OBJECTIVES: Emergency Department (ED) overcrowding (OC) is plaguing EDs worldwide with grave implications on patient and caregiver comfort and quality of care. Alleviating this problem tops agendas of governmental and professional agencies. Many contributing factors have been cited and many approaches have been tried, without widespread success. Focused Operations Management (FM) integrates novel managerial theories and practical tools {such as the theory of constraints (TOC) and the Pareto diagram} into a systematic approach, helping managers to analyze complex operational systems, find bottlenecks and root causes and finally, chart routes to improved throughput and quality. This approach has proved effective in the industry and service sectors, radically improving performance at little additional cost. The FM approach has never been implemented in the ED and could considerably enhance the management of its operations. In this first phase of the research, we use semi-structured interviews with experts, to identify potential high-yield interventions. METHODS: A review of the ED operations literature was performed to identify major ED operational challenges, metrics and alleviating measures. Semi-structured interviews with ED head nurses and managers, hospital administrators and Health ministry administrators were conducted. The interviews centered on validation of major challenges identified in the literature search and assessing potential utility of FM tools. RESULTS: The major challenges we identified included ED boarding, prolonged length of stay, unjustified ED utilization and slow access to specialist consults, lab tests and imaging studies. Of the FM tools presented to specialists, those assessed to be most promising were ”the “complete kit” concept and TOC methods to identify and alleviate bottle necks and to reduce “work in progress”. CONCLUSIONS: implementation of the novel FM management strategies has enhanced operations and performance in many industries and services. The ED is in dire need and a good candidate for the use of these tools.