No one logged in. Log in

The plight of a struggling hospital, and the efforts to turn around its fortunes, are brought into sharp focus in this timely and thought-provoking book.

It tells how Linda Seed is unexpectedly thrown in at the deep end when she has to keep a hospital afloat after the chief executive is fired.

She attempts to find solutions that will improve the hospital's situation and bring a sense of pride back to hard-working staff, with no extra cash available to alleviate the problems.

At first Linda struggles for answers, inevitably starting to think that the task may be insurmountable, despite the best efforts of the dedicated workforce around her. But then she bumps into an old friend who agrees to offer a helping hand, reminding her that the bigger the problem, the greater the potential for improvement.

And so begins a journey which will test all her resolve and that of her colleagues as they work to improve the hospital's fortuntes.

This book is a must-read for all health professionals working in hospitals across the country. By challenging the mindset of workers and stakeholders, including patients, the author shows how major breakthroughs can be achieved with determination and vision.

Nursing Standard

This is a must read for politicians, policy makers, clinicians and managers. It tells the story of how healthcare systems can be managed in a sustainable way with the patient at the centre of decision making.

Dr Mike Williams


Alex Knight offers solutions to an ailing healthcare environment. This is a book that actually offers the reader practical and real solutions. Post Francis report there is still so much to learn and gain within the NHS. This is not a text book of how to do, but a novel of how the late Eli Goldratt's theory of management can be applied to the healthcare setting.
I found I could not put this book down - was not expecting this, I thought this would be hard to endure. Just how wrong I was. It gives the reader a chance to stop and think, and that instead of throwing money at an ailing organisation there are real changes that can be made. All is not lost. I think in the thick of things you cannot always see the wood for the trees. This book gives inspiration and solutions to make a difference.

The strengths of this book are both practical and enjoyable at the same time. It is realistic and focuses on behaviours as well that we can all identify with. Instead of feeling ground down by the system, the book gives a sense of real hope. Within the healthcare environment there are real challenges such as a population living longer but with more complex issues and conditions and so many targets you do not know where to turn to next.

The author has written this book in the style of Goldratt's "The Goal" as a business novel but applies this so well to healthcare in the 21st Century.

The author does not dismiss staff as a problem but acknowledges staff are trying hard. They are caring, but systems do not allow them to carry out their jobs as well as they would like. Somewhere along the way we forget the reason we are in the healthcare setting is for patients.

All staff from students to chief executives who work in the healthcare setting must make a point to read this book - there is hope if we pull together.

Nursing Times

Pride and Joy wraps quality improvement techniques with a story and characters and thus presents the key messages in a highly engaging way.

Professor Viv Bennett

Director of Nursing for Department of Health and Public Health England

This book is 5/5 because it is a page turner, has a fantastic plot and explains the underlying theory in an easy to understand and compelling way.
From healthcare students to CEOs, this book is for you.

Jake Matthews BMedSc

Founding Chairman

The Birmingham Medical Leadership Society (BMLS)

Wow - what a great job you did! I know Eli would be proud. One of the best - if not the best book I have read on TOC. Excellent job! 

John Covington

President, Chesapeake Consulting, USA

In choosing to fictionalise his experience of working with many healthcare systems, Alex Knight challenges his readers to think about the realities of hospital management in new ways. 'Pride and Joy' is an essential read for those 
who wish to implement change and improve the quality of care within the hospital sector. 

Ailsa Granne

Oxford, England

Pride and Joy is a must for all healthcare workers who want to make a difference in their hospital and want to understand how to do it.

Dr Jan-Willem Eijgenraam

General Medicine, Acute hospital, The Netherlands

Patients should only stay in hospital as long as they need to. This is central to the quality of care. Read this book - it will change your view of how to manage patient flow in a hospital. It can transform the way we deliver care and steer us away from the downward spiral of poor quality, poor performance and inefficiency.

Jeffrey Worrall

Portfolio Director

NHS Trust Development Authority
Derby office

I enjoyed reading Pride and Joy, largely because it resonated with a lot of my own experiences. In fact, I am just exploring the clinically derived planned discharge date in my current job to streamline our discharge process for complex patients. I thought the idea of explaining some of the theory through a story was great and made complex ideas much easier to follow - Alex always did this well at our training too.  

Paediatric Consultant

NHS Trust, England

Alex has achieved a great thing with this book, it is an educational business book but set within the context of a novel which is easy to read and difficult to put down. Business theory can be pretty dry but when applied in the novel format to the failing hospital it comes alive and is somehow simplified.

