Healthcare Agenda 2025

Timeliness and capacity constraints are among the biggest challenges facing healthcare delivery systems worldwide. Many assume that the only solution is hiring more staff and acquiring additional equipment, but what if the key to solving this issue lies elsewhere? This presentation explores a groundbreaking action research study where an ophthalmologist increased patient throughput by 64% in just a few weeks—all without extra costs. The secret? Implementing the Theory of Constraints (TOC), a proven methodology for identifying and resolving bottlenecks. Using the Five Focusing Steps (5FS) of TOC, the doctor streamlined operations through drum-buffer-rope scheduling and buffer management, leading to immediate, measurable improvements. The presentation will break down these concepts in simple terms, demonstrating how they can be applied not only in ophthalmology but across various healthcare settings. However, this success story also reveals a critical lesson: while TOC can drive significant efficiency gains, sustaining these improvements requires ongoing commitment. After the TOC champion left the organization, the changes were not maintained—highlighting the importance of leadership and long-term implementation strategies.

Emergency departments are high-pressure environments where delays can have serious consequences. Josh Wilson recounts a real-world ED improvement project that leveraged TOC, Lean Six Sigma, and change management to identify and resolve a key constraint—CT imaging. The initiative included Gemba walks, stakeholder engagement, and data-driven analysis, ultimately transforming diagnostic throughput and overall ED efficiency. This session demonstrates how an integrated, flexible approach can produce fast and sustainable impact.

Explore the potential of the Theory of Constraints (TOC) and its thinking process tools to accelerate the mastery of therapeutic skills in psychotherapy. This presentation examines how these methodologies can streamline the lengthy training process traditionally required to develop intuitive diagnostic abilities. By incorporating TOC and TP tools, therapists can efficiently handle a diverse range of cases. The discussion includes the urgent need for quicker training methods due to rising mental health demands, the application of TOC for systemic improvements, and innovative strategies to empower patients. This approach suggests a promising way to enhance therapeutic relationships and promote sustainable healing, offering a transformative process for the future of mental health care.

A passion for efficiency and enhanced patient care along the spectrum of clinical need has guided Dr Vander Stelt's efforts in creating a stream-lined and high-performance minor procedures clinic. Close collaboration with her community hospital and a focus on continuous improvement have allowed the clinic to survive in spite of ongoing challenges. Methods used have continually been reproduced by colleagues. Some highlights include: - wait-times less than 7 days for over 95% of visits - decreased referral to specialty services for over 95% of visits - decreased patient trajectories for subsequent specialty care, when needed - improved morbidity and mortality - reproducible, flexible model - increased patient satisfaction

This session demonstrates how the Theory of Constraints (TOC) was applied in a hospital emergency department to significantly reduce patient wait times and decrease risk of harm. The initiative also led to measurable improvements in staff morale and wellbeing. By addressing key bottlenecks and implementing focused improvements, the team created a sustainable model that enhanced both patient outcomes and workforce engagement.

This case study showcases the implementation of the Theory of Constraints (TOC) in the surgical department of the largest private hospital in Cyprus, aiming to optimize operating room (OR) utilization and enhance surgical efficiency. TOC thinking process tools and Drum-Buffer-Rope (DBR) were employed to identify and address system constraints. The study revealed that ORs operated at only 56% utilization, with significant idle times between surgeries and during morning preparations. The DBR scheduling method was applied to manage workflow, ensuring that the constraint—the OR—was always prioritized, minimizing downtime and maximizing throughput. A cross-functional project team, including surgeons, nurses, and management, collaborated to implement solutions that improved operational efficiency while maintaining high standards of patient care. The results highlighted the potential of TOC and DBR in healthcare settings, offering a structured approach to reducing bottlenecks, enhancing financial performance, and delivering superior surgical services.

This powerful case study demonstrates how the Thinking Processes for Education (TOCfE) helped students in Mozambique overcome internalized barriers to learning and self-expression. Daniela Avancini guided students through the Ambitious Target tool using a sensitive, dialectical approach that promoted autonomy and cognitive flexibility. The process enabled students—many of whom faced deep social and emotional challenges—to set meaningful goals and experience a shift in self-perception. This session highlights how TOCfE can transform lives by fostering agency, even in highly adverse environments.

