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Every dollar of the material prosperity we enjoy can find its roots in the industrial revolution and our ability to produce more for less. We came off the farms to work in the factories and delivered unprecedented growth in wealth for our toil.
This is Part 3 of our series on Asset constraint management: Part 1 | Part 2 | Part 3 | Part 4 | Part 5
Dickens gave us the literary view of what those early days were like and Marx had us thinking about how the means of production, distribution and exchange could be put to better effect if it were all owned and run centrally. Thankfully, I live in a country where Marx’s ideas carry little weight. Instead, our commercial and economic systems are deeply grounded in the concept of free enterprise, with unprecedented opportunity of wealth for toil.
People are at liberty to enter into a voluntary exchange between each other for the provision of goods and services that have the intention of delivering additional value and wealth to both parties. In the free market, it means that we have to compete against all comers in the global economy to both persuade and influence our existing customers to remain loyal and to win new ones.
If we have established that there are customers willing to pay us for products or services we wish to offer the market, then the question has to be how we go about producing them. Because we are thinking about production, we’ll ignore for now the work that goes into, in the first place, the marketing and engineering of the product or service—which is better suited to the domain of portfolio, program and project management.
My definition of production is simply the making of goods or services available for use. It is clear, then, that besides the desirability of the product or service itself, the critical factor is how we go about its production. How long will it take to get to the customer? What fixed and variable costs will I incur in doing so? What contribution will I make per unit, and what profit will the product or service add to my business? What penalties will I incur if I cannot deliver against my promise? What premium might I get if I can supply in shorter times than my competitors? How much do I need to invest in plant, equipment and inventory to be a reliable and agile supplier to my customers? How will I ensure that everything I supply is routinely of a quality that satisfies the needs of my client and minimises rework? What kind of learning program do I need to pursue with my team to continuously upgrade their ability to deliver ever better outcomes?
We owe an enormous debt to the pioneers of productivity, from the ‘scientific management’ of Frederick Taylor to Deming’s System of Profound Knowledge and from Taichi Ohno and the Toyota Production System onto the revolution wrought by Eliyahu Goldratt and his Theory of Constraints (TOC).
Ohno gave us the first fundamental principle of Lean in his famous quote: ‘All we are doing is looking at the timeline,’ he said, ‘from the moment the customer gives us an order to the point when we collect the cash. And we are reducing the timeline by reducing the non-value-adding wastes’. I always thought that the simplicity of Ohno’s injunction was akin to golf: get the ball in the hole in as few strokes as possible, or Goldratt’s injunction to make more money now and in the future. Compelling ideas because of their simplicity but requiring high levels of mastery to accomplish.
Below is a diagram of eight different types of waste identified by the Toyota Production System and subsequent development of Lean Manufacturing. In Goldratt’s words, he stood on the shoulder’s of giants to take what his predecessors had accomplished and use his insights from TOC to go further. While eliminating waste is a good start, it’s not the reason you run a business. What you’re there to do is, as mentioned a moment ago, ‘make more money now and in the future’.

There is a fascinating story told of the early days of TOC production software development. There were two significant challenges. First, most of the focus in those early days was in developing software for financial controls. Thus, access was granted to the ops analysts and programmers for minimal amounts of time in the dead of night when everyone else had gone home. Second, the memory available on the processors was tiny, so the pioneers had to enforce certain assumptions about fixed lead times and batch sizes, or else the computer couldn’t calculate the resulting production plan. This rule on batching and lead times became the norm in the development of materials requirements planning (MRP) software.
“Get the ball in the hole in as few strokes as possible”
The consequence of these fixes was an enormous impost on big manufacturing companies, in the form of the massive inventories the algorithms demanded. In a way, it suited them, as their management accounting systems were being run based on absorption costing principles. The more stock you made, the more of your cost base you ‘absorbed’ into it. Work in progress piled up on the shelves and the balance sheet showed them as assets. The only trouble was that much of the resultant product didn’t have a customer. All that production capacity, working capital and physical space were wasted.