The novel follows the story of Linda the newly appointed interim CEO of a failing hospital and how, with real leadership and teamwork, she transforms the outcomes of the hospital, improving patient care and operational and financial performance. Having spent much of my career in Tesco over the last 30 years I recognise the principles that allow organisations to achieve the seemingly impossible - to improve customer service, operational efficiency and profits.

Linda enlists the help of her consultant friend Stevie who helps her to identify the pressure points and bottlenecks in the hospital, where to invest resources, and to focus the efforts of the senior team on patient-centred outcomes.

This book should be read by anyone who has an interest in improving the NHS for the future, but also by anyone interested in how to improve Customer Service at the same time as becoming operationally excellent and more profitable.

A new genre of business book.

Andy Dewhurst


At last, a management theory book that is easy to read and is set in the NHS. 

I read Pride And Joy with a mixture of feelings that is hard to describe. Firstly, a sense of relief that from now on managers and clinicians will have a reference source when the challenges of delivering excellent patient care seems an impossible task. Secondly, it busts the myth that TOC is too complicated and not appropriate for the NHS and, thirdly, it picks up on the human interest aspect and demonstrates how much passion and commitment NHS staff are prepared to invest for their patients. 

It is a must read for managers and clinicians but also for all those in the wider NHS family who may well have an influence or hold a trust or team to account. If they give providers a chance and the support to implement TOC then we could have a very different NHS. 

My only regret is this book was not available when I was at the beginning of my career! Thank you, Alex, for writing it now.

Averil Dongworth

London, England

Pride and Joy, by Alex Knight, is written with humour and wisdom, in a style similar to Dr Goldratt's book The Goal. 

The book is an inspiring call for process improvement in healthcare using Theory of Constraints principles.

Gerard Jacobs

Acute hospital, The Netherlands

I love the book, it’s full of golden nuggets of insight. I can see myself dipping into it and revisiting some of the sections.

Head of Outpatients

NHS Trust, England

Pride and Joy is a good and very powerful read. I could relate to the content and it caused me to reflect on a lot of the scenarios.

Matron (Neuro Sciences)

NHS Trust, England

I've had Pride and Joy for almost a year now but took the opportunity of a few days away to finally finish reading it. Alex Knight's understanding of the application of TOC in creating a global breakthrough in improvement is unequalled in my opinion, and he has managed to share much of this knowledge in this excellently constructed novel. I am very familiar with TOC but I came away from this book with new insight. The over-riding thought I was left with on completing the book was how TOC opens your eyes to the contradictions we see all the time in the hospital. We accept these as the norm and do not choose to ask ourselves...why? So why does flow work some days and not others, even when attendances at A&E are the same? Why do patients with similar conditions stay greatly varying amounts of time in hospital? Why is it that we struggle to keep up with demand when we run seemingly endless numbers of extra sessions? The answers are here in Pride & Joy. The book is a fitting tribute to the work begun by Alex's mentor, Eli Goldratt. TOC has been left in very able hands.

Michael Fox


Leading us through the busy corridors of a hospital, and the bureaucratic maze of the greater healthcare system, Alex Knight demonstrates how dire situations can lead us to finding real breakthroughs. The exponential rise of medical costs relative to the moderate increase of health budgets poses a growing core conflict. On one hand, the need to treat more and more patients, while on the other hand, the need to give the best quality of care to each patient. This conflict intensifies when budgets are limited and costs are soaring. Is there a way out of this conflict? Through this wonderful novel, Knight shows us that there is a way out.  

Linda, finds herself unexpectedly managing a hospital that’s in turmoil, struggling to float financially while keeping up medical standards. Instead of giving up, Linda and her team are finding a solution to improve the hospital’s operation. Breakthrough and simple solutions are not a myth! If we have the courage to challenge fundamental assumptions about how we run organizations, and have the stamina to introduce real changes, even the sky will not be the limit.

Rami Goldratt

CEO, Goldratt Consulting

The author Alex Knight effectively explores the all too common and seemingly impossible dilemma in healthcare of needing to save £ millions from the budget whilst costs are increasing and simultaneously needing to treat more patients in a timely manner to meet government targets.  No wonder chief executives are sacked for failing to achieve what we might consider to be impossible!
Knight follows the style of his mentor and friend Eli Goldratt who invented Theory of Constraints and wrote the international best selling business novel ‘The Goal’. Written as a novel rather than a text book, Pride and Joy is an enjoyable and exciting read for anyone.  It is also a great resource for leaders and managers particularly working in healthcare.  However the principles of Theory of Constraints can be extracted and applied to any system. 
If you want to read a good novel or learn the technical principles of Theory of Constraints this book is a must. 

Joy Whitlock

Quality and Safety Improvement Manager

The book’s simplicity is its success. Every health care professional should read it.

Matron (Children)

NHS Trust, England

I thought this was a great book that provided a fresh look at healthcare administration. I'm a clinic manager of multiple primary and urgent care clinics, and I constantly hear how "we need more staff," and "we're too busy". This is true because we continue to rely on common practice rather than thinking about common sense methods of improvement.
This book gives a great refresher on some very important management, production, and flow principles taught in "The Goal," which you should also read, but Pride and Joy is geared towards multiple different healthcare environments, including the Emergency Department, inpatient floors, and outpatient clinics. This book gave me a great start on how to think about implementing some basic principles to improve the flow through my clinics, with the goal of bringing "pride and joy" back to the healthcare workplace.
I am already implementing a buffer system in my urgent care clinics to ensure there are always patients ready for the doctors to see, and am working towards identifying which resources are causing the most delay to patient flow most frequently, using techniques illustrated in this book. Our patient volumes have recently gone up significantly, but thanks to our initial efforts based on principles from this book, we have maintained our flow and patient satisfaction continues to rise.
If you're a healthcare worker and are tired of cutting costs, layoffs, and everything else that makes you pull your hair out, you'll definitely enjoy this book

Caleb J Sandford

Clinic Manager - Family Practice/Convenient Care, USA

Pride and Joy’s descriptions of the challenges of the country’s health providers at first sight didn’t appear to be that relevant to those of us providing chilled food to the major supermarkets. But it was. An ever shortening of lead times from retailers placing orders  to products being on the shelf anywhere in the UK along with the additional time demands for product segregation, more complex recipes and a more dynamic demand pattern were all themes explored in the book. Anyone concerned with decluttering processes and speeding up process flows will enjoy the read especially as it demonstrates the pressures of applying theory amidst the pressures of daily life and the demands for reduced costs. 

Mark Duddridge

Managing Director, chilled food manufacturer

In a word, this novel helps the reader understand why good people with good intentions can face substantial challenges when it comes to performance breakthroughs. It offers a practical way of addressing fundamental issues in health care with the goal of reaching affordable, high-quality care that remains clinically driven and patient focussed. The method used abides by the same principle of constraints identification and glorification no matter where it is applied: inpatient wards, outpatient clinics, community services, physician’s offices and elsewhere. 

Ruth Vander Stelt MD


Pride and Joy is a great read, combining entertainment with insight into how complexity can be simply and practically managed. I have waited a long time for an alternative to 'The Goal' and the healthcare setting of this book will make the TOC principles and tools more readily accessible to service providers and particularly healthcare. I will definitely be recommending this book.

Dr Roy Stratton

Reader in Operations and
Supply Chain Management

Nottingham Trent University

Pride and Joy is an excellent read. It does the two things we expect from all good books: it is entertaining and, at the same time, constantly challenging. And yet, while it is written in the style of The Goal, it is quite different: the characters are more interesting and the environment is not only unlike manufacturing, it is one that we all care about. Managing a hospital is not fun but it is a life mission and it is exciting, especially for the reader. For people knowledgeable of the Theory of Constraints (TOC), the book offers to move beyond the known areas. One needs to generalise the basic TOC concepts in order to apply "What to change?", "What to change to?" and "How to cause the change?" to such a volatile environment. Each of the steps has its own dramatic moments, which makes the reading so satisfying. 

Eli Schragenheim

Author of:

Supply Chain Management at Warp Speed: Integrating the System from End to End. Manufacturing at Warp Speed: Optimizing Supply Chain Financial Performance. Management Dilemmas: The Theory of Constraints Approach to Problem Identification and Solutions

Pride and Joy is a highly enjoyable, easy to read book and one that will no doubt be of benefit to anyone working within the system. Told through a novel (rather than text format), the book is easy to understand and provides a simple solution as to how patient care can be improved within the healthcare service. 

Ian Bottrill

Pride and Joy tells the story of Linda Seed, a newly-appointed hospital CEO, as she struggles with the challenges facing many NHS organisations: rising demand for services, budget cuts, and overworked staff. Linda is guided by Stevie, an old friend, who is a consultant steeped in the Theory of Constraints approach to performance improvement. The story twists and turns through ups and downs as Linda, guided by Stevie, gradually turns the hospital around.

