Customer Reviews

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

5 star:		(7)
4 star:		(4)
3 star:		(0)
2 star:		(1)
1 star:		(1)

 

 

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."

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).

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.

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.

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!

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.

For a textbook shipper, this merchant take to long to send book. I order book in mid-December, I did not get the book until mid-January. This is unacceptable

Julie Wright and Russ King did an excellent job of demonstrating how many of the tools from the theory of constraints. fit together. Although written from a health care perspective, the information provided was valuable to any industry. Especially useful to me was the clear and concise demonstration of how a current reality tree is constructed and utilized.

Another fine aspect of this book is the depiction of human nature and resistance to change within an organization. In the end, I would say reading this has increased my confidence that systems can be changed, and not to be afraid of facing those who are unwilling to accept change.

It was written in novel format, and to be honest, the first half of the book did tend to drag on a bit. In the end, it all fit together, and it was obvious that the authors were building a complete view of the current reality; however it would be easy to put the book down in a haste to move forward. Don't put the book down though, it all fits together in the end.

We All Fall Down is quite an interesting blend of things you would not expect to see together - novel, technical book and non-profit self-help guide. At the core, this is a book on Goldratt's Theory of Constraints (TOC). Stylistically the book is an interesting novel (though you wouldn't buy it just for the story). The point of application is the British National Health System, though that's not the sole area for which the concepts will apply. I found it hard to put down, though I'm not sure if that was in anticipation of the story development, seeing how an analysis would turn out, or to learn the next nuggest about TOC.

What I really liked about the book was the new material that went beyond The Goal or Critical Chain. Wright gets into several very useful and broadly applicable tools for logical thinking and problem solving. These include the current reality tree and evaporating cloud. I've ordered Thinking for a Change: Putting the TOC Thinking Processes to Use (The CRC Press Series on Constraints Management) and The Logical Thinking Process: A Systems Approach to Complex Problem Solving. If you have a specific interest you can probably do better with these or other TOC books, but if you're new to the concepts of TOC or want to see it applied to a health care system, you'll find We All Find Down interesting.

Written as a detective story, the author takes you on a journey that 'unpicks' the puzzle of the Health Service. It clearly demonstrates how powerful staff can become once they are aware of the effect the core conflict of the organization is having on their daily lives.

Instantly recognizable, the situations described in this book will ring true to every reader, but what about the answer? How to break out of the often impossible position people are forced to face day after day. Breaking this conflict, through the power of cause and effect logic, enables the system to achieve successes beyond everybody's expectations?

"It is not the strongest or most intelligent of the species who survive, it is those most responsive to change"... Charles Darwin.