John Shook on A3 Reports in Sloan Management Review

The Magazine » Toyota’s Secret: The A3 Report « MIT Sloan Management Review

John Shook had an article published in the latest SMR, based on his book Managing to Learn: Using the A3 Management Process to Solve Problems, Gain Agreement, Mentor, and Lead.

Hopefully this provides some good exposure to the broader business community. My understanding of A3 has been strengthened during my time with LEI, but I'm still a "Porter" ("learner") not a "Sanderson" (mentor) -- those names are the two main characters in the book.

As with many Toyota tools, such as kanban or 5S, the true value is hidden beneath what you can actually see.

"The ultimate goal of A3s is not just to solve the problem at hand, but to make
the process of problem solving transparent and teachable in a manner that
creates an organization full of thinking, learning problems solvers."

Not just solving problems, but developing people. Building people before building cars. Good stuff.

The article is a nice overview for those who are brand new to A3s, or those you might want to expose to the approach.

Recently, I've seen a number of hospitals using A3s for planning problem solving purposes - in The Netherlands and the UK. One hospital in the U.S., claims to have produced and used over 5,000 A3 reports, that the method has been taught to their entire staff.

The one challenge I'd see to this is providing enough "Sandersons" to make sure people are being mentored and using A3 in the best way possible, not just a superficial way.

Have and experiences to share?

Here is John's blog post about his article and the other related piece in SMR.

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Caution! Warning Signs in the UK

I was fortunate to be in England for five days last week. I saw the "gemba" at five hospitals in three days and attended the Lean Enterprise Academy Lean Healthcare Transformation Summit on Friday.

One thing I was taking pictures of in my travels were all of the warning signs -- the "cautions" and "be carefuls." I love England and London, so I'm not trying to make fun... but it sure seemed like there were a ton of warning signs everywhere. Is this due to an extremely litigious society (you'd think the U.S. was bad) or general British politeness and helpfulness? One sign at a rail station cautioned "Do not run on stairs." Good advice.

Some of the warnings do seem to be a bit much, though, including these two different warning signs for hot water taps:

And a second separate faucet:

Signs like these are often an issue in hospitals, where warnings and cautions to the employees and physicians are posted everywhere.

These signs, like the "Warning: Very Hot Water" seem like poor examples of problem solving. If the water is that dangerously hot -- why not adjust the plumbing so it is cooler? Isn't that easier than making and posting a sign? I can't for the life of me remember a similar sign in a U.S. bathroom. Have you?

I've got quite a collection of hospital warning signs, including:

On some pharmacy robotics: "Danger: Do not reach inside machine when running."

Why is the automation designed that you could even reach inside and hurt yourself? Where is the interlock that prevents the door from opening or shuts the machine down if the door is opened? Is "be careful" right right approach?

A sign on a piece of laboratory equipment read: "Do not spill."

The sign was warning the technologists to not spill patient specimens into the machine when loading them. Why? Because there was a bare circuit board exposed underneath the loading area. Why rely on people to not spill? Why not design the machine so the board is protected against the inevitable spill?

I think people probably also tune out the warning signs and start ignoring them if there are too many. Visual clutter means people don't pay attention to what's posted, I think.

Here's a common sense warning in a Tube car:

Here's a door in an Underground station -- how many warnings can they pack on that single door?

Does your organization abuse warning and caution signs? When I present about this to healthcare audiences, I typically challenge the audience to keep your eyes open today... how many warnings, cautions, and "be carefuls" can you find? For each, is there an opportunity to use some error proofing methods to prevent the error instead?

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Nice Lean Healthcare Overview in Healthcare Journal

Leading Lean: A Canadian Healthcare Leader's Guide :: Vol. 12 No. 3 2009 :: Healthcare Quarterly :: Longwoods Publishing

Today, I'll share a link I've been wanting to post for a few weeks now, see the link above. It's an overview to Lean in healthcare article written by a doctor, a med student, and two others.

They surveyed five different Canadian hospitals to look into their methodology and results from their Lean efforts, including one organization that's a member of our Healthcare Value Leaders Network - Hotel-Dieu Grace Hospital in Windsor, Ontario Canada.

