This is an individual chapter of Theory of Constraints Handbook. The function of this chapter is to present a holistic procedure by which TOC can be efficiently used in Large Scale Healthcare Systems. By determining and briefly describing the TOC procedures had to carry out facility/organization broad systemic evaluations - Current Reality Tree (CRT) and Core Problem (CP) - through to the training of personnel in the Thinking Processes (TP) of the Evaporating Cloud (EC), Negative Branch (NBr) and Ambitious Target (AT), this chapter details how TOC can bring clarity to relatively complex, service oriented, systemic issues. Additional definition of this procedure details why focus is needed to maximize the experience and instinct of people within the organization. The clarity and focus supplied by these procedures empowers individuals to add to, and take ownership of, strategic and tactical options. This is accomplished by equipping them with the personal abilities needed to understand why changes have to be made, and how each participant can make efficient contributions through enhanced interaction and feedback procedures to benefit clients and stakeholders alike.