Towards a solution to the global healthcare crisis: using hierarchical decomposition and theory of constraints (TOC) to address the healthcare supply chain wicked problem

Healthcare is facing a crisis globally, with rising demand and technological advances escalating costs and outpacing supply. The healthcare supply chain (HCSC) encompasses various links, from primary and specialty care to hospitals, which often fail to function quickly, seamlessly, or cost-effectively individually or together. Indeed, the complexities of healthcare make this a "wicked problem" without easy solutions. Research has typically focused on individual links in the supply chain oversimplifying and neglecting their interdependence. Key characteristics - such as the system's hierarchical structure, diverse stakeholder involvement, interdependencies among links, the importance of timeliness, and the need to cope with complexity, change, and uncertainty - are frequently overlooked. Addressing the healthcare crisis requires a pragmatic approach to improving service delivery. This paper advocates for a systems perspective, allowing a breakdown of the problem into manageable units of analysis based on the system hierarchy, viewing each link in the HCSC as integral to the whole. We outline a multimethodology that capitalises on HCSC characteristics to enhance patient flow and provide timely, high-quality, and cost-effective care. It emphasises classifying, prioritising, and synchronising treatment based on urgency. The paper also discusses existing solutions to the system's components and presents a comprehensive strategy for the overall issue.