This presentation discusses how the Enterprise Project Management Office partnered with the Phlebotomy team at Boston Children’s Hospital to successfully reduce patient visit times at the Phlebotomy clinic, resulting in 77% of patients completing their visit in 20 minutes or less. It explains how we used Lean, Change Management, the Theory of Constraints, and one-piece flow training to collaboratively drive improvement in a clinical setting.

Dr. David Boger presents a new Emergency Department design—currently under construction—that integrates TOC principles into every aspect of flow. The blueprint features robust triage, care initiation zones, centralized imaging, and drum-buffer-rope logic built into key bottlenecks. This session offers a forward-looking view of how TOC can be embedded at the architectural level to hardwire operational excellence into patient care environments.

They said it couldn’t be done. An 18-month healthcare IT overhaul—forced into a 90-day timeline. Legacy systems crumbling. A skeptical organization. A go-live date that couldn’t move. Failure wasn’t an option.

How do you cut through red tape, eliminate bottlenecks, and deliver massive IT upgrades at lightning speed? Step inside the 91-day transformation and see how it’s done.

In healthcare, we often focus on treating symptoms rather than addressing the root cause of preventable crises. One such crisis is medication-induced suicidal thoughts, a known risk of many commonly prescribed medications for anxiety, depression, and other conditions. Yet, these risks are often not proactively discussed with patients. Using the Theory of Constraints (TOC), we identified a critical bottleneck in the prescribing process: the absence of structured, open conversations about medication side effects and safety planning. The Prescription Safe Plan (PSP) was developed as a systematic solution to this constraint; removing ambiguity, supporting clear patient-prescriber communication, and ensuring that individuals have a proactive plan in place should they experience a chemically induced suicidal crisis. Developed by Debi Roberts at The OLLIE Foundation and now available in 16 languages, PSPs are helping healthcare providers shift from reactive crisis response to proactive prevention. By integrating TOC principles, this approach ensures that resources—knowledge, awareness, and protective strategies flow more effectively to where they are needed most. This session will explore how TOC thinking led to the creation of PSPs and how similar methodologies can be applied to remove barriers, enhance patient safety, and improve outcomes in healthcare systems worldwide. Prevention starts with conversation. Let’s ensure every prescription comes with one.

Radiology services encompass image acquisition, interpretation, and image-guided procedures—each with its own workflow and constraints. Dr. James Rawson presents a comparative analysis of radiology process bottlenecks, from equipment to workforce limitations. This session explores how TOC thinking can reveal hidden constraints and inform more effective management strategies across the diagnostic imaging continuum.

Faced with a critical shortage of emergency physicians, Benjamin Newman’s team turned to TOC to design and implement a telemedicine program that would restore flow and capacity. The initiative applied bottleneck analysis, thinking process tools, and Critical Chain Project Management to deliver fast, effective results. This session provides a practical look at how TOC principles can be adapted to technology-driven solutions in urgent care environments.

This case study explores the application of the Theory of Constraints (TOC) in the linen management system of a major hospital, aiming to improve operational efficiency and reduce costs. As one of the first TOC implementations in a housekeeping sub-system, the study utilized TOC tools such as the Goal Tree, Current Reality Tree, and Evaporating Cloud to identify constraints and develop solutions. Key challenges included high operational costs, inconsistent linen availability, and inefficient replenishment processes. The implementation of the Five Focusing Steps (5FS), along with the replenishment solution, led to significant improvements. The linen system transitioned to a more cost-effective operation with better inventory control and reduced waste. This case highlights the potential of TOC in non-traditional areas of healthcare, demonstrating how systemic thinking and constraint management can enhance service quality, operational performance, and financial outcomes.

Chronic wound care places serious demands on hospital capacity. Marcin Ludyga presents a case study on applying Critical Chain Project Management (CCPM) to optimize surgical flow, reduce infection risk, and increase bed turnover without increasing infrastructure. The session explains how full-kitting specialty care and focusing resources on operating room constraints led to improved outcomes and greater system flexibility.

