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Much has been debated about the pros and cons of publicly funded private health care and its ability to solve the wait-list dilemma. Perhaps no topic has been more controversial than the notion of queue jumping. Some may bristle with the notion of wealthy people jumping the queue, but we need a reality check. It would seem that the wealthy are essentially already jumping the queue by having their procedures performed in the United States or elsewhere.

Systems Thinking: From Heresay to Practise

The concern is that sometimes individuals pay huge dollars i. My argument is to keep these profits in Alberta and use them to pay for our public health care services. If jumping is already occurring in the context of the current health system, then could we somehow learn to embrace the notion of jumping and simultaneously allow all Albertans to benefit?

Perhaps we could let anybody in our current system jump to the front of the line for hip surgery, cataract surgery or whatever else might present with a wait-list. I say this with one major caveat — jumpers would have to pay perhaps five times the actual cost of the intervention.


For example, if the total cost to the health-care system i. When a jumper pays five times the cost for cataract surgery, all derived profits would be retained within the cataract system to pay for four other people waiting in the queue.

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This is a sort of Robin Hood approach except that the jumpers are voluntarily helping to pay for those marooned in the queue. Profits would help underwrite more equipment, nurses, technical staff and physicians.

Systems Thinking: From Heresy to Practice |

Performance incentives could be offered to physicians capable of ramping up their practices to meet the increased demand. Eventually, the more queue jumpers we have in this model, the faster the wait-lists would shrink and disappear. This proposal would seem to benefit most everyone. The jumpers would likely be happy because they not only had their personal medical needs met, but they also voluntarily helped the system and others less fortunate.

The taxpayer would benefit and I am certain that we would all be happy to see the end of wait-lists. Thinking about the model, the only unhappy people might be those profit-minded individuals wishing to embrace the private provision of health care services.

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Profits from the queue jumpers in my model would benefit the public system and would not benefit private individuals or shareholders. In my model, the ultimate beneficiary from the jumpers is other less fortunate patients and the Alberta taxpayer. An actuary would have to look at this model, but it seems that the more jumpers we have, the more supercharged the system would become and the faster wait-lists would be eliminated. The rate-limiting steps would be the speed with which procedures and investigations could be performed, staff availability and the number of people interested in paying to queue jump.

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In order to allow more people to become jumpers, limited tax credits or tax deductions could perhaps be offered. In addition, insurance companies could offer plans to cover jumping expenses. Instead, participants are required to continue to follow the method and to ensure that they are engaged in the study of their service in a systematic way.

This chapter documents the application of systems thinking methods to an English local authority Adult Social Care department. The author shows how the perception of large demand for scarce social care resources leads councils to screen out many of the applicants for this service through the strict application of eligibility criteria.

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A systems analysis shows the inefficiency of this approach: many of the users are later found to require a more expensive service once their condition has deteriorated sufficiently to be eligible. By redefining the purpose of this service and refocusing on doing what matters to the end user and ensuring it is done right-first-time, the social workers in the system are enabled to experiment with new methods of providing the service. The results from before and after the experiment are then examined, showing both cost savings and improved operational measures for service delivery.

Following the Gershon Report , a public sector Shared Service Centre SSC was created to bring about joined up services and service transformation. This paper evaluates the Change Programme that was established in order to facilitate this transition in terms of success and sustainability. It also examines, to some extent, the services that the organisation provided. The results achieved are outstanding, making the targets the service was set by central government look unambitious in comparison.

One approach to organisation and business improvement has been systems thinking ST and there is some recent evidence that systems thinking interventions in the service and housing sectors have made some significant improvements Jackson, et al. In , a book called The Machine That Changed the World shook the automotive industry by showing how far ahead certain Japanese car makers were in manufacturing, design, and supply chain capability using lean production techniques pioneered by Toyota over the last 50 years.

However, since that publication the sphere of influence of lean has been vast and ubiquitous. Originating in automotive manufacturing, lean has spread into general manufacturing, into the service sectors such as retailing and, more recently, into public and third sector organisations. Moreover, many have argued that the term lean is highly inappropriate for describing the depth of approaches deployed in Toyota.

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A management thinking shift has recently been noticed in public services to adopt manufacturing improvement paradigms in their attempt to face economical and operational challenges. This chapter investigates the utilization of systems thinking in public service operations for potential added value. A case study of systems thinking implementation at a UK city council help desk was carried out using in- depth interviews with key personnel coupled with observations and document evaluation.

Results show that systems thinking could create significant added value to the business and to the working place. In addition, a strong relationship was demonstrated between the systems thinking implementation and the affective commitment level of employees.

This chapter is one of a few studies that demonstrate the applicability of manufacturing systems in other settings and that they can generate significant added value for the overall service department. This chapter investigates the outcomes of service improvement initiatives undertaken within a major UK bank.

It reports on the processes and outcomes from the perspective of bank employees engaged with the change initiatives.