Along comes Goldratt with his remarkable truth: all systems have constraints—if they didn’t, the output would be infinite. Since no system is capable of producing an infinite output, the theory holds as a valid falsifiable scientific hypothesis. A consequence of this insight was the development of the Five-step FOCUS, Drum Buffer Rope Scheduling and the TOC approach to management accounting called Constraint Accounting. These three innovations in productivity provided a platform to address the systemic issues associated with the complexity of the production environment.
Consultants and improvement practitioners around the world applied these methods and tools across an increasingly diverse array of industries. It turned out there were four basic production shapes—V, A, T, and I—each of which had their particular challenges. It is a testimony to the power of TOC’s approach to production planning and control that it can tailor the general principle to the specific use case. The four main production archetypes are recalled by the letters VATI because of the way the parts flow through the system. Each process looks like one of the letters, traced from bottom to top.
To quote from Eli Schragenheim’s paper in the TOC Handbook (p.201):
Material dependency, resource dependency, convergence points and divergence points are the fundamental elements of a product flow diagram (PFD). Production operations can be classified into families based on which element is the dominant element in the PFD of that particular operation. If divergence is the dominant element, then we have a V plant. If convergence is the dominant element, then we have an A plant. If both divergence and convergence exist (and exist at the same stage, then we have a T plant. If we have neither convergence or divergence, then we have a simple case of resource contention, and the plants are classified as I plants.
It’s essential to know what kind of product flow you are dealing with if you’re looking to optimise production. The way you implement Drum Buffer Rope (DBR) in each case is different. Some quick examples:
V – producing different electrical cables from separate windings and insulation of the same gauge copper wire.
A – the manufacture of an aero engine.
T – the production of a range of cars of the same model, but with different features such as a sunroof and mag wheels.
I – production of alumina in a refinery.
V and A – the overhaul of an aeroplane. The V pulls it apart to get to all the serviceable components, and the A puts it all back together again.
It is beyond the scope of this article to articulate the way you could use DBR in each environment. Still, there is more than enough evidence that this breakthrough in optimising production is, for all practical purposes, universally applicable. If you are in the market for systemic improvement, some further investigation will yield a handsome return.
A critical success factor for the delivery of excellence in production is the constraint accounting framework. At a speech given to an accounting conference, Goldratt once famously declared that ‘accounting is the number one enemy of productivity’. Accountants would like to know what a product costs so they can establish what profit it contributes when that cost is subtracted from the selling price.
To achieve this feat, they add together the material costs of the widget being produced to the product of the minutes and unit cost of the labour that went into making it. The problem is that not all minutes are equal. Saving a minute at the constraint saves a minute for the system as a whole, whereas saving a minute at a non-constraint is a mirage. Optimising production is a function of how the constraint performs, and not the efficiency of the parts.
The ultimate in optimised production is that you are able to replace a sold product the instant it is bought by a customer. I go to the supermarket and scan my bar of chocolate across the till. Every gear should go into action to send it to replenish the shelf as if an attachment to an email. But most operations don’t do this. Instead, they wait until the retailer has assembled their sales report; they compare that against their own sales report; they wait to run a sales and operations planning meeting and finally they let a production order loose onto the shop floor. Then, they delude themselves about what makes up a minimum production order and what size batch they need to ship to make it economically viable.
Eventually they have a container load to ship and thousands more bars of chocolate have been sold. The system is stuffed with inventory to try and deal with the extended lead time it takes to replace a bar of chocolate.
They would like to avoid the risk of carrying inventory by doing everything they can on a make to order basis. Their customers won’t tolerate the time it would take to go from order to fulfilment, so they come up with very fancy forecasting algorithms to predict how much they should be making to stock. They always get it wrong and end up writing down or scrapping the excess.
The real task at hand is to understand what is reasonable and possible in terms of lead time to replenishment. By Little’s Law, the less lead time we take, the less inventory there will be in the system. Use the insights from TOC and DBR to reduce lead times, increase due date performance, increase throughput and reduce inventory.
Let me leave you with a few questions:
As an executive in charge of production, you need to be a reliable and responsive supplier to your customers. Yet how do you really know what you can promise, by when? You don’t want to be a tyrant demanding impossible feats from your team. But, until you investigate the principles of TOC, you may not know what is reasonable and possible. In the next article in this series, we’ll look at how maintenance can move from a regret cost to a throughput enabler.
