Improving the productivity and efficiency of an integrated mental and addiction care – an application of the theory of constraints and five-focusing step to evaluation of adult ADHD patients

This paper suggests that the productivity and efficiency of social and health care services can be improved considerably by redesigning and streamlining the processes. The paper presents the theory of constraint (TOC) and five-focusing step (5FS) solution to the productivity and efficiency problems of an integrated mental and addiction care outpatient clinic (MTPA-model) team. The MTPA is an integrated walk-in clinic where clinical decisions on key patient groups are supported by a clinical decision support system (CDSS). One of the critical service processes of the MTPA is a CDSS-assisted adult ADHD diagnostics process. The aim of the paper is to describe the improvement of productivity and efficiency of a typical multidiscipline team of MTPA-model. A combination of the action research approach and design science research was applied to solve the emerging service process problems and create a CDSS. The paper outlines the principles of the TOC applied for the established CDSS-assisted adult ADHD diagnostics process. The bottlenecks or constraints of an adult ADHD process are defined. The data from the designed CDSS and the currently used electronic health record provided material for applying the 5FS methodology for improving the productivity and efficiency of the adult ADHD process. We suggest that applying the 5FS-process of TOC to mental and addiction care processes generally, and to the multi-professional team especially, is an effective way to negotiate constructively about the bottlenecks or constraints of the process and improve the productivity and efficiency of integrated mental health and addiction care services and operations. Based on the results, a general framework for improving the productivity and efficiency of a multi-professional team and health care services organization by applying the 5FS methodology is proposed.