whose purpose is to ensure that the pace of everyone’s work is synchronized to the Drum. While Buffers ensure the Drum is protected from variation, the Rope is designed to ensure that buffers are not too long, too short, or excessive. It is designed to protect the system from being overloaded. See Figure 2 for a summary of DBR.
Fig. 2. The DBR at work Finally, BM is a tool to manage the execution of the plan. The function of BM is to help resources prioritize tasks to improve synchronization, expedite urgent tasks to avoid delays, escalate situations requiring additional approval or resources, and improve critical processes preventing flow. BM becomes operational by using a color scheme based on how much each of the buffers determined in DBR are consumed. By continuously monitoring events during execution, we determine colors by “buffer consumption.” Buffers start as green, and, as they are consumed, they turn from green to yellow, red, and finally black. A system needs to be developed to determine buffer status dynamically without burdening employees. Visual tools (such as a computer display or colored stickers) are used to communicate the conditions of all buffers to all resources so they can prioritize their activities. These three tools can be adapted to improve flow in emergency departments, inpatient units, and clinics. 5FS is generic enough that can be used in any healthcare environment. DBR can be more quickly applied to clinics because the physician schedule is the Drum, and the system design requires it to determine the different Buffers and the Rope schedule. BM can also be applied to any healthcare environment, but it is more appropriate to be used in inpatient units where the Drum schedule is not possible. TOC offers an innovative and practical methodology to improve patient flow, an essential part of healthcare systems worldwide.
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