title: Improving the process of developing technical reports for health care decision makers: using the theory of constraints in the evidence-based practice centers.
abstract: OBJECTIVE
  To apply the Theory of Constraints (TOC) to the Evidence-based Practice Center (EPC) process.
  
  
  METHODS
  Participants in the EPC process were interviewed, and the technical contracting literature was reviewed. Undesirable effects (UDEs) that might occur in the EPC process were identified and, in a TOC Current Reality Tree (CRT), a fundamental UDE was selected and tracked back to potential root causes, focusing on the core "constraint". The resulting draft CRT was presented at an EPC directors' meeting and finalized. From possible solutions obtained from interviews and literature, a Future Reality Tree (FRT) was constructed.
  
  
  RESULTS
  Three UDEs were identified and that a report is not used was deemed fundamentally undesirable. Nine root causes were identified, and using the CRT, a core constraint emerged: EPC partner does not know how to conceptualize and articulate needs, objectives, and specifications. Two change strategies ("injections") appeared to address the core constraint: establish an ongoing relationship between partners, EPC, and Agency for Healthcare Research and Quality early in the process, and use a changes clause; in a FRT the injections lead to the positive outcome-the production of a successful EPC report that meets partner needs and, therefore, will be used.
  
  
  CONCLUSIONS
  As with any complex enterprise, the EPC needs to engage in self-reflection and active improvement to maximize its value. The development of technical reports intended to inform decision making represents a complicated area, involving a network of interrelated processes. Using the TOC permitted us to understand process failures; results serve as a guide to improvement.
authors: Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA. Meenal.P@Duke.edu
authors: Meenal B
authors: MB
authors: Patwardhan
authors: Antonio
authors: A
authors: Sarría-Santamera
authors: David B
authors: DB
authors: Matchar