About this Presentation
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.
What Will You Learn
To help you get the most value from this session, we’ve highlighted a few key points. These takeaways capture the main ideas and practical insights from the presentation, making it easier for you to review, reflect, and apply what you’ve learned.
The session reveals that financial constraints in organizations are often a symptom of flow breakdowns, not a lack of capital — and that unlocking throughput can free up performance without new funding.
It shows how rethinking priority, capacity protection, and work release can reduce the “need” for money by making existing resources more effective and aligned to true demand.
The presentation hints that when leaders learn to manage constraints first, money becomes a follower of performance — not the driver — leading to faster improvement and less waste.
Instructor(s)
Christopher Strear, MD, MBA, FACEP
Dr. Strear is a board certified emergency physician and Chief Medical Officer of Columbia Memorial Hospital in Astoria, Oregon. Dr. Strear has led patient flow initiatives utilizing TOC applications at multiple hospitals and health systems with outsized results. He has co-authored the book "Smash the Bottleneck: Fixing Patient Flow for Better Care" with Danilo Sirias and published the first application of TOC in North America to an inpatient healthcare setting.
Danilo Sirias, Ph. D.
Dr. Danilo Sirias holds a master’s degree in Industrial and Systems Engineering and a Ph.D. in Business Administration from The University of Memphis. He is recognized as a TOCFE trainer and TOCICO thinking process implementer. Currently serving as a Professor in the Department of Management and Marketing at Saginaw Valley State University, Dr. Sirias specializes in leveraging the Theory of Constraints to optimize patient flow across various medical settings such as Emergency Departments, Inpatient Units, Operating Rooms, and Outpatient Clinics. Notably, he co-authored the book