23. Identify bottlenecks

Where do you have waiting lists and thus bottlenecks?

Have you process - mapped all your bottlenecks so that you REALLY understand what is going on?

Why is there a bottleneck there? Is it due to shortage of skill, or something such as room space?

Is the bottleneck due to a current or past demand and capacity imbalance, such as maternity leave that was not covered?

How could you reduce the demand on the bottleneck?

How could you widen the bottleneck i.e. increase the capacity there?

Are there extended clinical skills ahead of the bottleneck?

Where do families wait?


A bottleneck is where there is, or has been, a demand and capacity imbalance. A queue forms at a bottleneck- a waiting list is such a queue. See Demand and Capacity on the left hand menu bar for more information. Identify bottlenecks and maximise flow through them. Bottlenecks are a common problem that may, at first, seem only solvable by employing more staff. Many CAMHS have bottlenecks to see the psychiatrist. Do you need more psychiatrists? Maybe not- can you redesign and extend skills instead? Do you need more treatment capacity? Maybe not- full booking to treatment can help, especially when combined with Let Go of Families.

Ideas for Action

  • Spot a bottleneck when you spot a queue. Process map in detail.
  • Relieve bottlenecks by reducing demand on bottleneck (such as extending roles or ensuring parallel rather than serial processes) or increasing capacity (such as employing more staff).
  • If planning to employ more staff, consider whether training up certain staff or employing a different type of worker could be the most effective use of limited monies e.g. using youth workers supervised by a psychologist to do some of the practical work in a return to school programme (see also Extend Capacity)

Try the bottleneck quiz!