how to draw current reality tree

6 Step 3: Synthesis—Development of the Current Reality Tree Based on the Theory of Constraints

Synthesis Methods

Primed with the insights provided in Step 1 and Step 2, we moved to synthesis—that is, to drawing up a representation of the current process, focusing on factors constraining the success of EPC products. We applied techniques described in the Theory of Constraints (TOC), a well-established, explicit, and reproducible means of identifying and addressing complex problems in a systematic and comprehensive manner.⁴

TOC is similar to traditional process improvement techniques, with the exception that it is designed to accommodate complex processes, such as provision of health services, which, unlike many industrial processes, are non-linear. TOC understands that processes do not function in isolation, but are part of a larger, intertwined system. Therefore addressing root causes at process levels does not result in sustainable solutions. Hence, as an alternative to investigating and addressing problems (or one root cause) at a process level, TOC demands a much more involved investigation into the relationship between several root causes of all the failures of processes in the system. It then forces the strategic thinker to explore the one root cause that leads to most undesirable effects (UDEs), and labels it as the core problem. TOC proposes to focus attention on this core problem. The core problem is called the "constraint" in TOC terminology. This constraint prevents an organization (e.g., an EPC) from reaching its goal (namely, developing a "useful" evidence report). Because the TOC thinking strategy has thought through other processes in a system that can affect the root causes of problems, its change strategies produce more sustainable results.

TOC proposes that this detailed investigation can be best performed through five systematic exercises. Each of these exercises requires construction of corresponding logic "trees." Most of these logic trees can be used as stand-alone tools, depending upon the nature of the questions under consideration.

We based our analysis for the current problem on the first of these logic trees, the Current Reality Tree (CRT). The CRT informs about the existing situation (what to change); this is followed by the design of new reality through the construction of a Future Reality Tree (what to change to). This involves introducing new ideas—strategies for change. These change strategies are called "injections" in TOC terminology. Identification of these injections and creating the Future Reality Tree were the objectives of Step 4.

Figure 1 illustrates a template of the CRT. It represents the various undesirable effects (UDEs) associated with the production and use of evidence reports, as well as a series of hypothesized causal relationships. At the top of the tree is the most important UDE, the UDE that is fundamental to the entire process. TOC proposes that strategic thinkers then explore other UDEs and their root causes, the relationship between them, and the core constraint (one root cause) that leads to the fundamental UDE.

Figure

Figure 1. Template of a Current Reality Tree.

We utilized the interview results, and the literature search to organize our thoughts to develop the CRT for the SOW process. For this purpose, we did the following:

• Identified the most relevant UDE.

• Explored other UDEs.

• Listed a set of root causes that led to the UDEs.

• Explored the relationship between the UDEs and the root causes, so that one (or two) core constraint (s) could be identified.

Synthesis Results

Our interviews with EPC researchers, partners, and AHRQ allowed us to identify a common UDE, described from their perspectives:

• For researchers a report was considered "unsuccessful" when the partners failed to use the report and complained that the report did not meet their requirements.

• Partners considered a report successful if it met their needs.

• AHRQ staff believed that even a technically excellent EPC report was unsuccessful if it was not useful.

Therefore we concluded that that a report that does not get used is unsuccessful and among all UDEs, this effect is deemed fundamentally undesirable.

We formulated the CRT (Figure 2) working from this fundamental UDE at the top through proximate causes, and finally root causes. For this purpose we made several assumptions:

• The partner had some potential use for a report for which they could articulate needs. This precludes the possibility that a report is requested for no reason at all. This led to the principal reason a report would not get used—that the report does not meet those needs. We distinguish here between:

  • Needs—the ultimate goal of the information seeking activity

  • Objectives—how the partner articulates their understanding of their needs, e.g., in the form of key questions

  • Specifications—how the work is described for purposes of communicating with the contractor in the form of a Task Order or Statement of Work

• EPCs have expertise sufficient to produce a technically perfect report given adequate resources and specifications. This assumption derives from the vetting process used by the AHRQ in selecting EPCs for the program.

Figure

Figure 2. Current Reality Tree for the EPCs.

In the next stage we extracted a list of root causes from our interviews:

• Partner does not know how to conceptualize and articulate needs, objectives, and specifications required for the desired report.

• Specifications for a report are not initially sufficient.

• Specifications for a report change "mid-stream."

• Partner's initial objectives regarding the final report are clarified late in the process.

• Partner's needs change late in the process.

• Volume of anticipated work required for the completion of the report is initially underestimated by the EPCs.

• True cost and time requirement of the project are underestimated.

• Project cannot be accomplished within the timeframe allotted because new costs emerge later during the course of the project.

• Budget and timelines cannot be revised.

Following TOC methods, we explored the relationship between these root causes in order to identify one (or two) major problems that lead to the rest, and ultimately result in a report not meeting the partner's needs, and therefore not being used (Figure 1). This could be the result of causes in one of two categories: (1) resources (budget or time), and (2) specifications (stipulations of content or process for development of content).

Whether a resource issue relates to budget or to time schedule, process failure can result from underestimation of resource requirements at the outset of the project, or because unanticipated requirements emerge later. Given the assumption about the capabilities of the EPCs, the proximate cause is insufficiency of the initial specifications.

The specifications can be insufficient because they do not provide an accurate guide to the ultimate volume or nature of work (e.g., number of studies to evaluate or specific techniques of synthesis to use) at the outset, or because the specifications change after the project is well underway. The latter problem (referred to in the interviews and literature as "scope creep") is the result of partners stating objectives at the outset that do not actually reflect their needs, or the partner's needs change due to external forces (e.g., new science, new political or other practical considerations). Insufficiency of initial specifications and scope creep are linked to the inability of the partners to conceptualize and articulate their needs, objectives and specifications (referred to as the "conceptual framework").

From this list and from Figure 2 we identified four basic "root causes":

1.

Partner does not know how to conceptualize and articulate needs, objectives, and specifications (the SOW).

2.

Partner's needs change late in the process.

3.

Insufficiency of specifications is never appreciated.

4.

Budget and timeline cannot be changed in response to down-line changes in project specifications.

Of these, the first (partner does not know how to conceptualize and articulate needs, objectives, and specifications) rates as a core problem or the constraint that prevents an EPC from achieving its goal because it affects most other problems. This is the reason why specifications are insufficient in the first place, which leads to an underestimation of the volume of work, results in new cost and time requirements that lead to delays in the report, and finally results in the report not being used. If this one problem is solved, it is expected that most other issues can be resolved. Note that two other root causes that are not technically core constraints could also independently impact the success of the SOW. These causes are: 3. insufficiency of specifications is never appreciated and 4. budget/timeline cannot be revised.

The second root cause, partner's needs change late in the process, is isolated from the rest of the CRT because resolving this root cause is beyond the span of control of the EPC. TOC suggests that we eliminate it from our logical thinking process.

dyerwils1983.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/books/NBK44036/

Share this post