The idea of using a novel as a teaching device works really well here. There are many management books on "How to Transform your Organisation" but very few take this form. Alex Knight is an engaging writer and his characters are highly believable to anyone who has worked in management or as a consultant. Because we care about the characters, we also care about what they are doing and the outcomes. Books about "methods" can be very dry, but this one is not. The use of Theory of Constraints to identify key pressure points and how they use this knowledge to engage colleagues offers valuable insights into how this could be used in practice.

I would have liked a brief appendix outlining the central concepts of Theory of Constraints and where to look for more information. But this is a minor caveat.

I applaud Alex Knight for writing such a readable and refreshingly different book and I hope others will read "Pride and Joy" and be encouraged to learn more about Theory of Constraints.

Dr Stephen King

Leeds University Business School

Pride and Joy has the potential of doing to healthcare what Goldratt’s The Goal did to manufacturing and supply chain.  Alex describes the environment and crisis situations where they could take place in the US, UK, Australia, Canada, etc. The problems are universal. The situation is complex and impossible to many BUT as anyone in TOC knows, the more complex the situation the simpler the solution.  Alex proves this to be correct.  Once you read each solution; your response should be: That’s brilliant!  You end up making this statement a number of times throughout the book. In my opinion, this book may provide the solution to implementing universal healthcare without bankrupting the country for the US.

James F. Cox III

Professor Emeritus, University of Georgia

It's the best novel related to business since The Goal. Eli would be proud of Alex and the team.

John D Hudson Jr

Principal, Sustained Solutions

Pride and Joy is an extraordinary book in the way it communicates actionable insights about the inherent simplicity in apparently complex human systems such as healthcare organisations. Taking the form of a very readable novel it describes how focussing on patient flow brings significant improvement in health outcomes without exhausting finite resources or compromising quality of care. As a customer and financier (through tax) of the UK healthcare system I sincerely hope the message in this book will be absorbed and acted upon by political, clinical and operational leaders.

John Murphy

Vice President of a major global industrial company

I have just finished reading Pride and Joy by Alex Knight. In my view this is the best and most significant TOC book since The Goal by Eli Goldratt, and it is probably better. 

Pride and Joy is set in the health system but it is applicable to every organisation of every type: for purpose or for profit that is trying to implement a process of ongoing improvement.

Why do I claim it is better than The Goal?  Well, in the intervening years since The Goal was written, TOC has developed enormously. Alex Knight has been involved deeply in the development of TOC and its application to the healthcare system and many other environments. The writing in his book demonstrates that Alex has a very deep understanding of healthcare systems and of TOC and how to use it to help organisations improve rapidly. 
Pride and Joy is a great read. It goes into more depth about how to actually apply TOC in the different situations than The Goal does. Reading Pride and Joy once is a great pleasure and an inspiration to get moving and to apply the same things to your own organisation, reading it again (and again) allows you to get into more depth, into the actual techniques, processes and strategies needed to affect significant and lasting change. Pride and Joy is even more important as it goes into the issues of how to make the change, about how to engage the people who must make and lead the change. It deals brilliantly with resistance to change.

I understand the goal behind Pride and Joy is to enable all the people who are involved in healthcare systems to see what can be achieved and what should be done to effect a change right across the nation, not just in one organisation. I think it has a great chance of achieving its goal. Dr Goldratt would be immensely pleased with this book.
I feel very strongly that Pride and Joy will help everyone who reads it to get more out of their lives

John Tripp


Goldratt-TOC Ltd

Pride and Joy is a jolly good read! It's a well written fast-paced novel, telling the story of how Linda, the acting CEO, and her old MBA friend, Stevie, with the senior management team, lead a hospital in its turnaround from being the worst hospital in the region to a top performer. It is imbued with hope and faith in human-kind and provides a great example to follow to bring pride and joy back into struggling health care institutions throughout the world.

The novel is based on dozens of real cases that Alex has worked with using Goldratt's Theory of Constraints as stated in the dedication. The concepts are very cleverly woven into the story and explained in an easy-to-understand fashion without being overstated. Readers familiar with The Goal will recognise several core TOC concepts along with clever simplifications and innovations to suit the healthcare context.

There's enough detail to be able to understand the logic behind the solutions they develop for the whole hospital and each of the many departments. There's even an index which is unusual for a novel but very helpful - though I find it hard to resist the temptation to re-read whole chapters :-)

This book is a must-read for all who care about the performance of hospitals and other healthcare organisations around the globe, and would also be relevant to other service operations and sectors like education.

Highly recommended. Well done, Alex and team.

Professor Vicky Mabin

School of Management, Victoria Business School, New Zealand