Some years ago, we guided a lean transformation project in a regional hospital. The ambition was to drastically improve the experience of patients in the surgical ‘one-day pathway.’ An in-depth patient survey and analysis of the value stream revealed that missing information for the patient and long and unpredictable waiting times were the main drivers for dissatisfaction. A sub-optimal planning and system appeared to be the most important root causes. Although the problems were recognized, quite some resistance existed in the organization to change the current way of working.
As part of the cultural transformation, we took a group of key players (doctors, nurses and managers) to a car manufacturing site. We weren’t there just to observe but mainly to assemble cars together, as a team, in a simulated work environment. We experienced and practiced the principles of teamwork, coaching, leadership, structured problem solving, flow and pull, quality at the source… at the assembly line.
It was some weeks later during the analysis phase, while measuring the waiting times as ‘zero measurement,’ that we saw a sharp (and unexpected) decrease in waiting times for a specific patient group (those having small treatments with local anesthesia). One of the doctors present at the training had very quietly changed his way of planning: instead of asking all patients to come at the start of his treatment block, he now called the next patient each time a patient left the treatment room (with a buffer of two). He translated what he had experienced into a ‘pull’ system for his patients. Wait times dropped from 120 minutes down to 30, patient complaints dropped to zero.
This is not someone shouting, “We are not Toyota!”, it is the name of a recently published book. Recently, while attending the Shingo European Summit in Cork, Ireland, a similar title of a healthcare presentation caught my eye. It must be a new hype, I thought feeling quite curious, as I would find it odd to present myself as “Hi, I am not Bart.” What would the speaker actually mean: We are not car manufacturers? We are not Japanese? We use different tools?
It was in fact a quite inspiring talk on how the healthcare sector has a huge potential to benefit from insights from other sectors, yet stressing the importance of leadership, focus on the patient and his/her individual needs, quality and, of course, “not to copy the Toyota tools blindly!” Wondering who had suggested this in the first place, some desk research of known literature showed me no suggestions on the topic. The focus is and always has been the creation of value, respecting individuals and developing them, pursuing a long-term purpose and extreme focus on quality. It can be brought together as a carefully designed culture, a set of desired behaviors supported by an appropriate leadership style and strong guiding principles. Might this be what went wrong in the ‘Western’ translation of what Toyota did? It can be difficult to grasp the principles and transpose them to your own organizational culture.
It reminds me of the Japan Kaikaku Experience I had with Mark Graban in 2012. At the start of the gemba tour of the Toyota Motor Corporation Motomachi plant, the guide advised us to look deeper than the visuals and tools we saw everywhere. They are only the result of the problem-solving process to solve a specific problem we experienced at a specific moment. The true essence is in the underlying behaviors and principles.
Coming back to the example of the doctor, there are always reasons not to change, yet he found one reason to do so. He did it by ‘going to gemba,’ grasping the essence of flowing value to his patients and finding a practical solution in the context of his hospital’s culture.
Instead of a “we are not…” position, I want to strike a blow for a “proud to be…” attitude. Let us start with what we are strong in, proud of, the values we muster, the purpose we pursue. And let us continuously be inspired and learn from each other.
