afternoon rush, turning our daily crisis meeting into a catastrophe meeting.
We were all crammed into the Trust HQ Board room. It's a long narrow room with a ridiculously thick pile carpet that lurks silently, waiting to trip anyone accustomed to the smooth, polished floors of the corridor. The walls are decorated with expensive portraits of long dead Head Surgeons who view every meeting with justifiable distaste.
A long gleaming, solid wood table dominated the room. Chairs were packed around it and still more were crammed against the walls, but there were still some people standing. Me? I had grabbed my favourite spot, opposite the door with my back to the wall. The perfect spot for a manager who may be trusted to dole out bad news to dangerously ill people, but not to wear suitable clothes to work.
If you glanced in the room, it would have been easy to miss me, Mrs. Average with shoulder length mousy hair, just a mischievous glance away from being plain. I was trying to blend into the background despite the distraction of my horrific uniform of a navy blue synthetic skirt with a matching polka dot blouse. Yeuch! Here in my back-against-the-wall location I can watch the reactions of the others as they wait to hear just how bad it's going to get today.
Opposite me Fran the Fearsome, my boss, the Associate General Manager of Surgery was fulfilling her role as Duty Executive of the Day by starting the meeting. She looked effortlessly chic as she smoothed her elegantly tailored designer jacket and expertly flicked back her long, blonde hair as she started to speak. Not a synthetic polka dot in sight, but then she was senior management.
'Welcome everyone, despite the fact that we have just entered the month of July, we are still suffering from Winter Pressures,' Fran announced and paused. There were groans all round, just like every week I can remember. We spent all winter telling ourselves that the bed crisis would ease in the summer, only to find we have just as many patients now as in the cold months of winter. So what's new? I started to drift off as she waffled on about rocks and hard places, hitting the ground running and rising to meet the challenge. At last, she invited reports from the other members of the meeting and a tired and harassed looking male nurse from the Emergency Department kicked off proceedings.
'I'm afraid that unless five beds are found within the next hour we will have to report five, 24 hour trolley waits to the Department of Health, with another four, 12 hour waiters due before the end of the morning.'
There was a pause as everyone absorbed the depressing news before the ED man continued. 'As it's Monday we're not expecting the flow of admissions to slow down. In fact the usual Monday afternoon rush has been getting worse in recent weeks, not better as had been predicted.'
Next up was Joan, the Head of Nursing. Now here's someone who should be forced to wear a uniform. The poor woman has a severe problem with colour co-ordination and she was currently making a bold statement with an orange blouse and lilac suit. I think she's worked so many early shifts that she dresses in the dark. 'We have regular staff shortages on two thirds of the wards', she announced sternly, 'so please, please, be patient with the agency staff we have employed to fill the gaps.'
The Ambulance Liaison rep was just as critical as he reminded us that they 'cannot and will not' tolerate their ambulances being used as holding bays for patients that cannot be offloaded due to a lack of trolleys in ED. He stressed how this repeated behaviour is seriously impeding the services' ability to respond to 999 calls and threatened to take serious action if the management of the hospital cannot rectify the situation.
The reps from Trauma and Physio did a fine double act by listing all of their current patients along with their possible discharge dates. This was a totally unnecessary level of detail for this meeting; all we really needed to know was the number of patients they intended to discharge today. However, no one tried to stop them, as they seemed to be using this forum to justify their lack of discharges.
Eventually, it was my turn as Manager of the Admissions Department to spill my bad news and I started by gently correcting my ED colleagues. 'As you already know we have five, 24 hour trolley waits in ED with, I think you will find, another six, twelve hour waits to be reported before mid-day.' The ED Reps muttered to each other, but I ploughed on regardless. 'We have thirty routine surgical cases due in today, over two thirds of which are cancer or suspected cancer cases.'
I nodded to the Maxillio Facial Surgery Team, or Max Fax to those in the know. 'One of the cancer cases is a Max Fax patient, whom we cannot cancel.'
I was rewarded with a weak smile from the Max Fax team. 'We have nine routine medical patients due in. Three of these have been rolled from last week because of the lack of beds,' I continued. 'We have four outstanding requests for transfers from other hospitals, two to trauma,' I continued the nodding ritual with the trauma team, 'who have surgeons standing by to operate as soon as we can clear the necessary beds. The other two are waiting for medical beds, both terminal cases that need to be moved to this area to be near their families. 'Day surgery was opened over the weekend and we've already used all 10 beds in there. The teams on day surgery are furious as this goes back on last weeks promise not to use their beds. They are pushing my staff to move the patients off their unit before anyone else is allocated a bed.'
This comment provoked angry muttering from the ED, Ambulance Liaison and the Max Fax and Trauma teams so I was quick to continue. 'We have one critical care bed empty out of a total hospital bed-stock of 500 and the wards have only declared three definite, and eight potential discharges for the day. Leaving aside the possible discharges we need 61 beds to get the hospital back to normality, if it can be called that, and that doesn't account for any further requests for beds from ED.'
I sat down taking in the extra air of despondency my presentation had created. However, a bed temperature of minus 61 is certainly not the worst it's been and no one commented on my report. Fran nodded at me and turned her attention towards the other representatives in the room. As expected they couldn't produce any spare beds and the catastrophe meeting appeared to be drawing to a close without incident. However, I had an inkling that something bad was going to happen. Fran looked different, much too happy and my heart started bumping it's way down my spine the moment she asked the Heads of Departments to stay on for a few minutes.
The number of people in the room quickly reduced to a third of the original number and the remaining 10 of us waited for Fran to continue. 'I appreciate that the Monday meeting is not the customary place to announce such a major new project, but we concluded that the bed crisis was so acute that we could not afford to hang fire until the next scheduled monthly meeting,' Fran announced. 'I anticipate that my announcement today will encourage us to push the envelope and conclusively kick these problems firmly into touch. From next weekend, we will have a new team managing the hospital's beds. They will be called the Clinical Bed Management Team and they will be made up of Senior Nursing Staff.'
Bzzzzzzzz! Those three little words were already forming in my harassed little brain. Joan as Head of Nursing glowed in her lilac bloody suit and quickly scanned the room for a reaction. She didn't get what she expected as everyone was staring at me, waiting for my reaction. I looked down at the table, unable to meet their gaze, my head buzzing furiously.
'We all know the recent inspection by the Department of Health reported that we are working at a dangerously high capacity,' Fran continued. 'A major incident would leave us in dire straits. Their report demonstrated that we would struggle to get patients in and out of the hospital and it is for this reason that the board has decided to appoint a new team to tackle the problem.' Bzzzzzzzzz!
'Does anyone have any comments?'
Everyone in the room was looking at me, taking in my scowling face. The words were buzzing relentlessly inside my head and somehow I heard myself take a deep breath and quietly say. 'I don't understand.'
As uncomfortable silences go it wasn't the worst I've never heard. It was shorter than the time I called Mum from the States to tell her I'd just become engaged to Max. That lasted at least six seconds and was followed by a thud as Mum's backside landed on a chair. This one lasted about half the time, but there were no congratulations for me after it. The other reps looked embarrassed and Fran, well she looked as fearsome as I have ever seen her. Finally, she broke the silence. 'Details of the project will be emailed to you before the close of play today. Thank you for your time and Beth, please, will you stay for a while?'
I had to calm myself down, I pulled out a half written shopping list and started to jot down random items. Carrots, potatoes…I could hear the other people leaving, there were a few muttered words of congratulations to Joan. Onions, toothpaste, pizza…
I could hear Fran tidying her folder. Frozen peas, toilet cleaner, razor blades… It was just her and me. I looked up slowly to meet her steely gaze. We stared in silence for a few seconds, there was no way I was going to break it. I was boiling inside, the carrots and frozen peas hadn't helped. All I could think of were the razor blades. Eventually Fran decided to speak.
'Beth, Beth, Beth.' I tried to ignore the sickening maternal tone to her voice. 'You must have known something had to be done. You must see this is the best solution for everyone.'
She was obviously expecting a response from me, but I was on fire with a rage that I was determined to keep locked in. After another chasm of a pause, Fran continued, her voice sharper than a fresh hypodermic needle.
'This just will not be tolerated. Your position hasn't changed, you will be expected to step up to the mark and run with this project. The board are depending on you. I have told them you will, but with your current attitude I am beginning to doubt your ability to be a team player.'
I sensed that my silence was really getting under Fran's skin. I kept simmering quietly and restricted myself to looking at her with contempt.
'You have worked for me for five years and I can honestly say that your attitude has shown a marked deterioration during that time. You are developing a reputation for being uncooperative, at times downright obstructive.' Another pause, but I wasn't going to say a word.
'You must realise that this attitude will land you in trouble very soon. You know you will never get promoted if you keep this up! What do you have to say for yourself?'
I decided it was time to leave, I quietly picked up my file, checked my bleep that had silently gone off eight times during the meeting and walked towards the door. Finally, I turned to Fran. 'I shouldn't have said, "I don't understand",' I said before pausing to wonder if I should really continue. A smirk crept across the Fearsome One's face so I drove the insult home. 'What I should have said was, You don't understand.' I turned sharply and strutted out of the room, leaving a stunned and very angry Fran.
Copyright © 2006 Julie Wright and Russ King
Buy a signed copy now at a discount price of £15.99 including postage direct from us and see how it can help YOUR business! Alternatively it is also available on Amazon
Got any questions? Email Russ here.
"He who laughs, lasts"
Mary Poole
Home