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project-like sites. They have bottlenecks, and their work-in-process (WIP) can be easily seen. Measures of performance are operations-like. All the issues in which TOC has proved its ability to improve are in the nature of healthcare organizations. Thus, there exist “full-scale” implementations and methodologies in health care organizations. Ronen et al. (2006) prescribed an end-to-end methodology based on TOC and Focused Management methods that has significantly increased Throughput, reduced lead time, and improved quality in health service organizations with existing resources. Motwani et al. (1996) illustrate how TOC can be applied to service and not-for-profit organizations. Umble and Umble (2006) describe a successful implementation of buffer management in the UK national healthcare system. This research illustrates recent applications in the Accident and Emergency departments and the hospital admission process of three facilities.

Wright and King (2006) describe the problems and the environment of a health service organization in a novel (a The Goal- like book) We All Fall Down: Goldratt’s Theory of Constraints for Healthcare Systems. The issue of implementing TOC in a hospital has inspired the leading healthcare community, and the book, although not a scientific one, was presented in the prestigious New England Journal of Medicine (Pauker, 2006).

Young et al. (2004) describe three established industrial approaches—Lean thinking, TOC, and Six Sigma, and explore how the concepts underlying each of them might relate to health care. Leshno and Ronen (2001) described the complete kit concept as a part of a full Focused Management implementation (constraint management, WIP reduction, performance measures alignment, and strategy) in a private hospital. Ritson and Waterfield (2005) present a case where TOC was implemented in a mental health service.

“One TOC Tool” Implementations and Research

Except for the healthcare industry, where several TOC tools were implemented, in all other service industries we observe “one TOC tool” implementations.

For example, papers were focused on the application of Throughput Accounting (TA) or the elimination of prevailing costing practices in the service organization. Roybal et al. (1999) focused on using activity-based costing and the theory of constraints to guide continuous improvement in managed care. Gupta et al. (1997) integrated TOC and Activity-Based Management (ABM) in a health care company.

Patwardhan et al. (2006) used the TOC tool of the thinking processes (TP) in Evidence-Based Practice Centers.

A Large Part of the Literature Is Examining the Feasibility of TOC Applications in the Service Industry

Goodrich (2008) has explored the potential of using TOC in change management for professional service organizations. Taylor and Churchwell (2003) have investigated the feasibility of the TP and their potential in a state hospital. Schoemaker and Reid (2005) explored the use of TOC TP and applied it the government sector, at the Albuquerque Public Works Department. Reid and Cormier (2003) applied the TOC TP in the services. Moss (2002) has explored the feasibility of using main TOC tools in service firms.

Limitations of Current Research

TOC research lags behind the research done on other managerial methods. A quick and non-scientific literature survey using Google Scholar (2009) reveals that the citations of TOC-related topics are by far fewer than those on TQM and Lean/JIT. For example, the term “Theory of Constraints” is cited 6680 times, as opposed to 23,700 for “Lean Production” citations, and 281,000 for “Just in Time.” “Drum Buffer Rope” is cited 906 times, while “Kanban” is cited 18,900 times. Goldratt is cited 6300 times while Deming got 142,000 citations.

So, what are the core problems of TOC research?

TOC is a simple and practical tool for better management. Simplicity is seldom a main desire for current business academic research. TOC does not use any complex stochastic and deterministic models. Rather, it uses heuristics that work well in practice.