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Several authors have investigated and proposed implementation for the theory of constraints philosophy in manufacturing organizations. However, no study has addressed the application of TOC (the theory of constraints) in service organizations. This two‐part article illustrates how TOC can be applied to service and not‐for‐profit organizations. Part 1 explains the basic principles of TOC.

Several authors have investigated and proposed implementations for the theory of constraints (TOC) philosophy in manufacturing organizations. However, no study has addressed the application of TOC in service organizations. The second of two articles, illustrates how TOC can be applied to service and not‐for‐profit organizations. The first part explained the basic principles of TOC: in this issue those principles are applied in a health‐care environment.

In recent years, there has been significant interest in the application of continuous quality improvement (CQI) into health care organizations. This paper reports the findings of an in‐depth, detailed investigation to identify and assess the ingredients that lead to the successful implementation of CQI programs in the emergency care of St Mary’s Hospital in Grand Rapids, Michigan. The field work was undertaken from January to November 1996.