Theory of constraints
Hospital Operations
Definition. The theory of constraints is a systems management approach which holds that the output of any goal-directed system is limited by a very small number of constraints, so that improvement must be focused on identifying and managing those constraints.
Explanation
Goldratt introduced the approach in the business novel The Goal (Goldratt & Cox, 1984). Later work organised it into a philosophy of ongoing improvement and a set of thinking processes for diagnosing and solving problems (Rahman, 1998). Its operational core is the five focusing steps: identify the constraint, exploit it so that it never runs idle, subordinate every other step to it, elevate its capacity if necessary, and return to the first step when the constraint moves elsewhere.
In health care the constraint is usually a scarce resource on the patient pathway, such as a biopsy slot, diagnostic imaging, an operating theatre, a specialist’s schedule or the radiotherapy planning team. Speeding up a step outside the constraint does not increase the number of patients treated; it only lengthens the queue in front of the constraint, a point developed in the oncology chapters on workforce, workload and capacity management and bottleneck management. Because case mix, staffing and scheduling rules change, the binding constraint has to be measured repeatedly rather than assumed.
Related concepts
Bottleneck Patient flow Lean management Six Sigma
Read on The Health Topics
- Bottleneck Management 101: An Interdisciplinary Introduction with a Focus on Healthcare
- Bottleneck Management in Oncology: Finding the Constraint That Sets the Pace
- The Capacity Problem in Oncology and How to Solve It
- Workforce, Workload and Capacity Management in the Oncology Hospital: An Introduction (101)
References
Goldratt, E. M., & Cox, J. (1984). The goal: Excellence in manufacturing. North River Press.
Rahman, S. (1998). Theory of constraints: A review of the philosophy and its applications. International Journal of Operations & Production Management, 18(4), 336–355. https://doi.org/10.1108/01443579810199720
Cite this entry: Kurutkan, M. N. (2026). Theory of constraints. In The Health Topics glossary. https://healthtopic.org/glossary/theory-of-constraints/
Articles that discuss this concept
5 articles on The Health Topics use this concept. The list updates as new articles are published.
- Bottleneck Management 101: An Interdisciplinary Introduction with a Focus on Healthcare 10
- The Capacity Problem in Oncology and How to Solve It 2
- Managing an Oncology Hospital as a System: Patient Journey, Process, Bottleneck and Capacity 1
- Bottleneck Management in Oncology: Finding the Constraint That Sets the Pace 1
- Workforce, Workload and Capacity Management in the Oncology Hospital: An Introduction (101) 1