Theory of Constraints

Software/firmware defects account for 12 Class I medical device recalls, the most of any category. The root cause is not poor engineering. It is planning fallacy, a cognitive bias that makes every team overestimate their timeline and underestimate their defect rate.

A deep dive into conflict avoidance as the root cause of FDA quality system failures. Analysis of 500 enforcement actions shows that CAPA failures are not procedural problems. They are cognitive problems that require a different objective function.

What 500 FDA enforcement actions reveal about how organizations think. The same seven failure patterns appear across medical device companies, decade after decade. The root cause is not poor procedures. It is cognitive biases that evolved for small-group survival but break down in modern industrial settings.

When I read financial assistance policies, I keep finding the same three conflicts. They are not paperwork problems. They are structural problems that trap staff and patients in impossible choices.

I built a small self-serve diagnostics tier for the cases where a full consulting engagement is too much, too early, or too expensive.

When an AI participates in a problem-solving conversation, people drop defenses they have carried for decades. This is not about a better search engine. It is about changing the dynamics of the room.

I built an AI agent that applies TOC Thinking Processes autonomously to improve business ideas. When I pointed it at itself, it resolved two real tensions via Evaporating Cloud across 10 iterations.

Twelve people walk into a working group carrying separate problems and walk out carrying a shared one. Episode 05 of the Cascade Valley audio drama series.

A board commissioner and an AI sit alone in an empty conference room and talk honestly about what just happened and why. Episode 06 of the Cascade Valley audio drama series.

Distorted cost accounting in public institutions does not just produce bad budget decisions. It produces learned helplessness in the people who manage those budgets. The system, not the people, is the cause.

King County faces a familiar cycle: deficits, targeted cuts, new taxes, repeat. A Theory of Constraints lens on their own public data suggests the measuring stick itself may be the problem.

A practitioner reference for using the Theory of Constraints as strategic compass and Lean as tactical toolkit. Decision heuristics, integration sequence, and source literature.

A practitioner's guide to TOC by a Goldratt-trained, TOCICO-certified consultant. The Five Focusing Steps, Evaporating Cloud, Current Reality Tree, and throughput thinking explained with real case studies across healthcare, manufacturing, and small business.

A fine art printing company in Kent, WA was drowning in rework and backlog. The constraint was obvious once we looked: the graphic artist was doing every job twice. A pre-flight checklist and a simple scheduling change fixed it.

A hospital CFO runs the same numbers two ways and gets answers that disagree by a factor of five. Episode 04 of the Cascade Valley audio drama series.

A Chief Nursing Officer processes what happened at the board meeting -- and discovers that the structural conflicts she has been managing for years have a name. Episode 02 of the Cascade Valley audio drama series.

A clinical ultrasound project was six months behind schedule. The constraint was not the engineering — it was the register map tool that every team depended on and nobody had questioned.

How applying the Theory of Constraints 5 Focusing Steps transformed a reactive, email-only support model into a white-glove customer success engine for a high-value ultrasound research systems manufacturer.

A baker named Rachel thinks she has two bad options: raise prices and lose customers, or hold prices and lose her business. She has neither. This is how the Evaporating Cloud works.

Every business has one thing that limits how much it can get done. Find that one thing, fix it, and everything improves. Fix anything else, and nothing changes. A practical guide for small business owners.

Healthcare has adopted Lean almost exclusively for process improvement, but the Theory of Constraints answers the question Lean cannot: where should you focus? Using both together produces dramatically better results.

A dramatized community hospital board meeting — fictional health system, real governance dynamics — showing what changes when an AI has a seat at the table.

How standardizing a communication protocol on a smartphone-powered defibrillator project unblocked an entire engineering team and saved two months of development time.

Why 'FTE Headcount' is a vanity metric that hides the real constraint: Nursing Minutes at the Bedside.

You cannot 'sprint' a circuit board design. A systems architect's view on why software methodologies break when applied to physics, and how Critical Chain solves the real constraint.

When Regulatory departments prioritize 'documentation stability' over 'engineering reality,' patient safety suffers. A systems view on the conflict between Compliance and Quality.

The word "waste" smuggles in a verdict before the analysis begins. Theory of Constraints offers a sharper test: waste relative to what?

Why 'Scope Creep' is usually a symptom of a deeper strategic failure—in software, in hardware, and in healthcare.

A proactive approach to discharge readiness that treats discharge delays as an input quality problem, not a process problem.

Analysis of 134 structural conflicts across 10 Washington State nursing CBAs reveals why higher wages aren't fixing nurse burnout.

Most dashboards measure local efficiency at the expense of global throughput. Here is how to define the minimum dataset that actually drives system performance.