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South African Journal of Industrial Engineering

On-line version ISSN 2224-7890
Print version ISSN 1012-277X


HARTMANN, D.; BICHENO, J.; EMWANU, B.  and  HATTINGH, T.S.. Understanding system failure in health care: a mental model for demand management. S. Afr. J. Ind. Eng. [online]. 2021, vol.32, n.2, pp.17-36. ISSN 2224-7890.

The load on health systems caused by systemic overburden leads to heightened costs, longer waiting times, a reduced quality of care, and associated problems. This may be caused by 'failure demand'; however, its definition is inadequate for a complex hierarchical system. Although accounting for a significant proportion of load in other industries, the academic assessment of failure demand in health care remains limited. We present a novel way of identifying repeat consumption, which we loosely equate with failure demand. We present a framework that can be used to identify 'system failure', the trigger for later repeat consumption. This provides new insight into understanding whether common events represent system failure. A diagnostic framework was developed from observations, the literature, and brainstorming. Commonly observed exit scenarios in health care were tested against the framework to create a system-failure list. The framework and the categorisation table were shared with eight international Lean health-care experts. Following feedback, the framework and categorisations were fine-tuned and consensus was achieved via member-checking. Identifying and managing failure demand for these settings can lead to a reduced system load, thus reducing costs and increasing system efficiency and quality.

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