This is Part 3 of our series on Asset constraints management.
Part 1: Asset Constraints Management Capabilities
Part 2: Projecting Projects
Part 3: Producing production
Part 4: Maintaining production
Part 5: Controlling contractors
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What’s next?
The change from standard thinking to Theory of Constraints (TOC) is both profound and exhilarating. To make it both fun and memorable, we use a business simulation we call The Right Stuff Workshop.
We’d love to run it with you. To learn more:
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“Know the whole, focus on the constraint.”
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Concept validation
A concept can look convincing in a presentation and still make an important task harder. A patient may misunderstand an indicator. A clinician may need information the design does not provide. A promising workflow may depend on support unavailable in the intended setting.
These problems become more expensive when the organization discovers them after committing to architecture, tooling or a launch plan.
We must ask how effectively concepts are validated before significant resources are committed. Patient Centered Design treats this as a learning discipline: turn ideas into testable solutions rapidly using low fidelity prototyping, put them in front of relevant users and gather evidence about whether they improve the outcomes that matter.
“A convincing presentation shows what the team hopes will happen. A useful test reveals what people actually do.”
A prototype without a learning objective can generate interesting comments while leaving the key decision unresolved. Start by identifying what must be true for the concept to succeed.
Does the patient intuitively understand the required action without explanation? Can the professional recognize when the result is ready to use? Does the proposed approach fit the work surrounding the task? Will people take meaningful steps toward adoption?
State the assumption and the evidence needed to assess it. Agree what would support proceeding, what would require revision and what could make the concept unviable. Gather quantitative data along with qualitative verbal feedback.
Prioritize questions with substantial consequences for the investment. An attractive enclosure deserves less attention than an unresolved issue that could prevent safe or practical use of the whole solution.
A picture is worth a thousand words. A simple user experience prototype is worth a thousand pictures. Choose artifacts that maximize learning with the least effort. The appropriate artifact depends on what the team needs to discover.
A sketch may help users explain how they interpret a proposed interaction. A physical mock-up may expose handling difficulties. A simulated interface can support a sequence of tasks. A more complete prototype may be necessary to examine timing, feedback or combined interactions.
Build enough realism to test the assumption accurately. Excessive detail can consume resources without improving the evidence, while insufficient fidelity can conceal the issue being investigated.
Make limitations clear to participants and observers. A manually simulated function may help test an experience, but it does not establish that the technology can deliver that function reliably.
Patients and healthcare professionals can differ in experience, confidence, physical ability, responsibilities, and access to support. Those differences influence whether the concept helps them complete the job.
Define the participants and contexts relevant to the test. Include people whose circumstances could expose difficulties the development team has overlooked.
A familiar expert may work around a confusing interface that challenges a new user. A clinician from a highly supported center may assume resources unavailable elsewhere. Research needs to reveal these dependencies.
Match the study to its purpose. Exploratory sessions can identify problems and guide iteration. They do not automatically establish population-wide performance or replace the evidence required for later design validation.
An Experience Café gives participants a structured opportunity to encounter concepts and talk about their experience. Its value comes from the quality of the scenario, observation and follow-up questions.
Set up situations that reflect what the person is trying to accomplish. Let participants interact with the artifact rather than rely solely on a demonstration by its designer. Build rough and rapid.
Assign roles to facilitators and observers. Agree how comments, actions and difficulties will be captured. Keep the session focused on learning rather than defending the proposed solution. Hold a conversation around the prototype. “Can you show me how you would use this?” “Tell me what you are thinking here.”
Ask participants to explain what they believe is happening and what they would do next. Observe where the concept supports that understanding and where they hesitate, improvise or seek help.
A facilitator can unintentionally make a weak concept appear successful by explaining each step or supplying missing information.
Use neutral prompts and allow participants to reveal their interpretation. When assistance is necessary, record it along with the point at which the person became stuck.
Follow observations with questions about purpose and reasoning. What did the participant expect? Which information did they look for? Why did they choose that action?
Separate a preference from evidence about task performance. “I like this one” may reflect appearance or familiarity. Successful completion, appropriate interpretation and manageable effort provide a stronger basis for assessing whether the concept addresses the need.
“Every explanation the facilitator must supply is a question about what the design expects the user to know.”
The product interaction belongs within a wider job. Test preparation, readiness, execution, monitoring and what follows, wherever these activities affect the concept’s value.
A device may work well once configured while setup introduces avoidable complexity. A result may be easy to view while the professional still needs to transfer it manually before acting.
Include relevant dependencies on caregivers, staff, information and other systems. Investigate whether the concept reduces burden for one participant by increasing it for another.
Use realistic scenarios appropriate to the development stage. Important exceptions and recovery steps deserve attention alongside routine success. An incomplete or interrupted task can reveal weaknesses that a carefully guided demonstration leaves hidden.
Ease of use involves what a person must notice, understand, remember, decide and physically do. A tidy interface can still demand substantial mental effort.
Human performance depends on limited attention, working memory and feedback. Examine how the concept supports those processes during a task.
Does it make the relevant information perceptible? Can the user understand its meaning? Is the next action clear? Can they recognize whether that action succeeded?
Look for unnecessary steps, demands to remember information across screens and alerts that interrupt without helping a decision. The best change may simplify a sequence or improve feedback rather than add another feature. Confirm its effect through observation and appropriate measures.
Choose measures that reflect the priority outcome and the study’s purpose. These may include completion time, errors, requests for help, repeated actions or failure to notice important information.
Subjective workload measures can complement observed performance. NASA Task Load Index can help structure participants’ assessment of workload, while PURE provides an expert assessment of the effort required to complete tasks. Satisfaction ratings on a Likert scale can be used to compare concepts directly with each other and a baseline solution.
Do not treat one measure as a complete account of usability. Faster completion may accompany misunderstanding. A participant may complete the task correctly while reporting effort that makes repeated use impractical.
Interpret results together and examine the conditions under which they occurred. Record the limitations so decision makers understand what the test has established.
Pretotyping examines whether people take meaningful action toward using or adopting an idea before the full solution exists. It addresses a different question from whether a working product can be engineered.
A clearly described concept, service simulation or expression-of-interest process may provide evidence about engagement. The strength of that evidence depends on the action required and the conditions surrounding it.
A click demonstrates less commitment than a substantive implementation conversation. Neither establishes clinical efficacy or successful device use.
For medical concepts, keep representations accurate and make the test status clear. Interpret behavioral evidence alongside clinical appropriateness, access requirements and the responsibilities of the people making adoption decisions. Interest alone cannot establish that the solution should proceed unchanged, particularly when workflows in the clinical setting are involved.
A value proposition explains which customer the concept serves, the job it supports and the difficulties it intends to reduce. It should connect directly with the outcomes identified through research.
Compare that proposition with the evidence from concept tests. Did participants experience the intended benefit? Did another difficulty become more important? Did the concept require assumptions that the intended setting cannot support? Did the concept do something better than a competitor’s current solution?
Capture both positive and negative findings. Use them to revise the concept, the proposition or the team’s understanding of the need.
Then test the important changes. Iteration should answer a question left open by the previous round. Repeating sessions without changing the artifact or research objective can accumulate comments while leaving uncertainty untouched.
Early concept validation supports decisions about direction and investment. It does not establish all the evidence needed for a finished medical device.
Technical performance, reliability, clinical benefit and intended-use safety require appropriate subsequent work. A convincing simulated experience may depend on functions the team has not yet demonstrated.
Make these boundaries visible in the decision record. State who participated, what was tested, the conditions, findings and unresolved issues. Explain how those findings affect the next commitment.
Overall, having a “winning concept” in hand, backed by user Experience Café data along with user needs in the form of outcome statements formally structured with a direction of improvement and unit of measure, sets a development team up for success. The outcome statement user needs provide a solid foundation for the design history file.
Rapid prototype experience testing gives the team answers to key decisions and sets a target to pursue early on. This results in faster development cycles, more robust regulatory submissions, and better returns on investment spending.
A Value Management Office can connect this learning with resources and stage decisions. Testing should help the organization commit at a pace justified by evidence and concentrate effort on the uncertainties that govern progress.
