Using the theory of constraints to create a paradigm shift in organisation performance at a large primary care provider practice.

Healthcare is in crisis with increasing patients' needs, rising medical technology investment, increasing expenses, and patients' inability to pay. To address this crisis, a new, simple, effective, and holistic management methodology is needed to rapidly and economically improve each link's performance in the healthcare supply chain (HCSC). The HCSC involves several links starting with the sick patient, then the primary care provider practice (PCPP) then the specialists … to the well-patient. Most HC research does not address this ill-structured, messy-problem environment: the causalities within a link and across the HCSC; the multiple criteria imposed by different HCSC stakeholders. Better management of the PCPP, the gatekeeper to other links is the leverage point to providing more, cheaper, better and timely healthcare. Action research at a PCPP using Theory of Constraint resulted in increases in revenue and net ordinary income; decreases in patient no-show rates and waiting times; and better provider utilization.