Smash the Bottleneck: Fixing Patient Flow for Better Care (and a Better Bottom Line)
- 3h 38m
- Christopher Strear, Danilo Sirias
- Health Administration Press
- 2020
Smash the Bottleneck: Fixing Patient Flow for Better Care (and a Better Bottom Line) lays out a concrete methodology for getting to the root of patient-flow problems and addressing them—quickly. The book highlights a continuous improvement methodology known as the Theory of Constraints (TOC), which emphasizes identifying, optimizing, and breaking down bottlenecks to improve overall system performance. Introduced in Eliyahu M. Goldratt’s seminal business book The Goal, this method and its concepts have since been adopted by Fortune 500 companies worldwide.
Uniquely, the authors tie TOC to healthcare delivery from a practitioner’s point of view. They provide numerous examples of common health system bottlenecks to illustrate how the methodology can be applied in readers’ own organizations. The book also showcases precisely how TOC can help to do the following:
- Decrease length of stay in inpatient units
- Coordinate resources and break down organizational silos
- Reduce overcrowding and increase throughput in emergency departments
- Shorten wait times in primary and specialty care clinics, imaging centers, and surgery centers
Poor patient flow has grave implications for quality of care, patient satisfaction, provider well-being, and an organization’s bottom line. Discover the practical knowledge and tools that you can use to break bottlenecks and enact meaningful, lasting change.
About the Author
Christopher Strear, MD, FACEP, earned a bachelor’s degree in chemistry and English from Williams College and a medical degree from the University of Pennsylvania. He completed his residency training in emergency medicine at Harbor-UCLA Medical Center in Torrance, California, and is a Fellow of the American College of Emergency Physicians (ACEP). Dr. Strear is currently the director of patient flow, as well as director of revenue cycle management, for Northwest Acute Care Specialists and is an attending emergency physician at a Level 1 trauma center in Portland, Oregon. He is a member of the board of directors and the president-elect of the Oregon chapter of ACEP, and he serves on the ACEP National Reimbursement Committee. Dr. Strear is a clinical assistant professor of emergency medicine at Oregon Health and Sciences University in Portland, Oregon. In addition, he has served as patient flow advisor and internal consultant to multiple hospital flow committees throughout the Pacific Northwest.
Danilo Sirias, PhD, earned a master’s degree in industrial and systems engineering and a PhD in business administration, both from the University of Memphis. He is also a Certified Critical Chain Project Manager and a certified Theory of Constraints International Certification Organization thinking process implementer. Dr. Sirias is currently a professor in the Department of Management and Marketing at Saginaw Valley State University. He has received multiple grants to further his research in the applications of TOC in healthcare. His research interests include managing patient flow in healthcare systems and developing strategies to improve quantitative reasoning. Dr. Sirias is a coauthor of the book Bridging the Boomer–Xer Gap, selected by Soundview Executive Summaries as one of the most influential business books of 2002 and by Foreword magazine as Book of the Year. He has published peer-reviewed research in several journals, including the Journal for Quality and Participation, International Journal of Applied Quality Management, the International Journal of Production and Operation Management, International Journal of Production Research, and Journal of Education for Business.
In this Book
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Preface
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Common Abbreviations
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Introduction
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Understanding the Fundamentals of the Theory of Constraints
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The First Focusing Step—Identify the Bottleneck
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The Second Focusing Step—Exploit the Bottleneck
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The Third Focusing Step—Subordinate Everything to the Bottleneck
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The Fourth Focusing Step—Elevate the Bottleneck
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The Fifth Focusing Step—If the Bottleneck Has Been Broken, Go Back to Step One
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Understanding a Constraint
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More Arrows in the Quiver—Additional Concepts in the Theory of Constraints
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Using Constraint Management to Improve Emergency Department Flow
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Using Buffer Management to Facilitate Inpatient Unit Flow
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Understanding the Outpatient Setting
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Phase 1—Gaining Momentum
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Phase 2—Stabilizing the System
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Phase 3—Designing a Continuous Improvement Process
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Epilogue
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Additional Reading
