Once the stable and capable delivery system is established, it becomes much clearer which step (or steps) in the delivery system determine the flow of the system (a.k.a flow dictator, capacity constrained resource, or pacemaker operation). In many cases, the flow dictator determines the output of the entire system. The first step in our process, before any investments are made, is to determine if the flow dictator is operating at full effectiveness. The criteria for full effectiveness is the resource is operating with high utilization, high efficiency, and producing high quality. If any one of these criteria are violated, the focus will be to determine how to fully exploit the resource before any investment decisions are made.