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We’re excited to provide free access to 7 of the 35 (and growing) Theory of Constraints (TOC) healthcare presentations ranging from a discussion of buffer management (a major TOC tool for focusing improvement) to the implementation of TOC in a large family practice clinic (having about 70 employees), to a specialty medicine clinic (oral surgery), to an acute hospital, to a mental hospital, to the healthcare supply chain and finally ending with a discussion of a hospital strategy and tactics tree (the TOC methodology for developing and implementing a strategic plan).

These applications were selected to build your TOC healthcare knowledge base from simple to complex. The same concepts that are applied to a family practice are applied to a hospital and further to the whole healthcare supply chain. For example, note the use of time and space buffers across the various applications.

We have listed below the references and abstracts for the free presentations on this portal. In addition, we have provided a comprehensive annotated bibliography of ALL the healthcare presentations and webinar videos currently in our archives. And, at the end of this annotated bibliography is a link to the TOC book list which includes a section on healthcare.

We recognize that all countries are faced with a massive healthcare problem. The organizations described in these presentations have made significant improvement by using the TOC philosophy to continuously improve. TOC is the best methodology for today BUT there will always be a need for continuous improvement. These tools are part of the journey to excellent healthcare organizations.

Our hope is that you’ll learn from these 7 presentations and are moved to join TOCICO to gain access to the rest of our archives.

TOCICO membership includes:

  • FREE on-line access to all past TOCICO conference videos including the 28 additional healthcare videos – there are several hundred videos starting with the second conference in 2004. These were previously sold for $149 per conference (totaling $1,788), but now, viewing ALL of them are INCLUDED with your membership.
  • Discounts on TOCICO products and conference attendance.
  • FREE access to the over 50 recorded webinars by some of your favorite TOC authors.
  • FREE registration to all new webinars – and just wait until you hear what’s in the works!
  • FREE pdf of the TOCICO Dictionary – 135 pages of pure content.
  • All 6 Strategy & Tactics trees by Eliyahu M. Goldratt
  • Over 20 Theory of Constraints articles with more on the way.
  • And, access to networking with the TOC community around the world on the TOCICO website. Build your page, start discussions, or contact another member – the new TOCICO website is web 2.0 ready and ready for you to engage.




Stratton, R. (2012). Buffer management in context. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

This presentation explores the conceptual origins of buffer management in the context of TOC developments across make to order, engineer to order, make to availability (MTO, ETO, MTA) manufacturing environments and more recently in the service sector. The presentation relates the buffer management concept to the seminal work of Shewhart (1931) and Ohno (1978) and discusses the practical and theoretical basis for extending the buffer management concept to enhance ‘lean’ developments, with particular reference to construction and healthcare management.
(Video length approximately 34 minutes)



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Cox III, J. F. and T. M. Robinson (2012). The Use of TOC in a Medical Appointment Scheduling System. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

The use of TOC in healthcare is an emerging field. This presentation describes the use of the five-focusing steps (5FS), throughput accounting (TA), drum-buffer-rope (DBR), buffer management (BM), the engines of harmony, and the thinking processes (TP) in a family practice organization. Many medical providers use an patient appointment scheduling system based on fixed appointment times to schedule patient flow; the use of TOC in this type of scheduling system is a new and significant area of study. The TOC tools (the TP) and BM were used to improve scheduling, execution, and patient flow by eliminating the major causes of interruptions, thus providing a smoother flow of patients to and from the provider. The attendee benefits from understanding: 1. The application of each TOC tool to the medical practice through various examples in an actual practice. 2. The use of BM to proactively improve appointment scheduling and execution systems. 3. The major causes of poor organizational performance across a medical practice. (video length approximately 31 minutes)


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Wadhwa, G. (2007). Viable Vision: Achievable in Healthcare. TOCICO International Conference: 5th Annual Worldwide Gathering of TOC Professionals, Las Vegas, NV, Goldratt Marketing Group.

