This is an individual chapter of Theory of Constraints Handbook. aaoeWhy do so many of the changes initiated by management fail to deliver the desired improvement for the organization as a whole (typically 70% of all changes fail) and is there anything that can be done to significantly reduce this failure rate?aaA To answer these two important questions, this chapter provides a framework for designing and implementing a continuous improvement and auditing process within organizations from a Theory of Constraints (TOC) perspective and to share some of the important new TOC developments in this field and practical ways to integrate this approach with organizational strategy and as a focusing method for LEAN, 6 Sigma and other improvement techniques. The chapter starts with the definition of key concepts and a brief historical perspective on this subject and then provides an overview of the current gap, extent and consequences (vicious cycle) related to typical errors of omission, commission, detection and correction in using traditional continuous improvement and auditing methods and why so few changes result in a improvement for the organization (why change). It then examines the underlying conflicts and assumptions that need to be challenged (what to change), the solution criteria, direction and details of a solution to break these conflicts and prevent new undesirable effects (to what to change), and finally sharing the insights on how to practically overcome the typical implementation risks and obstacles (how to cause the change and achieve a process of ongoing improvement) to implementing such a TOC-based continuous improvement and auditing solution developed over the past 20 years.