Smash the Bottleneck: Fixing Patient Flow for Better Care (and a Better Bottom Line)

Smash the Bottleneck: Fixing Patient Flow for Better Care (and a Better Bottom Line)

by Danilo Sirias, Christopher Strear


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Overcrowding is endemic in most US hospitals, and untangling patient flow is a top priority for today’s healthcare leaders. 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: decrease length of stay in inpatient units; coordinate resources and break down organizational silos; reduce overcrowding and increase throughput in emergency departments; and 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.

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Product Details

ISBN-13: 9781640551503
Publisher: Health Administration Press
Publication date: 04/30/2020
Pages: 180
Sales rank: 566,198
Product dimensions: 6.00(w) x 9.00(h) x 0.40(d)

About the Author

Danilo Sirias, PhD, is currently a professor in the Department of Management and Marketing at Saginaw Valley State University. Christopher Strear, MD, FACEP, 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. 

Table of Contents

Preface xi

Acknowledgments xiii

Common Abbreviations xv

Introduction xvii

Part I Smashing the Bottleneck: Moving Patients Through the Hospital 1

1 Understanding the Fundamentals of the Theory of Constraints 3

2 The First Focusing Step: Identify the Bottleneck 15

3 The Second Focusing Step: Exploit the Bottleneck 25

4 The Third Focusing Step: Subordinate Everything to the Bottleneck 35

5 The Fourth Focusing Step: Elevate the Bottleneck 57

6 The Fifth Focusing Step: If the Bottleneck Has Been Broken, Go Back to Step One 65

Part II Moving Beyond the Bottleneck: Constraint Management in the Emergency Department and Inpatient Units 69

7 Understanding a Constraint 71

8 More Arrows in the Quiver: Additional Concepts in the Theory of Constraints 75

9 Using Constraint Management to Improve Emergency Department Flow 87

10 Using Buffer Management to Facilitate Inpatient Unit Flow 107

Part III Outpatient Flow: Office Practices, Clinics, and Urgent Care Centers .117

11 Understanding the Outpatient Setting 121

12 Phase 1: Gaining Momentum 125

13 Phase 2: Stabilizing the System 133

14 Phase 3: Designing a Continuous Improvement Process 149

Epilogue 159

Additional Reading 161

Index 163

About the Authors 173

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