Lean Healthcare

Toyota Production System as a Learning System

By Jon Miller Published on October 8th, 2006

There is a new working paper by Michael Balle, author of The Gold Mine, that addresses how the Toyota Production System is in fact a learning system, using a hospital in France as a case study. The first page of the article contains a notice that it is a working paper and that quoting, duplicating or distributing without the author’s permission is prohibited. So I will do none of that, but provide a link to the article.
The working paper and the work at this French hospital builds on the ideas of several other papers by consultants and authors of TPS. There is nothing new here per se in terms of process improvement tools or techniques and how they apply to hospitals, but that is not the point. The paper provides a good perspective of TPS as a learning system. There are a few good examples with photos and descriptions of problem solving, establishing basic stability as foundation for continuous improvement.
There are a couple of good quotes also, which I will not duplicate here but rephrase as I have heard them said. One is the idea of “making things is making people” at Toyota, meaning you must first develop your people before you can make good products. The second is that it’s better to apply a 60% solution systematically rather than a 100% solution only sporadically. Another variant of this is “quick and dirty improvement is better than delayed perfection”.
The article raises an interesting question about stability as a necessary foundation for continuous improvement, particularly for hospitals. This issue may be addressed later when the working paper is further developed, but it may not. This is the issue of workforce stability. At least in the United States the turnover of nurses is a serious problem in many hospitals. The shortage of nurses is exacerbated with the fact that the changeover of personnel at the nursing level can be high. This will get worse over the next 5 to 10 years as a large number of nurses who reach retirement age leave the workforce.
Papers like this one that raise these issues in general terms will certainly help hospitals who are attempting to implement the Toyota Production System get a better handle on what they need to do to succeed.

  1. Mark Graban

    October 9, 2006 - 5:03 am

    The author proves, apparently, that the best way to NOT have something distributed around the world is to put it on the Internet.

  2. Jon

    October 9, 2006 - 3:02 pm

    I have just started a web site at http://thelovingorganization.com
    I have a link to Panta Rei on my site. One of the main purposes of my site is to introduce and explain the lean movement and the ideas behind it.
    There will also be some attempt to connect lean with complexity science, and the whole history of of this organizational and management revolution, of which lean and TPS is the premier example.
    The relation of TPS to health care is a special interest of mine. I have been on a list relating complexity to primary care, and complexity to organizations for some time.
    And I hope to have people from these communities join in the learning effort.
    I need your help, and others interested in lean and organizational improvement.
    Please visit my site, sign the guestbook, and register for the blog and contribute. You and others may also register for the site itself and contribute articles and share your favorite sites.
    Look forward to seeing you online at http://thelovingorganization.com
    Jon Bennett

  3. LaMar

    October 12, 2007 - 2:45 pm

    I agree that basic stability is key. David Mann’s book, CREATING A LEAN CULTURE, reinforces this very well. I see this much in opposition to the vast vast majority of consultants who start with a value stream map and then want to kick off a half dozen Kaizen PROJECTS. I think the consultants aren’t stupid. They know there is enough waste in almost any value stream that they can keep coming back time after time and with a positive ROI on the PROJECT and management will still be happy. Problem is no real learning took place and the management system isn’t in place to sustain. Great link – reinforces my suspicions about quick fix consultants and myopic executives.

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