TOC for Large-Scale Healthcare Systems (Chapter 32 of the Theory of Constraints Handbook)

Julie Wright


Level of TOC knowledge acquired:

Advanced and Intermediate


27 pages

Designed for:

Consultants, Implementers, Leaders and Managers


Change Management/Buy-In, Management Skills and Ongoing Improvement




Evaporating Cloud, Five Focusing Steps, Thinking Processes, Current Reality Tree, Future Reality Tree / Negative Branch and Pre-requisite Tree / IO Map







This is an individual chapter of Theory of Constraints Handbook. The purpose of this chapter is to introduce a holistic process by which TOC can be effectively used in Large Scale Healthcare Systems. By identifying and briefly explaining the TOC processes needed to perform facility/organization wide systemic analyses - Current Reality Tree (CRT) and Core Problem (CP) - through to the training of staff in the Thinking Processes (TP) of the Evaporating Cloud (EC), Negative Branch (NBr) and Ambitious Target (AT).

This chapter outlines how TOC can bring clarity to seemingly complex, service oriented, systemic problems. Further definition of this process details why focus is necessary to make the most of the experience and intuition of people within the organization.

The clarity and focus provided by these processes empowers participants to contribute to, and take ownership of, strategic and tactical solutions. This is accomplished by equipping them with the personal skills necessary to understand why changes need to be made, and how each participant can make effective contributions through improved communication and feedback processes to benefit patients and stakeholders alike.


  • Why Change
  • What to Change
  • What to Change to
  • How to Cause the Change
  • The Process of Ongoing Improvement

Comprehensive coverage of the Theory of Constraints 

Complete Table of contents of the Theory of Constraints Handbook

About the Authors:

James F. Cox III, Ph.D, CFPIM, CIRM, holds TOCICO certifications in all disciplines. He is a Jonah's Jonah, Professor Emeritus, and was the Robert O. Arnold Professor of Business in the Terry College of Business at the University of Georgia. Dr. Cox has written three books on TOC.

John Schleier holds TOCICO certifications in all disciplines. He was President and Chief Operating Officer of the Mortgage Services Division of Alltel, Inc., Executive Vice President of Computer Power, Inc., and Director of Office Systems and Data Delivery for IBM.


The Theory of Constraints Handbook: