Purpose The purpose of this paper is to present an approach based on the thinking process of the theory of constraints (TP–TOC) to support decision-makers, managers and professionals of health to diagnose and improve healthcare systems focusing on the service quality deployed to patients. Design/methodology/approach A case study was developed in a SUS-affiliated philanthropic hospital in southern Brazil, through the analysis of its ED processes and application of the TP–TOC. The Current Reality Tree and the Evaporating Cloud tools of the TOC were used to identify the root causes (RC) and their connections with undesirable effects. Findings The analysis of this case helped to understand and identify the causes of the current problems in the analyzed processes related to internal management and external causes. The proposed approach allowed the hospital team to progress in the understanding of such causes in a sequential manner, giving conditions to apport different perceptions and to identify relevant facets and causes related to the problem. The research provided a systemic and an integrated vision of the losses in the organizational processes and indicated the steps to be prioritized in order to eliminate such losses. Originality/value The paper proposed an approach that allowed the systematic and systemic analysis of organizational processes through the application of the TP–TOC. The recognition of the existence of RC responsible for processes losses represents an excellent opportunity for improvement because it allows managers to focus their efforts on the more productive areas.

中文翻译：

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约束理论在公共卫生中的思考过程

目的本文的目的是提出一种基于约束理论（TP–TOC）的思维过程的方法，以支持决策者，管理人员和卫生专业人员对医疗系统进行诊断和改进，重点是针对部署到的服务质量。耐心。设计/方法/方法通过分析其ED过程和TP-TOC的应用，在巴西南部的一家SUS附属慈善医院进行了案例研究。TOC的“当前现实树”和“蒸发云”工具用于识别根本原因（RC）及其与不良影响的联系。调查结果该案例的分析有助于在与内部管理和外部原因相关的分析过程中理解和确定当前问题的原因。所提出的方法使医院团队能够以顺序的方式逐步了解这些原因，并提供条件以评估不同的看法并确定与问题相关的相关方面和原因。该研究为组织过程中的损失提供了系统的，综合的愿景，并指出了消除这些损失应优先考虑的步骤。原创性/价值本文提出了一种方法，该方法允许通过TP-TOC的应用来对组织过程进行系统和系统的分析。认识到存在负责过程损失的RC代表了一个极好的改进机会，因为它使管理者可以将精力集中在生产力更高的领域。