Improving Healthcare from the Toyota Factory Floor

Author: Dr. Tim Hill, Senior Lean Consulant, Leading Edge Group

David Ng and his colleagues used to look sheepishly at the hospital advertisements across the river in Detroit, colourfully promoting emergency-ward wait times of as little as 29 minutes – and free sports tickets for patients forced to wait longer. At Dr. Ng's Hotel-Dieu Grace Hospital of Windsor, Ont., on the other hand, residents of the car-industry city had to line up in emergency for hours, with not even a remote chance of compensation.

His team finally found a treatment for those chronic backlogs, though, and now the idea behind it -- borrowed from the auto industry itself --is taking Canadian health care by storm. A study just published by Dr. Ng's team suggests that adopting an assembly-line process pioneered at Toyota Motor Corp. had slashed the emergency department's lengthy wait times, results many others are hoping to match. Toyota is making headlines these days mostly for production defects, but its so-called Lean manufacturing philosophy has been adopted in one fashion or another by close to half of this country's health-care facilities in the last two to three years, one expert estimates.

The Windsor study appears to be the first Canadian research in a peer-reviewed journal to report scientifically on the front-line impact of the system. The Toyota principles have also been used, though, to eliminate delays plaguing pathologists in Ottawa, boost cancer-screening productivity at a Moose Jaw, Sask., hospital and get new mothers home faster after being discharged from a Vancouver maternity ward.

"I believe strongly that we are creating a new norm," says Tim Burns, who oversees an Ontario government program aiming to apply the Toyota system to 90 of the province's hospitals by 2011. "There is evidence that it works. It's a pretty enduring fad." As the concept becomes de rigueur, however, some red flags are going up. One consultant says that many health-care facilities are being offered a watered-down version of the system that may line the pockets of the advisors hired to help them but will bring about little lasting change. "A lot of health-care facilities are getting ripped off," said Tim Hill, a veteran Lean expert based in London, Ont. "There is a lot of hit and miss out there.... You need to instill a problem-solving culture, so you can get to the root cause."

The Toyota production system, coined "Lean" by the American authors of a 1990 book on the company, was developed by the car maker after the Second World War, its goal to focus efforts on only what offers value to customers, largely by cutting waste and empowering employees to devise efficiencies.

The multi-stage process includes: "value-stream mapping," where the organization's production process is laid out in detail to help identify glitches; "Kaizen" meetings at which front-line workers brainstorm efficiency ideas; just-in-time delivery of supplies; and the concept of using visual cues to help employees streamline their work. The idea was widely applied in the U.K. and U.S. health-care systems in the early 2000s – and across the manufacturing industry a decade or more earlier, Mr. Hill said.
 

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