UNDERSTANDING SYSTEM FAILURE IN HEALTH CARE: A MENTAL MODEL FOR DEMAND MANAGEMENT

• Dieter Hartmann http://orcid.org/0000-0001-9641-0095
• John Bicheno University of Buckingham, Business School
• Bruno Emwanu School of Mechanical, Industrial and Aeronautical Engineering, University of the Witwatersrand
• Teresa Sharon Hattingh Department of Industrial Engineering, The North West University http://orcid.org/0000-0001-5930-2546

DOI:

https://doi.org/10.7166/32-2-2344

Keywords:

Failure demand, Health care, System Failure, Efficiency, Demand Management, Quality, Health Policy

Abstract

The load on health systems caused by systemic overburden leads to heightened costs, longer waiting times, a reduced quality of care, andassociated problems. This may be caused by ’failure demand’; however, its definition is inadequate for a complex hierarchical system. Although accounting for a significant proportion of load in other industries, the academic assessment of failure demand in health care remains limited. We present a novel way of identifying repeat consumption, which we loosely equate with failure demand. We present a framework that can be used to identify ‘system failure’, the trigger for later repeat consumption. This provides new insight into understanding whether common events represent system failure. A diagnostic framework was developed from observations, the literature, and brainstorming. Commonly observed exit scenarios in health care were tested against the framework to create a system-failure list. The framework and the categorisation table were shared with eight international Lean health-care experts. Following feedback, the framework and categorisations were fine-tuned and consensus was achieved via member-checking. Identifying and managing failure demand for these settings can lead to a reduced system load, thus reducing costs and increasing system efficiency and quality.