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Focus and Leverage


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Table of Contents

The Meeting

Preliminary Strategy Session

Aviation Dynamics-The First Visit

The Plant Tour

Aviation Dynamics-Day 2

The Hospital Visit

Aviation Dynamics-The Strategy

Becky Leaves the Hospital

MRO Strategy-Day 1

MRO Strategy-Day 2: Morning

MRO Strategy-Day 2: Afternoon

The Hospital-Preliminary Strategy

Hospital Improvement Team

Aviation Dynamics-The Return Visit

MRO-Scheduling Discussion

Hospital Executives

Follow-Up Meeting-Hospital Executives

MRO Scheduling Rollout

MRO Review and Training

Hospital Wait Times

Emergency Room-Wait Time Reduction

MRO-Unscheduled Maintenance Strategy

The Finale

About the Author

Bruce Nelson is an independent consultant (co-owner, Focus and Leverage Consulting) specializing in the enhanced profitability of organizations in a variety of business segments. Bruce received his BS degree from Weber State University, Ogden, Utah. In addition, he is board certified by the Theory of Constraints International Certification Organizations in the TOC Thinking Processes, TOC Operations Management, and TOC Project Management and is a certified Jonah, Jonah's Jonah, and Academic Jonah. Bruce is an internationally recognized professional in Constraints Management and Systems Analysis. Bruce has 33 years combined experience as an educator, executive, and consultant with numerous Fortune 500 companies and a number of international organizations and companies. Bruce is the coauthor of two books: Epiphanized: A Novel on Unifying Theory of Constraints, Lean, and Six Sigma, Second Edition (coauthored with Bob Sproull, Taylor & Francis) and Epiphanized: Integrating Theory of Constraints, Lean and Six Sigma (North River Press). He is also a frequent contributor to the Focus and Leverage blog site ( Bob Sproull is an independent consultant who, along with Bruce Nelson, owns and operates Focus and Leverage Consulting, a Management Consulting firm specializing in improving the profitability of organizations from all business sectors. Bob is a certified Lean Six Sigma Master Black Belt, a Theory of Constraints Jonah, and an experienced manufacturing executive who has served as Vice President of Quality, Engineering, and Continuous Improvement for two different manufacturing companies. He has an extensive consulting background in manufacturing, healthcare, and MRO and focuses on teaching companies how to maximize their profitability through an integrated Theory of Constraints, Lean and Six Sigma (TLS) improvement methodology. Bob is an internationally known speaker and is the author of four books: Second Edition Epiphanized: Integrating Theory of Constraints, Lean and Six Sigma (co-authored with Bruce Nelson 2015, Taylor & Francis); Epiphanized: Integrating Theory of Constraints, Lean and Six Sigma (coauthored with Bruce Nelson, North River Press); The Ultimate Improvement Cycle-Maximizing Profits Through the Integration of Lean, Six Sigma and the Theory of Constraints (Taylor and Francis); Process Problem Solving-A Guide for Maintenance and Operations Teams (Productivity Press).


"This book, Focus and Leverage, discusses the powerful results that can be obtained when observing and analyzing a business from a holistic, systemic point of view, and then explains how Lean-Six Sigma initiatives are substantially improved with the system focusing mechanism, provided by Theory of Constraints (TOC). ... This book defines two very practical and robust applications that I consider the most powerful planning tool available today: the Interference Diagram (ID) combined with the Intermediate Objective (IO) map, or the ID/IO simplified strategy concept. ... In the book, Bruce Nelson and Bob Sproull use the business situation from two seemingly different business environments, and yet illustrate the commonality between the two. First is the situation from a Maintenance, Repair and Overhaul (MRO) facility, and second is the situation of a Hospital Emergency Room. Using this innovative method they show how significant leaps in business performance can be obtained in a very short period of time.

This book also introduces an interesting and innovative concept for system planning and scheduling. It is a scheduling concept that the authors refer to as M-DBR (Multiple-Drum-Buffer-Rope), which is a valid refinement of the traditional DBR proposed by TOC."
-David Poveda, M.A.Sc., CDDP Instructor; Owner & Director, FLOWING Consultoria

"Wow... what a great book and sequel to Epiphanized. A detailed, step-by-step guide to problem solving in any industry, not only covering the technical problems a company may face while running an improvement project and the mechanics of improvement, but also detailing the human and cultural changes a company will need to address when undertaking the journey to improvement. I was there... while reading the book, I felt as though you put me in the story working side by side with Conner, Sam and Joe as they took Aviation Dynamics and Saint Luke's from near failure to success. I especially liked seeing this book written from Conner's perspective and seeing his genius come out in the story while guiding Sam, Joe and their clients to succeed in their efforts. Bottom line is that this is a great how-to book with a fantastic real life story line."
-Mark Rader, Lean Six Sigma Master Blackbelt

"Some authors write revolutionary business management books that question industry practices and propose a truly different new and convincing approach. That is true of Bruce Nelson and Bob Sproull's books. Some books are so enticing that you are torn between finishing the book and starting to apply the ideas it presents. This is such a book. ... The authors are passionate and experienced `changers' or `improvers.' You will sense this throughout the novel. ... I have been mixing Lean, TOC, and Six Sigma together for more than 25 years. I know it works; it works well. Don't just buy this book ... read it, think about it, adapt it to your context, and try to apply at least some of it."
-Philip Marris, CEO Marris Consulting, Paris, France, Founder and Administrator of the LinkedIn "TLS-TOC, Lean & Six Sigma" Group

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