This presentation shows the results of a collaboration between a medical practitioner, Christopher Strear, and an academic, Danilo Sirias, proposing a practical approach to implementing TOC to improve patient flow. This collaboration started after Chris, without any TOC training (just reading the Goal), applied the 5 Focusing Steps to a hospital where inpatient lengths of stay were too long, and the ED was closed to ambulance traffic for 60 hours every month, on average, due to overcrowding. Within months of applying TOC to the hospital's system, they had virtually eliminated ambulance diversion. Their rates of patients who left without being seen rate in the ED fell sharply, and inpatient length of stay was reduced to levels below the national benchmark. This was accomplished during a devastating influenza epidemic, a period of record ED patient volumes, record ambulance traffic, and record numbers of admissions. Danilo found this case while doing a literature review of TOC cases in healthcare and contacted Chris. Their work and the potential applications of TOC to improve patient flow has been published in the book titled: Smash the Bottleneck: Fixing Patient Flow for Better Care.

This session tells the story of a New Zealand surgeon who, with no formal business training, turned to TOC to improve both patient outcomes and financial performance. Guided by Graham Scott, the surgeon identified the true bottleneck in his practice—then aligned all operations to support it. The result was a more profitable, efficient, and calm environment. This practical case demonstrates how TOC thinking can revolutionize not just systems, but mindset—and how these principles apply across both public and private healthcare settings.

Patient falls remain a leading source of harm in hospitals. In this presentation, Dr. Bahadir Inozu shares findings from a three-month initiative at Ankara Etlik City Hospital, where Constraints Management and High Reliability Organization principles were used to dramatically reduce fall rates. Using TOC’s Five Focusing Steps, the hospital identified systemic bottlenecks and implemented high-leverage solutions. The results offer a scalable, data-driven model for improving patient safety and operational performance in complex healthcare systems.

Public hospitals around the world share a familiar set of challenges: long wait times, departmental silos, burnout, and budget shortfalls. Graham Scott exposes how traditional budgeting and accounting practices create local optima that block flow and fuel inefficiency. This session unpacks ten common hospital problems—traced back to flawed financial models—and shows how TOC offers a path to better resource allocation, improved coordination, and more patient-focused outcomes without demanding additional funding.

Timeliness and capacity constraints are among the biggest challenges facing healthcare delivery systems worldwide. Many assume that the only solution is hiring more staff and acquiring additional equipment, but what if the key to solving this issue lies elsewhere? This presentation explores a groundbreaking action research study where an ophthalmologist increased patient throughput by 64% in just a few weeks—all without extra costs. The secret? Implementing the Theory of Constraints (TOC), a proven methodology for identifying and resolving bottlenecks. Using the Five Focusing Steps (5FS) of TOC, the doctor streamlined operations through drum-buffer-rope scheduling and buffer management, leading to immediate, measurable improvements. The presentation will break down these concepts in simple terms, demonstrating how they can be applied not only in ophthalmology but across various healthcare settings. However, this success story also reveals a critical lesson: while TOC can drive significant efficiency gains, sustaining these improvements requires ongoing commitment. After the TOC champion left the organization, the changes were not maintained—highlighting the importance of leadership and long-term implementation strategies.

Emergency departments are high-pressure environments where delays can have serious consequences. Josh Wilson recounts a real-world ED improvement project that leveraged TOC, Lean Six Sigma, and change management to identify and resolve a key constraint—CT imaging. The initiative included Gemba walks, stakeholder engagement, and data-driven analysis, ultimately transforming diagnostic throughput and overall ED efficiency. This session demonstrates how an integrated, flexible approach can produce fast and sustainable impact.

Explore the potential of the Theory of Constraints (TOC) and its thinking process tools to accelerate the mastery of therapeutic skills in psychotherapy. This presentation examines how these methodologies can streamline the lengthy training process traditionally required to develop intuitive diagnostic abilities. By incorporating TOC and TP tools, therapists can efficiently handle a diverse range of cases. The discussion includes the urgent need for quicker training methods due to rising mental health demands, the application of TOC for systemic improvements, and innovative strategies to empower patients. This approach suggests a promising way to enhance therapeutic relationships and promote sustainable healing, offering a transformative process for the future of mental health care.