From the intro:

Canadian healthcare organizations are increasingly asked to do more with less, and too often this has resulted in demands on staff to simply work harder and longer. Lean methodologies, originating from Japanese industrial organizations and most notably Toyota, offer an alternative - tried and tested approaches to working smarter. Lean, with its systematic approaches to reducing waste, has found its way to Canadian healthcare organizations with promising results. This article reports on a study of five Canadian healthcare providers that have recently implemented Lean. We offer stories of success but also identify potential obstacles and ways by which they may be surmounted to provide better value for our healthcare investments.

I was in the U.K. last week and saw presentations from or talked with Lean healthcare practitioners from England, Scotland, The Netherlands, Sweden, and Italy. While our payer systems and structure may be different, the waste that you see in the process and the operational details are very much the same across countries.

Virtually all healthcare systems face the same challenge: improving the quality of patient care, increasing the number of patients served and reducing wait times, while keeping spiralling costs in check. For many, it is difficult to imagine finding new opportunities to do more and better with less; yet such demands persist, and many organizations, in fact, continue to succeed.

One proven approach is Lean.

The primary motivation may be different (for example, more of an emphasis on reducing patient waiting times from referral to surgery in the UK), but the methods are pretty similar. As Ohno said, "start from need." If quality and patient safety is your biggest problem, start there. If the problem is cost, start there (by improving quality). These issues and objectives are all pretty interconnected.

Either way, you need a "burning platform" as they say. What's yours? What can you learn from the experience of the Canadian hospitals even if you're in a different country?

Coincidentally, Paul Levy shared this on his Running a Hospital blog yesterday. This morning, I get to see Paul speak at MIT, should be interesting. He's been posting a lot about Lean recently, their efforts at Beth Israel Deaconess Medical Center, including:

• Running a hospital: 5S gets you organized to be Lean
• Running a hospital: Pig -- Part 1
• Running a hospital: Interns Learn Lean -- They get it in two days!

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"Lean Won't Work Here... We're Different"

I'm sure anybody who has done any work with Lean has head these words said in one form or another, often prefaced with a "You don't understand..."

We're different.

Diff'rent (it's fun to spell that way, like the old show I grew up with, Diff'rent Strokes).

Yes, you are different. Your organization is unique. Special even.

No, I'm not being condescending.

I first heard the "we're different" expression when I started working at General Motors.

"We're different, we're not Japanese." This was the refrain until Toyota proved the Toyota Production System could work at NUMMI in California and TMMK in Georgetown Kentucky.

I'll get to healthcare in a bit... considering the progress that's been made with Lean in so many different settings, to think that one automaker would think they are so different from Toyota is kind of shocking in hindsight, no?

"We're different, machining engine blocks is different than snapping together cars." When I worked at a GM engine plant, this was a rationale used to explain away why that Lean stuff (we couldn't call it "lean" - effort to keep the UAW happy) couldn't work. Our new plant manager, trained at NUMMI, proved it could work, as it had previously at a GM transmission plant (although the engine people could say they were different than transmissions, but that was really splitting hairs).

So you aren't a car assembly plant in Japan. Lean doesn't apply?

"We're different, we don't build cars." That could be said in many companies like Boeing or Intel where they aren't assembling cars, but Lean methods are applied.

Books like Lean Thinking and The Toyota Way helped generalize high level Lean and Toyota principles that could be applied in different settings.

"We're different, product development (or sales, or service) is more complex than manufacturing." People outside of the factory floor struggled to see how Lean could fit until there were success stories. I recently heard a story about a car dealership apply standardized work and job breakdown sheet concepts to the salespeople... they doubled their sales conversion rates.

"We're different, we don't build things." Or so said the people in credit card processing and software development until they figured out how to apply Lean principles. Cycle times fell and quality improved.

And then...... we get to healthcare. In the late 1990s, healthcare organizations realized that Lean thinking could help improve quality, patient flow, cost, employee morale and a number of other important outcomes.

So this leads to the classic statement (still heard often today):

"We're different, we're taking care of people, not building cars." We have enough success stories from the early adopters to say, with a great deal of confidence that Lean CAN work in healthcare.

The same progression of "we're differents" can be seen in a hospital. Let's say the clinical laboratory is the starting point (a common one). Then, you get the following statements, which might be said in each and every department as Lean improvements march along. The evidence that it works in other departments isn't enough to sway others:

• Microbiology: We're not the core lab, they are high volume and we run much more complex testing. We're different.
• Blood Bank: We're not the core lab or micro, people could die if we make a mistake. We're different.
• Pharmacy: We're not like the lab, that's like a factory. We're different.
• Nursing (Telemetry): We actually touch patients here. Lean might work in ancillary departments. We're different.