“Early validation creates value when it changes the concept or the commitment before an unresolved assumption becomes expensive.”
Examine one proposed investment. Which assumption could defeat the concept, and what is the least costly credible way to test it?
Prepare an appropriate artifact, involve representative users and observe meaningful tasks. Review the evidence, revise the concept and record the next learning decision. This gives Patient Centered Design a practical route toward solutions people can successfully use and organizations can responsibly develop.
A development team can become committed to a concept before it has seriously considered an alternative. The idea is familiar, a senior sponsor favors it or an available technology makes it attractive. Detailed engineering begins while the reason for choosing that approach remains largely untested.
Concept engineering provides a more disciplined basis for commitment. It develops several viable approaches, compares them against important needs and combines their strongest elements where doing so improves the solution.
Within Patient Centered Design, the purpose is to identify a concept that can help patients and healthcare professionals accomplish their jobs successfully. Question 2.1.1 examines the effectiveness of that work.
“A winning concept earns its place by addressing important needs and surviving comparison with credible alternatives.”
Concept work begins with a concise problem statement and an agreed objective. Both should describe the progress the intended users need, rather than assume the answer.
An illustrative problem might concern a clinician’s difficulty identifying whether the information needed for a treatment decision is complete. “Build a new dashboard” commits to one response before exploring the problem.
Clarify the users, operating context and desired outcome. Review the patient journey and the clinical work surrounding the interaction. Establish which unmet needs the concept must address.
Resolve major differences in interpretation before the selection exercise. A mechanical engineer, clinician and commercial leader can otherwise compare ideas while quietly applying different definitions of success. Shared language makes their conversation more useful.
Concept selection needs criteria grounded in research and requirements. Include the outcomes patients and professionals consider important, particularly those existing approaches satisfy poorly.
Then identify necessary capabilities and constraints. Relevant considerations may include safety, reliability, usability, manufacturing, service requirements, implementation and the resources available to develop the solution.
Separate mandatory conditions from characteristics that permit tradeoffs. A concept that cannot satisfy a necessary safety condition needs resolution or rejection; attractive performance elsewhere cannot compensate for that failure.
Define the criteria clearly enough for consistent comparison. “Easy to use” leaves the team guessing. The number of required actions, time to complete an activity or ability to recognize readiness can provide more concrete grounds for conversation, depending on the need.
Concept engineering encourages broad idea generation, with constraints applied more deliberately during selection. This gives the team room to consider alternatives before familiar solutions dominate.
Use sketches and short descriptions to make ideas visible. Invite different functions to contribute approaches, concerns and connections the team might otherwise miss.
The concepts should represent meaningful alternatives. Several versions of the same preferred design may leave the underlying assumptions untouched.
Explore how the required function could be achieved differently. Could information arrive earlier? Could preparation become simpler? Could a service change remove work the proposed product was intended to automate?
A concept should communicate its operating principle, important interactions and dependencies. A simple drawing can expose differences that remain hidden in a verbal description.
Explain what the patient or professional would do, what the system would provide and what supporting resources would be required. Include the activities before and after the visible product interaction.
Build enough detail to support the decision at hand. Early concept selection does not require complete engineering specifications, but an appealing image alone gives little basis for comparison.
Record what is known and what is assumed. If one idea appears stronger because its description omits difficult tasks, the matrix will reward an incomplete account of the solution. Consistent descriptions support a fairer evaluation.
The Pugh matrix provides a structured way to compare concepts. List the criteria as rows and the candidate concepts as columns. Choose a reference concept, known as the datum, against which alternatives will be assessed.
For each criterion, judge whether a concept is better than, similar to or worse than the datum. The simple notation is positive, same or negative.
Discuss the basis for each rating. Record supporting evidence and unresolved questions. The matrix makes differences visible and gives the team a shared place to examine them.
Totals can help identify promising candidates, but they should not make the decision automatically. The significance of a weakness depends on the criterion involved. Several small advantages may leave a concept unable to address its most important requirement.
“The matrix is useful when it exposes the reasoning behind a choice and the evidence still needed to defend it.”
Early conversations often rely on incomplete information. Simple comparisons can be more useful than elaborate scores that suggest a level of precision the team does not possess.
