Theory of Constraints in field service: Factors limiting productivity in home care operations

Johan Groop

Research output: ThesisDoctoral ThesisMonograph


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.
Translated title of the contributionKapeikkoteoria kenttäpalveluissa: kotihoidon tuottavuutta rajoittavat tekijät
Original languageEnglish
QualificationDoctor's degree
Awarding Institution
  • Aalto University
  • Lillrank, Paul, Supervising Professor
  • Helkkula, Anu, Thesis Advisor
Print ISBNs978-952-60-4593-1
Electronic ISBNs978-952-60-4594-8
Publication statusPublished - 2012
MoE publication typeG4 Doctoral dissertation (monograph)


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

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