Let's say you have success in reducing waste and engaging the staff in that first nursing unit. The chain continues:

• Nursing (Med/Surg): We're different, we have a much greater variety of patients.
• Nursing (ICU): We're different, our patients require much more attention and work, they're much sicker. Lean can't work here.
• Emergency: We're very complex, we can't predict who is going to come in. We're different.
• Operating Rooms: We're different than the E.R., we have such a variety of cases, Lean couldn't work here.

Then, beyond the hospital, primary care providers and areas will say "We're different...."

Dr. Sami Bahri, "The World's First Lean Dentist" is different from a hospital. But he's managed to make Lean work for the benefit of his patients and staff (and his practice, as a business). He's different.

Dr. John Tebbetts and Dr. Mark Jewell are cosmetic surgeons, who while being very different, have made Lean work -- again to the benefits of their patients and their practices. They are different.

I've heard reports of Optometrists using Lean principles to double the throughput of their offices and I had a veterinarian contact me the other day asking about Lean.

"We're different, we take care of animals -- do you know how many different species come through our door?" I wonder if they say that?

So, yes, you're different. That just means you can't blindly copy the other departments or areas that are different. You have to figure out how it applies to your department. Your emergency department might be different than the one down the street -- OK, great, now figure out how Lean methods apply to YOU and your setting.

Is "we're different" an excuse to not try Lean? Or is it the starting point for thinking and figuring out how Lean *does* apply? Lean in an operating room does NOT mean putting the operating room table on a moving conveyor belt that moves at a constant rate. But you can certainly find ways that Lean methods would help in an O.R. for patient, surgeon, staff, and hospital benefit.

Do Lean and TPS principles apply in pretty much every process? Yes, I'd say so. Does that mean Lean is easy to put in place? Of course not. But that, along with being different, should be no reason to not try. Am I a Pollyanna who thinks Lean is a cure all? No. But as I heard a physician in the UK say last week, "I sure hope that Lean works... because I know of no other alternatives."

Final thought - it's often said that "Lean doesn't succeed or fail... Lean is just a set of principles. What succeeds or fails is the organization or the leaders who try." Lean success isn't guaranteed -- it requires hard work and, yes, even a little creativity to figure out how Lean will work in your setting.

Because you're different.

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Random Lean Thoughts - July 13

Today's blog post will be just a bunch of random thoughts. For one, I just got back from London last night after a whirlwind Lean healthcare tour. I visited five hospitals between London and the south of England in three days, seeing organizations at various states of Lean, using different methods or "flavors of Lean." Thanks to regular Lean Blog commenter andrewmc for lining up Wednesday's visits!

Also attended Dan Jones' Lean Healthcare Transformation Summit that was done to launch their new book "Making Hospitals Work."

In my travels, I finished two books I had been reading in parallel and really enjoyed:

• Why We Make Mistakes: How We Look Without Seeing, Forget Things in Seconds, and Are All Pretty Sure We Are Way Above Average
• Chasing the Rabbit: How Market Leaders Outdistance the Competition and How Great Companies Can Catch Up and Win

I plan on doing a review of each book -- but geared specifically for my healthcare readers, mainly.

I also started reading a new book that has been very interesting so far:

• The Best Practice: How the New Quality Movement is Transforming Medicine

During my travels, I read a funny column about pay and bonuses in the finance industry by a columnist from The Independent. She asks why, if bankers love their jobs, do they need constant bonuses and excessive incentive rewards.

She wrote, in describing a I-banker she knew:

He loved his job. He did not have to be bound and gagged and dragged, weeping and wailing, into his gleaming office in the City. He did not have to be "compensated", like some Nobel-winning novelist forced to write marketing material for Rentokil, with truckloads of cash. But he got them anyway. Because bankers, unlike every other breed of human being, will, apparently, work only if they're paid several times more than a prime minister.

And:

To switch on their computer, you have to give them something called a bonus. And if you accidentally give them one that's a few hundred grand less than the person they sit next to, there's hell to pay. And then you have to start the agonising process of recruitment - as tricky, apparently, as getting pandas to mate - all over again.

Funny stuff. I'm not opposed to high pay. It's just the bonus culture of finance is very curious. I guess Dr. Deming would have thought everyone should be able to feel pride in their work, even bankers. But it seems the culture has evolved where nothing happens unless their incentivized. Anyway, I love the droll humor of the British newspaper columnists.

