I have just finished reading We All Fall Down: Goldratt’s Theory of Constraints for Healthcare Systems. I found it a little hard to get into the book, but mostly because i wasn’t familiar with many of the healthcare acronyms and terminology which took a while to get used to. The story centers on Beth Seagers, an overworked admissions manager in a busy NHS hospital. Her staff hate her, her boss hates everyone, the patients hate the waiting lists she is responsible for and her colleagues hate the fact that she is in charge of the single most valuable resource in the hospital: beds.My wife is a gastroenterologist and although she does not come home complaining with the same terminology that We All Fall Down uses, in the end it all comes down to beds. Many of the conversations I overhear late at night or trying to get back to sleep in the wee hours of the morning are when she has been called by somebody asking to use one of her department’s beds.Beth’s hospital is running at an incredible 98% capacity meaning that the longest time a bed is empty is for 15 minutes.When her witch of a boss announces a new change initiative to bring new consultants in to change the way that admissions works, Beth twigs two things at once. First, the new consultants are actually intended to be doing her job and she’ll be out of work. Second, the new initiative is going to fail just like all those before it.To her rescue comes a surgeon, unhappy with operations being constantly cancelled and email advice from her brother in law on new ways to think of the hospital, its beds and how to prioritise work around them — a thinly disguised Jonah to those of who have read other Theory of Constraints novels. It is he who helps her discover both the core problem at the heart of the hospital and the key constraint that stops the hospital from freeing up more beds.The book will appeal to two broad audiences. First up, those who work in healthcare and are fed up to the back teeth with working in a dysfunctional systems full of talented caring individuals who are not seeing the benefits of their efforts. Second, for those of us who have read other Theory of Constraints books, We All Fall Down spends a lot more time explaining some the Thinking Processes toolbox and explaining the need to and how to work through not just Current Reality Trees, but Future Reality Trees and trees for communication as well.For all readers, the book also adds another few nails in the coffin of the idea that ToC is just a manufacturing theory whose ideas do not work in other domains.