A passion for efficiency and enhanced patient care along the spectrum of clinical need has guided Dr Vander Stelt's efforts in creating a stream-lined and high-performance minor procedures clinic. Close collaboration with her community hospital and a focus on continuous improvement have allowed the clinic to survive in spite of ongoing challenges. Methods used have continually been reproduced by colleagues. Some highlights include: - wait-times less than 7 days for over 95% of visits - decreased referral to specialty services for over 95% of visits - decreased patient trajectories for subsequent specialty care, when needed - improved morbidity and mortality - reproducible, flexible model - increased patient satisfaction

This session demonstrates how the Theory of Constraints (TOC) was applied in a hospital emergency department to significantly reduce patient wait times and decrease risk of harm. The initiative also led to measurable improvements in staff morale and wellbeing. By addressing key bottlenecks and implementing focused improvements, the team created a sustainable model that enhanced both patient outcomes and workforce engagement.

This case study showcases the implementation of the Theory of Constraints (TOC) in the surgical department of the largest private hospital in Cyprus, aiming to optimize operating room (OR) utilization and enhance surgical efficiency. TOC thinking process tools and Drum-Buffer-Rope (DBR) were employed to identify and address system constraints. The study revealed that ORs operated at only 56% utilization, with significant idle times between surgeries and during morning preparations. The DBR scheduling method was applied to manage workflow, ensuring that the constraint—the OR—was always prioritized, minimizing downtime and maximizing throughput. A cross-functional project team, including surgeons, nurses, and management, collaborated to implement solutions that improved operational efficiency while maintaining high standards of patient care. The results highlighted the potential of TOC and DBR in healthcare settings, offering a structured approach to reducing bottlenecks, enhancing financial performance, and delivering superior surgical services.

This powerful case study demonstrates how the Thinking Processes for Education (TOCfE) helped students in Mozambique overcome internalized barriers to learning and self-expression. Daniela Avancini guided students through the Ambitious Target tool using a sensitive, dialectical approach that promoted autonomy and cognitive flexibility. The process enabled students—many of whom faced deep social and emotional challenges—to set meaningful goals and experience a shift in self-perception. This session highlights how TOCfE can transform lives by fostering agency, even in highly adverse environments.

This presentation discusses how the Enterprise Project Management Office partnered with the Phlebotomy team at Boston Children’s Hospital to successfully reduce patient visit times at the Phlebotomy clinic, resulting in 77% of patients completing their visit in 20 minutes or less. It explains how we used Lean, Change Management, the Theory of Constraints, and one-piece flow training to collaboratively drive improvement in a clinical setting.

Dr. David Boger presents a new Emergency Department design—currently under construction—that integrates TOC principles into every aspect of flow. The blueprint features robust triage, care initiation zones, centralized imaging, and drum-buffer-rope logic built into key bottlenecks. This session offers a forward-looking view of how TOC can be embedded at the architectural level to hardwire operational excellence into patient care environments.

In healthcare, we often focus on treating symptoms rather than addressing the root cause of preventable crises. One such crisis is medication-induced suicidal thoughts, a known risk of many commonly prescribed medications for anxiety, depression, and other conditions. Yet, these risks are often not proactively discussed with patients. Using the Theory of Constraints (TOC), we identified a critical bottleneck in the prescribing process: the absence of structured, open conversations about medication side effects and safety planning. The Prescription Safe Plan (PSP) was developed as a systematic solution to this constraint; removing ambiguity, supporting clear patient-prescriber communication, and ensuring that individuals have a proactive plan in place should they experience a chemically induced suicidal crisis. Developed by Debi Roberts at The OLLIE Foundation and now available in 16 languages, PSPs are helping healthcare providers shift from reactive crisis response to proactive prevention. By integrating TOC principles, this approach ensures that resources—knowledge, awareness, and protective strategies flow more effectively to where they are needed most. This session will explore how TOC thinking led to the creation of PSPs and how similar methodologies can be applied to remove barriers, enhance patient safety, and improve outcomes in healthcare systems worldwide. Prevention starts with conversation. Let’s ensure every prescription comes with one.