Now I'm home, as I write this, on a Sunday night watching a Tivo-ed recording of Friday's 20/20 program about GM's past and future (you can watch a lot or all of it online, it seems).

A few Lean-related tidbits:

• There was a good discussion about kaizen and andon cords in the Toyota factories. A Toyota production VP from Indiana talks about the cords being pulled thousands of times per day. The quality teamwork portrayed is striking in comparison to the descriptions of the drudgery of work on the GM line (although GM people claim they've successfully copied that stuff now).
• A UAW leader seems to overstate how "proactive" the union was in killing the infamous Jobs Bank. Too little, too late. The Jobs Bank seemed crazy 15 years ago.
• Jim Womack said, on camera, that there's basically nothing in new CEO Fritz Henderson's resume that would give anyone any hope of things being different with GM leadership in the future. Ouch.
• I caught the host saying "the leaner GM" meaning, of course, smaller not "Leaner" as we would say here related to the Lean/Toyota philosophy.
  

And the funniest thing, to me, not being a fan of the rapper Ludacris. In a segment about GM's important role in American pop culture, they played a snippet from a song of his where he rapped about Escalades, including:

Cadillac grills, Cadillac mill's
Check out the oil my Cadillac spills

Um, quality problems? Don't be ludicrous. The pop culture references from the 1960's (Little GTO, etc.) didn't mention quality problems did they?

I also learned, from the WSJ Europe edition (MSNBC link) that Rick Wagoner is STILL a GM employee. He's just not CEO anymore. Still collecting his $1 salary and benefits while the company figured out what to do with him. And new CEO Fritz Henderson said he's never had a problem with the speed of decision making at GM (he said this to ABC, which teed up the slam from Womack). Fritz Henderson (like Wagoner) is the ultimate GM insider. He doesn't have a good perspective on what fast is, apparently.

For the sake of being fair and balanced, the WSJ's Paul Ingrassia is optimistic about GM's future,
which drew this letter in response.

I'm fast off to bed... I love England, but it's nice to be back in the U.S.

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The New GM Is No Longer the "Leaner" GM?

I've complained about this before, it hardly fazes me any more when the media say that GM is going to be "leaner" in the future. Of course, Lean Thinkers realize they mean "smaller" not "more lean" in the sense of the Toyota Production System approach.

USA Today was the latest, in discussing GM coming out of bankruptcy:

New beginning: A smaller, leaner GM

Right in the headline. Argh.

So will GM become more customer focused? Have more flexible factories? Have better quality? Better employee relations?

Well, we'll see... but they may be considering a superficial, pandering change -- their logo:

It will have the same headquarters and many of the same top executives. GM's logo remains a blue square with silver letters — although a change to green is on the table, to reflect a new environmental focus.

A green logo? Barf.

Image from the Auto Observer blog.

The "green" crowd has a term similar to "LAME" (which can mean "Lean as Misguidedly Explained") - they call this sort of thing "greenwashing." Does GM think, "Hey, American public, why don't you love us? Don't you know we're green? We changed our logo!!!!" This newer article has denials from GM about the logo change.

More from the article:

The company will hold the best assets of Old GM.

Well, except for NUMMI.

"Today marks the beginning of what will be a new company, a New GM, dedicated to building the very best cars and trucks, highly fuel-efficient, world-class quality, green technology development, and with truly outstanding design,"

As opposed to what ever they were dedicated to before.

I will, however, give GM some credit. In an email sent to customers, they avoided the use of the L word:

The New GM is positioned for a profitable, self-sustaining and competitive future.

They can claim that all they want, as long as they quit using "leaner" in their TV ads, like this one. I am, though, suspicious when somebody (even in conversation) says "let's be completely honest here" -- you weren't already being honest?



Can GM market their way out of this? Can they get truly "Lean" or can they at least quit throwing "leaner" around?

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I'd Like to "5S" the Wimbledon TV Broadcast Screen

Hello from jolly old England. I'm in London for the Lean Healthcare Transformation Summit being put on today by Daniel T. Jones of the Lean Enterprise Academy.

This post, strangely enough, has nothing to do with healthcare. But, I was thinking about England while watching the amazing Wimbledon final match between Federer and Roddick.

Watching the match on a widescreen HDTV, I got to wondering about the score box that's constantly on screen. For about 1/4 of the serves, part of the action was obscured by the score box.

Federer's serve, shown above, is coming right out of the score box.

