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

~ Julie Wright (Author), Russ King (Author)

Editorial Reviews

Product Description

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 Admissions Manager in a busy British NHS hospital. Someone with very little authority but a huge amount of responsibility. She has to find beds for patients in a hospital that is claimed to work at 98% capacity – an impressive achievement that means the maximum time a bed is empty is less than 15 minutes. It’s best not to mention the waiting times.

Unfortunately there are far more patients than beds and no money to bring more beds in. Someone has to decide whether a bed is taken by a patient who needs an extensive operation that will allow them to live a few more months, a breast cancer patient, or someone with two broken legs. Added to that, Beth is struggling against her caustic boss ‘Fearsome Fran’ and her meddling assistant ‘Evil Eddy’ who tries to undermine her and take her job.

Everything comes to a head when Fearsome Fran announces a new silver bullet plan to free up more beds. Beth knows that not only will it not work, but that she is effectively being demoted. But what can she do? She has 61 more patients than she has beds and a very short period to time to stamp her authority on Fran’s new plan in order to stop it making things much worse.

Her luck changes when eligible bachelor Professor John Summers becomes her unlikely ally after becoming frustrated with the number of his operations that keep being cancelled. She also starts receiving some interesting advice over email from her brother-in-law in the US and slowly starts to believe that she can unravel the mess of the health service system and find the core problem and then the main constraint of her particular hospital.

We All Fall Down. Goldratt’s Theory of Constraints for Healthcare Systems is a textbook written in the style of a witty, thriller novel. The reader is involved with Beth’s challenges and dilemmas, and through her experiences, discover how Eli Goldratt’s theories can be applied to the healthcare and service industries.

You don’t have to be mad to work in the health services, you have to be caring, dedicated and resourceful as any errors can have fatal consequences. If you know someone from the health service, buy them this book so they can see the whole picture and what they can do improve the system. However, this book is also essential reading for anyone who has been frustrated by hospital delays or who works in other service industries such as teaching.

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 did for the manufacturing industry. Don’t be left on the waiting list!

Product Details

• Paperback: 353 pages
• Publisher: North River Press (January 31, 2006)
• Language: English
• ISBN-10: 0884271811
• ISBN-13: 978-0884271819
• Product Dimensions: 8.9 x 6.1 x 1.1 inches
• Shipping Weight: 1.3 pounds (View shipping rates and policies)
• Average Customer Review: 4.4 out of 5 stars  See all reviews (10 customer reviews)
• Amazon.com Sales Rank: #391,782 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

9 of 9 people found the following review helpful:

5.0 out of 5 stars How to change? Start where you are, April 3, 2006

By	Steven Holt - See all my reviews (REAL NAME)

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."

11 of 12 people found the following review helpful:

2.0 out of 5 stars Not good enough, June 15, 2006

By	A. Bolger "Anthony" (Montevideo, Uruguay) - See all my reviews (REAL NAME)

I was quite disappointed with this book. I've heard that the results in the British Health System after implementing TOC are quite outstanding. If it's true, this book doesn't reflect it.
First of all, written as a novel, the backround story is not good. Two brothers are in a great fight and won't talk to each other because one of them is a TOC follower. Come on! I'm sure the authors's could've found a better backround story.
The description of how the NHS works is poor. The Health System is different from the one in my country, so I found it very hard to try to figure out how the NHS works, the different departments, the interactions, etc.
From the TOC point of view, good for someone just starting with TOC, but too light for someone who has read any other book.
To explain the concept of a system constraint, the book uses the same type of analogy used in Goldratt's "The Goal" (the boy scout trip), but the example and the explanation is not good.
The clouds built to find these problems conclude that the core problem of the NHS is the lack of communication between the different levels. I was expecting a more detailed analysis from the operations point of view.
In the last chapter a year has passed, and there is a summary of everything I would have expected the book to explain throughout the book, all in one chapter, with insufficient detail.
This book is good if you are involved in the NHS, and therefore know its problems, and if you know nothing about TOC.
If you want to learn about TOC Thinking Processes, I recommend Dettmer's "Goldratt's Theory of Constraints" with the main concepts, and "Management Dilemmas" (Shragenheim) with many interesting practical examples. Also "It's not luck".
If you want to learn TOC Operations, "Manufacturing at Warp Speed" (Dettmer & Shragenheim).
Project Management: Project Management in the fast lane (Newbold).

2 of 2 people found the following review helpful:

4.0 out of 5 stars Very good story - incredibly insightful, January 22, 2007

By	Farnoosh "ProlificLiving" (USA) - See all my reviews

This book was a slow start, then I really started to come up to speed on the healthcare system, their challenges and issues and enter Harry, with the ideas on Theory of Constraints which Beth grasps very quickly and starts to put to use. It is very encouraging as she decides to take on this amazingly large task to hand, armed with just her new thinking and analyzing techniques. I really enjoyed the read. I was however very frustrated and disappointed at the endless number of punctuation, grammar, and other similar English language errors that the publishers had made. I will be sure to contact them to make them aware of it. Good read, and I highly recommend it.