Radiology services encompass image acquisition, interpretation, and image-guided procedures—each with its own workflow and constraints. Dr. James Rawson presents a comparative analysis of radiology process bottlenecks, from equipment to workforce limitations. This session explores how TOC thinking can reveal hidden constraints and inform more effective management strategies across the diagnostic imaging continuum.

Faced with a critical shortage of emergency physicians, Benjamin Newman’s team turned to TOC to design and implement a telemedicine program that would restore flow and capacity. The initiative applied bottleneck analysis, thinking process tools, and Critical Chain Project Management to deliver fast, effective results. This session provides a practical look at how TOC principles can be adapted to technology-driven solutions in urgent care environments.

This case study explores the application of the Theory of Constraints (TOC) in the linen management system of a major hospital, aiming to improve operational efficiency and reduce costs. As one of the first TOC implementations in a housekeeping sub-system, the study utilized TOC tools such as the Goal Tree, Current Reality Tree, and Evaporating Cloud to identify constraints and develop solutions. Key challenges included high operational costs, inconsistent linen availability, and inefficient replenishment processes. The implementation of the Five Focusing Steps (5FS), along with the replenishment solution, led to significant improvements. The linen system transitioned to a more cost-effective operation with better inventory control and reduced waste. This case highlights the potential of TOC in non-traditional areas of healthcare, demonstrating how systemic thinking and constraint management can enhance service quality, operational performance, and financial outcomes.

Chronic wound care places serious demands on hospital capacity. Marcin Ludyga presents a case study on applying Critical Chain Project Management (CCPM) to optimize surgical flow, reduce infection risk, and increase bed turnover without increasing infrastructure. The session explains how full-kitting specialty care and focusing resources on operating room constraints led to improved outcomes and greater system flexibility.

This presentation shows the results of a collaboration between a medical practitioner, Christopher Strear, and an academic, Danilo Sirias, proposing a practical approach to implementing TOC to improve patient flow. This collaboration started after Chris, without any TOC training (just reading the Goal), applied the 5 Focusing Steps to a hospital where inpatient lengths of stay were too long, and the ED was closed to ambulance traffic for 60 hours every month, on average, due to overcrowding. Within months of applying TOC to the hospital's system, they had virtually eliminated ambulance diversion. Their rates of patients who left without being seen rate in the ED fell sharply, and inpatient length of stay was reduced to levels below the national benchmark. This was accomplished during a devastating influenza epidemic, a period of record ED patient volumes, record ambulance traffic, and record numbers of admissions. Danilo found this case while doing a literature review of TOC cases in healthcare and contacted Chris. Their work and the potential applications of TOC to improve patient flow has been published in the book titled: Smash the Bottleneck: Fixing Patient Flow for Better Care.

This session tells the story of a New Zealand surgeon who, with no formal business training, turned to TOC to improve both patient outcomes and financial performance. Guided by Graham Scott, the surgeon identified the true bottleneck in his practice—then aligned all operations to support it. The result was a more profitable, efficient, and calm environment. This practical case demonstrates how TOC thinking can revolutionize not just systems, but mindset—and how these principles apply across both public and private healthcare settings.

Patient falls remain a leading source of harm in hospitals. In this presentation, Dr. Bahadir Inozu shares findings from a three-month initiative at Ankara Etlik City Hospital, where Constraints Management and High Reliability Organization principles were used to dramatically reduce fall rates. Using TOC’s Five Focusing Steps, the hospital identified systemic bottlenecks and implemented high-leverage solutions. The results offer a scalable, data-driven model for improving patient safety and operational performance in complex healthcare systems.

Public hospitals around the world share a familiar set of challenges: long wait times, departmental silos, burnout, and budget shortfalls. Graham Scott exposes how traditional budgeting and accounting practices create local optima that block flow and fuel inefficiency. This session unpacks ten common hospital problems—traced back to flawed financial models—and shows how TOC offers a path to better resource allocation, improved coordination, and more patient-focused outcomes without demanding additional funding.

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