But look at all of the wasted real estate to the side. Why not put the score box there? We can't say "it's always been there" since the score probably wasn't constantly on the screen until ten years ago or so? Tennis is not a sport that benefits from widescreen... you get more of the part of the stadium where the action doesn't normally occur. Tennis does benefit from HD... I guess it would be too disorienting to watch a tennis match that goes sideways? But the best seats at the stadium are center court... on the side.

My suggestion to NBC would be this -- why not put the score box vertically off to the side? I would have the numbers right side up, of course.

Wouldn't this work better? How do I submit a suggestion to NBC? I wonder what their thought process is? I guess it's "value" to being able to see the score, but so is seeing the serve.

OK, maybe not the most profound Lean thoughts ever, but this seems so obvious (to move the score box), I wonder what I'm missing or not thinking of?

Update: Here is what ESPN tried in 2004:

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LeanBlog Podcast #70 - Tamra Kaplan, Long Beach Memorial Medical Center

Episode #70 is an interview with Tamra Kaplan, the COO of Long Beach Memorial Medical Center. We talk about the lean transformation work being done in the hospital and Ms. Kaplan's experience in leading this effort. For an earlier blog post about her promotion to COO and Lean at LBMMC, click here.

For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple iTunes.

You can use the player (use the VCR-type controls) below to listen to a "streaming" version of the podcast (or click here for the streaming audio and RSS subscription). The streaming link is faster for one-time listening (hardly any delay to start listening). Or you can use the download link to put it on your iPod or other MP3 player.

MP3 File Right-Click to "Save As"

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If you have feedback on the podcast, or any questions for me or my guests, you can email me at leanpodcast@gmail.com or you can call and leave a voicemail by calling the "Lean Line" at (817) 776-LEAN (817-776-5326) or contact me via Skype id "mgraban". Please give your location and your first name. Any comments (email or voicemail) might be used in follow ups to the podcast.

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Medical Errors in Hospitals Still Occur at Alarming Rate

It has been over 10 years since the publication of the Institute of Medicine's study on preventable medical errors: To Err Is Human: Building a Safer Health System. So how are we doing? Are there still nearly 100,000 patients dying in the U.S. each year due to preventable errors? I haven't heard anyone claim that this problem is solved yet.

FOXNews.com - Study: Medical Errors in Hospitals Still Occur at Alarming Rate - Longevity | Prevention | Aging

The first story, above, indicates errors are still a major problem:

While patient safety in US hospitals is improving, "medical mistakes still occur at an alarming rate," according to the sixth annual HealthGrades study of patient safety in American hospitals, released today.

Between 2005 and 2007, medical errors cost Medicare over $6.9 billion and were responsible for more than 92,000 potentially preventable in-hospital deaths among Medicare beneficiaries, report Dr. Rick May and others at HealthGrades, a healthcare ratings organization in Golden, Colorado.

Keep in mind these are just Medicare patients. What percentage of all patients are on Medicare? I don't have that number handy... would really be interested to extrapolate 30,000+ Medicare patient deaths to the whole patient population.

Some more numbers:

More than 913,000 total "patient safety events" occurred, representing 2.3 percent of the nearly 38 million Medicare hospital admissions.Patients who suffered one of these mistakes had a one-in-ten chance of dying, the report indicates.

Multiplying those out, that's a 0.23% chance of dying because of a "potentially preventable" error. Or 2.3 out of 1000. Yikes.

The AHRQ says there are about 29 million hospitals admissions each year in the U.S. At 0.23%, that would be a total of 66,700 deaths per year.

Are these incidents random events? It seems not -- it behooves us, as patients, to find out which hospitals have better quality. You can do so at the HealthGrades website, but alas they sell the detailed reports (and no need for disclosure here, I don't take a cut for referring you to them). It seems difficult to, as a patient, draw valid conclusions from the data they show, but maybe that's the subject of another post (or for another blogger).

The investigators observed that, on average, Medicare patients treated at award-winning hospitals were 43 percent less likely to experience a medical error compared with those at bottom-ranking hospitals. "This finding of better performance was consistent across all 12 patient safety indicators studied," the authors write.

At least things aren't consistently bad. So what are the "award winning" hospitals doing differently? It's got to be a matter of PROCESS, not people. I can't imagine the award-winning hospitals are hiring people who are smarter or more careful.

Errors with the highest occurrence rates were "failure to rescue," defined as death among surgical inpatients with serious treatable complications; bed sores; postoperative respiratory failure; and serious postoperative infections.