Weighted methods may help when criteria genuinely differ in importance. Paired comparisons can support more structured judgments about relative priority. When measured engineering performance is available, use those data directly in the evaluation.
Choose the method for the decision and evidence, rather than adding complexity by default. Explain how weights or ratings were established and which assumptions could change the result.
Check whether the leading concept remains attractive under reasonable changes to uncertain judgments. A decision that reverses after a minor rating adjustment deserves closer examination before the organization makes a substantial commitment.
Hybridization is a central part of concept engineering. A concept with several strengths may also have a weakness another option handles well.
Examine whether the useful elements can be combined into a stronger approach. For an illustrative monitoring solution, one concept may support straightforward preparation while another provides clearer feedback when a connection fails.
A hybrid might preserve both benefits, but it needs its own evaluation. Combining features can introduce new interfaces, added complexity or conflicting operating requirements.
Redraw the combined concept and reassess it against the criteria. Investigate whether it actually removes the weakness or merely moves the burden elsewhere. The aim is a coherent design whose interactions work together, rather than an accumulation of everyone’s favorite features.
Concept selection brings technical judgment, professional experience and organizational interests into the same conversation. The quality of that conversation affects the outcome.
Agree on meeting ground rules and use a team with relevant expertise across functions. Ensure that a strong personality or senior title does not become a substitute for evidence.
When disagreement cannot be resolved, capture the question and define an action. Assign an owner, the evidence required and a completion date. An independent facilitator can help when team dynamics obstruct useful comparison.
The method can make judgments more transparent, but it does not eliminate subjectivity. Leaders should expect the team to explain its reasoning and show how important uncertainties will be resolved.
The leading idea may depend on uncertain technical performance, user behavior, supplier capability or implementation conditions that significantly affect time to market. Identify those dependencies before detailed development absorbs significant resources.
Plan focused experiments, research or prototypes to address them. Match each activity to a question that could change the selection decision.
If a concept depends on clinicians adopting a new preparation routine, a technical bench test will not establish that assumption. If it depends on a material performing under particular conditions, user enthusiasm will not resolve the engineering question.
Prioritize uncertainties with serious consequences for the concept’s viability. Early learning should help the team avoid expensive redesign while preserving options until the relevant evidence is available.
At this point in the design process, using patient and healthcare professional journey mapping satisfies the Empathy stage of Design Thinking. Understanding the jobs to be done and desired outcomes satisfies the Define stage of Design Thinking. Concept engineering at its core is a practice that ensures the best solution direction is chosen before significant expense is incurred and satisfies the Ideate stage of Design Thinking.
With a selection of “winning concepts” in your pocket, complete the Design Thinking stages by rapidly prototyping and testing solutions with customers to gather data on which concepts your customers desire most. The Design Thinking stages provide an explanation of why a solution is preferred and a record of why alternatives were not chosen.
Retain the criteria, important comparisons, hybridization decisions and unresolved risks. This record helps future teams understand the consequences of a proposed change.
Selection establishes a direction for further learning and development. It does not prove that the solution meets user needs or performs safely in practice. Concept validation and subsequent engineering evidence must support those conclusions.
Keep the relationship with the original needs visible. A chosen architecture can gradually lose important benefits as specifications and implementation choices evolve. Traceability helps the team notice when a tradeoff undermines the reason the concept was selected.
The Voice of Business and Voice of Technology should inform selection alongside customer evidence. A concept needs a realistic development route and an operating environment capable of supporting it.
A Value Management Office can connect these choices with resources and portfolio priorities. Systems thinking helps the team examine whether the proposed improvement addresses a constraint governing patient access or successful use.
Evaluate the complete contribution. A technically impressive device can introduce training, service or clinical work that limits its benefit in the wider pathway.
“Concept engineering should leave the organization with a reasoned choice, a manageable learning plan and a clear connection to patient benefit.”
Review one current concept decision. Can the team show credible alternatives, agreed criteria, the basis for selection and the assumptions requiring further evidence?
Bring the relevant disciplines together, compare options and examine stronger combinations. Then test the uncertainties that could change the decision. That is how Patient Centered Design builds a defensible route from important needs to better products.
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