What Healthcare Can Learn From Toyota
about safety, quality and people
Whatever your personal feelings about Toyota vehicles, no one can deny that the Toyota Motor Corporation has become one of the most successful companies in the world today.
In 2020, Toyota replaced the Volkswagen Group as the largest car company in the world by revenue and in 2021, it dethroned General Motors (GM) to become America’s top selling automaker, ending GM’s 90 year domination of the market.
The Toyota Way
It’s success is no accident. Developed by Sakichi Toyoda (a Japanese inventor) and his son, Kiichiro Toyoda (Founder of Toyota Motor Corporation), the company has spent the last 75 years meticulously cultivating the Toyota Way. It is based on 2 pillars — continuous improvement and respect for people.
Of course cars are not people and sceptics argue that caring for people is much more complex than manufacturing a car. But there are parallels that can be drawn and lessons that can be learnt from an industry that also cares about safety, quality and people.
What can healthcare learn from Toyota?
Kaizen
Kaizen is a Japanese word. Broken down, kai means change and zen means good. Popularised by the Toyota Way, Kaizen refers to the philosophy of continuous improvement. It seeks to empower all employees from factory line worker to CEO in thinking, designing and implementing small changes to improve efficiency and productivity.
At the Toyota factory in Derby, employees used to physically carry windscreens from storage to the production line — often this took two people and resulted in numerous injuries. Using kaizen, employees designed and implemented a robot that carried windshields for them. Going a step further, robots would play a unique song signalling their arrival to employees on the production line. This saved 6.3 seconds per vehicle.
Further down the line, employees were struggling to pick out the correct number of screws required to fit a steering wheel from their box of screws, so a screw dispenser was created to dispense the correct number of screws at a push of a button.
Can we apply kaizen to healthcare — an industry that has seen increasing costs and waiting times? The Harbor-UCLA Hospital in Los Angeles County has. In fact, it even has it’s own Chief Kaizen Promotion Officer who oversaw a complete overhaul of the hospital’s outpatient eye clinic.
Using the Kaizen way, staff created a system of colour coded folders so it became clear what patients were there for and who they needed to see. They also put a locked box in each exam room with prescription pads so doctors could spend more time with patients rather that finding what they need to treat them.
The concept of continuous quality improvement is not new in healthcare. Certainly, in the UK, we are taught the Plan — Do — Study — Act (PDSA) cycles.
However, PDSA is often an isolated endeavour by a small group of enthusiastic individuals as opposed to an organisation wide culture. And even when individuals think of innovative solutions, they need to jump through hurdle after hurdle of bureaucratic red tape — tiring out even the most energetic of changemakers.
Healthcare providers should have Kaizen days or even weeks where staff from all levels and disciplines come together to produce quick and actionable improvements. From rearranging the medicines cupboard to redesigning the patient discharge process, all ideas should be voiced, trialled and rolled out.
In addition, healthcare providers should reduce the unnecessary red tape that hinders innovative solutions from being implemented whilst walking the fine line between safety and kaizen. Bureaucracy should not impede progress.
And when we cultivate a culture where ideas for improvement are heard and actioned, we will see quality improve.
Muda
A key part of Kaizen is the elimination of waste (Muda). According to Toyota, processes that do not add value are wasteful and it’s elimination lowers cost and ultimately improves the product.
If we treat patient care as a product, eliminating muda means discarding activities that do not add value to patient care. It doesn’t take healthcare staff to point out the redundancies and inefficiencies in healthcare.
We see muda in healthcare when physicians order more tests than is necessary, when teams do not communicate with each other and duplicate work is performed, when patient’s don’t turn up to their appointments, when multiple HR departments are created when only 1 is necessary, when nurses are required to fill in paperwork that does not contribute to patient care.
Kaizen does not necessarily mean adding better equipment, it also means having the guts to take away useless ones.
Respect for people
No work is solitary and no job a one-person endeavour. At Toyota, ‘respect for people’ is more than just a platitude, it’s a mindset. From valuing all improvement ideas regardless of rank or discipline to a ceaseless commitment to the safety of Toyota factory workers to reverence for consumer wants and needs — respecting people permeates everything that Toyota does.
“We make people while we make cars. It’s our people who make cars, not machines. That’s respect” Mr Yoshino — Toyota Executive
At Toyota, respecting people also means growing them. The company strives to develop T type people — achieving the downward stroke of the T means employees deepen understanding of their work, achieving the horizontal stroke implies employees are learning from other disciplines.
Training T type people takes time and effort — when a new plant is set up, coordinators are sent to develop T type people who practice and embody the Toyota Way. There is also an established mentorship programme and various training centres around the world that teach the Toyota Production System. At its core, Toyota believes that the company is only as good as the people that build it.
In healthcare, training is part of the culture; however, it is largely skills based and develops the downward stroke of the T.
Healthcare should encourage learning from other disciplines — front line clinical staff should be sent to training courses on customer service, doctors should learn from hostage negotiators on how to negotiate a shared plan with a patient and managers should learn from the gaming industry on how to engage patients in healthy behaviour.
Genchi Genbutsu
Another crucial aspect of respecting people is coming down to the shop floor when a problem arises. What do I mean by this?
The Japanese phrase Genchi Genbutsu directly translated means real location, real thing. In the Toyota Way, it refers to managers going and seeing.
To truly understand a problem, one needs to observe what is happening at the site where work actually takes place. If a problem occurs on the factory line, managers are expected to go to the line to understand why and how the problem occurred.
So often in healthcare, issues are addressed at arm’s length — managers communicate over email or at numerous incident meetings. Little effort is taken to go to the site where work takes place and understand the root causes of a problem. As a result, band aids are applied when what is really needed is a complete overhaul of the system.
When managers do not ‘go and see’, they unintentionally create a culture where staff do not feel listened to or understood. Not going and seeing, suggests to staff that their problems are not worth the manager’s extra effort to leave their cushy offices. This is no way to respect people.
When problems occur — and they do occur frequently in healthcare, leaders need to practice Genchi Genbutsu to respect people and ultimately effectively solve problems.
Conclusion
1 in 171 Toyota engines fail — a failure rate of 0.58%. In stark contrast, 2.9% of all hospital admissions in a large New York hospital experienced an adverse event caused by medical management. One could be forgiven for thinking that cars are safer than hospitals. So, healthcare has some way to go.
Success at Toyota did not occur overnight. Similarly, a culture change in healthcare will not be easy. Despite the differences between manufacturing and healthcare, it is clear that healthcare can learn from an industry that also cares about safety, people and quality.
Kaizen — What red tape can we remove to encourage more continuous improvement?
Muda — What is currently in our workflow that does not add value to the patient?
Respect for people — What industries can our staff learn from to enhance patient care and experience?
Genchi Genbutsu — Can we reward managers who take the time and effort to go and see the problems for themselves?