This presentation is a case study of Adirondack Oral and Maxillofacial Surgery clinic and their first (achieved by using TOC/lean/six sigma) and second (achieved by using the transformational strategy and tactic (S&T) tree and the decisive competitive edges of reliability and rapid response) Viable Vision. Gary Wadhwa, MD, provided his background in education, in business, operations, lean, six sigma, system dynamics, balanced scorecard, theory of constraints, etc. and how he implemented these tools at his practice to transform them from a break-even practice to making several million dollars in profit each year. He discusses the use of throughput accounting and the transformational S&T tree to determine the impact of the product mix on profits and eventually how to free up enough capacity to also do 30-40% pro-bono work while still making high profits. Dr. Wadhwa also has other videos describing his continued journey in implementing TOC in healthcare. (video length approximately 22 minutes)


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de Kiewiet, M. (2012). Solid gains throughout an acute hospital. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

This presentation of a case study provided a blended, holistic approach to operational excellence in an acute hospital. The hospital services a population of about 260,000 residents and 5 million tourists. The presentation goal and key learning points relate to sharing practical experience of what can be gained within a year by using the implementation of a blended approach to operational excellence of an acute hospital. The key learnings are: a two-pronged approach works, involve everyone, resistance to change has a lot to do with the mermaid syndrome (taking comfort in not changing), learning to see, pathway integration, the speed of implementation is important, project management and sustained results are vital. (video length approximately 28 minutes)


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Knight, A. (2012). TOC in healthcare: Broadening the shoulders of our giant. TOCICO International Conference: 10th Annual Worldwide Gathering of TOC Professionals, Chicago, IL, Theory of Constraints International Certification Organization.

Healthcare is accelerating towards a crisis of affordability. The likely outcome is deterioration in both access and quality of care. It is time to make explicit how and why a TOC-focused approach is the only option. This presentation establishes: 1. The conceptual similarities and differences between what was so dramatically improved by TOC production and project management approaches and the impact of these approaches on the healthcare environment. 2. The broader conditions under which TOC has been successful in healthcare, its applications and the boundaries of its applicability. 3. New knowledge to accelerate the impact of TOC in healthcare around the world is the core of the presentation. (video length approximately 57 minutes)


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Knight, A. (2011). Fifteen year progress report on achieving breakthroughs in health and social care using the theory of constraints. TOCICO International Conference: 9th Annual Worldwide Gathering of TOC Professionals, Palisades, NY, Goldratt Marketing Group.

This presentation reviews progress to date in the application of the TOC to achieving a breakthrough in performance in health and social care systems. These developments address how to improve emergency care, discharge management, out-patient management, elective surgery management and how to turn improvements in the operations into a decisive competitive edge. The presentation assesses progress to date, current limitations, together with future opportunities and challenges. Alex Knight also reflects on lessons learned in applying TOC to a new industry. (video length approximately 40 minutes)


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Ferguson, L. A. and A. van Gelder (Sept. 8th, 2010). Strategy and Tactics for Hospitals. TOCICO Webinar Series. TOCICO, Theory of Constraints International Certification Organization.

We present the generic Strategy and Tactics tree for hospitals for how to implement TOC to improve healthcare quality, provide a more rewarding environment and improve financial performance. Then, we share experiences of implementing TOC in both public and private hospitals.


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The Complete Healthcare Video Bibliography



The Complete Healthcare TOC Book List



Our hope is that you will learn from these six presentations and are moved to join TOCICO to gain access to the rest of our archives.

TOCICO membership includes:

  • FREE on-line access to all past TOCICO conference videos including the 28 additional healthcare videos – there are several hundred videos starting with the second conference in 2004. These were previously sold for $149 per conference (totaling $1,788), but now, viewing ALL of them are INCLUDED with your membership.
  • Discounts on TOCICO products and conference attendance.
  • FREE access to the over 50 recorded webinars by some of your favorite TOC authors.
  • FREE registration to all new webinars – and just wait until you hear what’s in the works!
  • FREE pdf of the TOCICO Dictionary – 135 pages of pure content.
  • All 6 Strategy & Tactics trees by Eliyahu M. Goldratt
  • Over 20 Theory of Constraints articles with more on the way.
  • And, access to networking with the TOC community around the world on the TOCICO website. Build your page, start discussions, or contact another member – the new TOCICO website is web 2.0 ready and ready for you to engage.


You may also want to check out our other Portals: