We All Fall Down: Goldratt's Theory of Constraints for Healthcare Systems

by Russ King, Julie Wright, Jane Wong

Book Overview

Who hasn’t gone into a shop or workplace at some point and seen the sign ‘You don’t have to be mad to work here, but it helps!’? This over-used phrase becomes very real in the case of Beth Seager, an... This description may be from another edition of this product.

• Format: Paperback
• Language: English
• ISBN: 0884271811
• ISBN13: 9780884271819
• Release Date: February 2006
• Publisher: North River Press
• Length: 353 Pages
• Weight: 1.35 lbs.
• Dimensions: 0.9" x 5.9" x 8.8"

Customer Reviews

We All Fall Down Stands Tall

Julie Wright's application of the Theory of Constraints to the healthcare system in the UK is relevant to anyone in the healthcare industry. The techniques used in the novel are so fundamental they transcend the model of financing and management of the system. In fact, you will have a better understanding of the system you are in if you read the book. I have always thought we physicians were a bottleneck in the system. Reading We All Fall Down confirms this. The novel is very entertaining, easy to read and makes some great points. I recommend it highly to anyone in healthcare management or leadership. It's not bad as a general read as well. Ed Millermaier, MD Chief Medical Officer, Ambulatory Care Division, Borgess Health, Kalamazoo, Michigan.

We all may fall, but this book stands tall!

Julie's book is very timely and instructive in how TOC can be applied to healthcare in particular, and the services industries in general. The book is engaging and powerful and also breaks new ground (such as expanding on Dr. Goldratt's 6 layers of resistance; and the real-world, relevant examples of use are especially good). In addition to the strong treatment of some of the key TOC Thinking Process tools, the book is a how-to for change management as well. I have read "We All Fall Down" 3 times, and each time have gained new insights into the applications.

A Great Business Book

Although this book makes reference to the NHS, there is plenty of management guidance within the pages for businesses of all sizes to benefit. We All Fall Down is very well written with just the right amount of humour. Whether you work within the NHS, a large corporation or for yourself, there is something to learn from this book. I really enjoyed it and would recommend it highly. Diane Stafford

How to change? Start where you are

There's a lot to like in this book. It's written in the tradition of the business novel, in which we live the character's problems and then learn the solutions with them. In that sense it is following in the footsteps of similar books, "The Goal" by Eli Goldratt (and, for that matter, any of his novels), "Great Boss Dead Boss" by Ray Immelman, "The Gold Mine" by Michael and Freddy Balle, and "Who's Counting?" by Jerrold Solomon to name a few. But there is one very key difference between "We All Fall Down" and all of those books-the main change agent is not a senior manager or executive who has significant amounts of position authority. Indeed, the main character, Beth Seager, is a low level manager who must deal with her boss's and other departments' conflicting goals and metrics. She faces rebellious employees and cruel hearted senior managers alike-at least that's how it looks to her initially. Over time she begins to see things differently as she takes a more systemic view of the situation. Another key point brought out in the book is that there is seldom a safe mechanism for employees to critique management decisions and that often decisions are made without any consultation with the people who have to carry them out. The higher up the decision is made (the closer it looks to a major company strategy) the less employees are able to critique and comment on it. No matter what the change, this destroys trust and significantly increases implementation difficulty. This is at heart a Theory of Constraints book and the main character learns and uses basic TOC principles and tools to solve the problems she faces. Unlike similar books, it takes place in a not-for-profit hospital; this is one of the few cases where the system goal is NOT to make money and it shows that the approach is just as valid for non-profit organizations. 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."

A Service to the Theory

Having researced 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. If you are new to TOC, then its an enjoyable intro to the subject. If you're familiar, then there's still enough insight to make it worthwhile. I certainly have a much greater understanding and appreciation for the challenges that the UK's healthcare system faces, or more importantly the stress the staff are under. And I daresay many of the symptoms and causes will work on other service orientated environments too. 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!