The five focusing steps, translated for the hospital floor
Theory of Constraints gives you five steps. Here's what each one looks like when the system is an emergency department and the throughput is people.
The five focusing steps come from manufacturing, where the throughput is widgets. On a hospital floor the throughput is people, and the language has to change with it.
Identify
Find the one step setting the pace of patient flow. Not the busiest step — the one everything waits behind.
Exploit
Get everything you can out of that step without spending money. Idle minutes on the constraint are the most expensive minutes in the building.
Subordinate
Make every other process serve the constraint. If the CT scanner is the bottleneck, nothing upstream or downstream gets to optimize for itself.
Elevate
Now, and only now, invest. More staff, more equipment, more space — aimed precisely at the constraint you’ve already squeezed dry.
Repeat
Fix one constraint and it moves. The discipline is finding the next one before it starts costing you.