The doctoral dissertations of the former Helsinki University of Technology (TKK) and Aalto University Schools of Technology (CHEM, ELEC, ENG, SCI) published in electronic format are available in the electronic publications archive of Aalto University - Aaltodoc.

Theory of Constraints in Field Service: Factors Limiting Productivity in Home Care Operations

Johan Groop

Doctoral dissertation for the degree of Doctor of Science in Technology to be presented with due permission of the School of Science for public examination and debate in Auditorium AS1 at the Aalto University School of Science (Espoo, Finland) on the 4th of May 2012 at 12 noon.

Dissertation in PDF format (ISBN 978-952-60-4594-8)   [2512 KB]
Dissertation is also available in print (ISBN 978-952-60-4593-1)


Public home care providers are pressured to improve productivity in the face of growing demand, limited budgets, and poor availability of labor. Capacity is already perceived to be short, and the ensuing stress experienced by staff is a common cause of concern. Still, productivity is typically low, suggesting that available capacity is not used to its full potential. This dissertation seeks to explore the mechanisms and practices that inhibit the ability of home care providers to make better use of available resources, and to provide general templates for resolving these issues.

Productivity in home care is analyzed using the Theory of Constraints (TOC). It is a management philosophy that focuses improvement efforts on the few constraints that have the greatest impact on overall performance.

Originally developed for the process-centric environments of manufacturing and distribution, TOC offers an assortment of tools for translating its principles into practice. These tools have been researched, adopted for, and implemented in a variety of service industries, including health services, with very persuasive results. In most cases so far, the structure of the service processes has resembled manufacturing closely enough to render the tools almost directly applicable. The structure of processes in a field service, such as home care, is, however, very different in several key aspects. The successful adoption of TOC in field services requires these structural differences to be identified, and the tools modified accordingly.

This dissertation examines the distinctive characteristics of field service processes, and discusses the implications for the applicability of TOC. It is argued that the differing structure of processes renders certain production management tools inapplicable, while other tools originally designed for distribution management are highly relevant in this context.

The study demonstrates that TOC can provide home care with a systematic framework for identifying and resolving factors that limit productivity. The application of TOC to home care reveals several policies and practices which, intuitively, may seem logical and efficient, but in reality are counter-productive. These policy constraints artificially accumulate demand in the morning. As a consequence, a disproportionately high level of capacity is needed to satisfy demand, while also reinforcing caregiver stress during peak hours. A resource constraint during peak hours promotes the emergence of shortages, leading to a reliance on external leased labor. As a result of the investigation, the home care unit that was studied was able to significantly reduce its use of leased labor, the savings of which are estimated at €0.5M annually.

Keywords: Theory of Constraints, TOC, field service, productivity, home care, Service Operations Management, health service, core problem, process

This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.

© 2012 Aalto University

Last update 2012-10-31