In June 2009, the new chief executive officer at the National University Hospital in Singapore had serious concerns about the hospital’s prolonged emergency department boarding time—the time between an emergency doctor’s decision to admit a patient and the patient’s occupation of a hospital bed. He knew that a prolonged boarding time was one of the leading factors contributing to emergency department overcrowding, which in turn hindered the delivery of high-quality medical care and compromised patient outcomes. The chief executive officer needed to decide what strategy the National University Hospital should adopt to reduce the prolonged emergency department boarding time and how the hospital should execute such a strategy.

In June 2009, the new chief executive officer at the National University Hospital in Singapore had serious concerns about the hospital's prolonged emergency department boarding time-the time between an emergency doctor's decision to admit a patient and the patient's occupation of a hospital bed. He knew that a prolonged boarding time was one of the leading factors contributing to emergency department overcrowding, which in turn hindered the delivery of high-quality medical care and compromised patient outcomes. The chief executive officer needed to decide what strategy the National University Hospital should adopt to reduce the prolonged emergency department boarding time and how the hospital should execute such a strategy.