There are some problems inherent in extrapolating the Medicare numbers, since those patients are older and, presumably, more likely to get bed sores. But still, this is a serious problem.

This related article also caught my attention:

Nearly 90 major medical mistakes logged at Utah hospitals in 2008 - Salt Lake Tribune

This number was only the events that caused death or serious harm in Utah, not all errors.

Despite a years-long effort to cut down on one type of medical mistake - surgical errors - they remain Utah's top problem. There were 45 surgical errors last year, such as performing the wrong surgery on the wrong body part. One example: A gastrointestinal tube that was guided into a lung instead of the stomach.

"We're struggling," said Iona Thraen, who reviews the mistakes as director of patient safety for the state health department.

Why are they struggling? It's not just Utah... why do the experts (I'm not pointing at myself as the expert) say many or most of these are preventable?

The standard practice is for hospital staff to manually count the sponges before and after surgery to ensure they are removed and confirm the removal with an X-ray, said Thraen. When reviewing the cases when sponges were left inside patients, the staff members are usually certain they counted and re-counted the material, she noted.

OK, you might wonder -- how hard is it to have some standardized work that says you count and even re-count? Does the phrase "usually certain" set off red flags?

Counting -- this is a form of visual inspection, done by a person --- it's going to be prone to error. We're human. We make mistakes.

But do we have to make as many? The sidebar at the bottom of the article highlights a situation that might not be unique or rare:

During a routine inspection of McKay-Dee Hospital in Ogden last year, state health department surveyors cited the facility for compromising patient safety because surgical staff didn't count instruments before and after surgery. They did count sponges and needles.

Inspectors were told that staff only counted instruments during open-heart surgery and that surgeons were "reluctant to allow staff to perform instrument counts" because "it added more time to the surgical procedure," according to the inspection report obtained by The Salt Lake Tribune.

Whoa. So when things like this are happening, as fancy RFID technology the only solution? The most cost effective solution?

How do you win the cultural battle that patient safety, not speed, comes first? Can you eliminate waste and take time out of the procedure rather than eliminating this step that impacts patient safety?

Seems like this, and many other medical mistakes, are cultural and social problems more than they are technical problems.

So I'll leave it on that. The LEI's John Shook has a blog post about looking beyond the technical for root causes of problems that fall in the social realm. Seems to fit here.

Comments?

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Lean Guy Drove a Prius For Two Years And...

... I wasn't impressed in the least. In my previous role as a consultant, I was given a company vehicle to use, even though it was basically for commuting to a local client, the airport, and occasional personal use.

I had the Prius just over two years and put about 12,000 miles on it. The driving experience was OK (it was peppy enough, I suppose) and it did get 41 MPG. But, aside from being ugly (which is a matter of taste), I was left with some pretty poor impressions of Toyota quality.

This is hard to stomach to a "Lean guy" who preaches the gospel that the Toyota Production System leads to better quality.

My impression was that, to keep the total price of the Prius low (since price is driven by the market, as Toyota teaches), they had to "get cheap" with components that we're part of the expensive hybrid drive system. Toyota couldn't just add cost (hybrid drive) and then try to pass that cost along in "cost plus" pricing. Toyota customers wouldn't buy the Prius at a significantly higher price (or at least not enough, Toyota must have figured).

The interior just felt cheap... the components, materials, and construction.

I wore a hold in the carpeted floor mat and I don't have particularly pointy heels... I drive with my heel in the same position, rotating my foot over to the accelerator. I have a Saab with 40,000 miles and the carpeted floor mat is just fine. The Toyota mat is pictured below:

OK, but a floor mat could be replaced easily (and probably under warranty). The driver's seat cloth was pretty worn and cruddy looking, if that is conveyed in the picture:

Fumbling with a GPS unit that I was unsticking from the windshield, it fell and, in my fumbling, I struck the clock on the dashboard. It wasn't that hard of a hit, but it must have been in just the right spot to knock the clock into the dash. On it's own, I'd say that was just an unlucky blow, but it got me thinking that maybe Toyota had used cheap fasteners or clips to hold the clock in place.

Has anyone else had a similar experience with the the Prius? For many people, the Prius might be their first Toyota. This is supposed to represent Toyota quality? The company that brought us Lexus?

Maybe people are so happy to drive a hybrid car and feel so good about that, so the customers/drivers are willing to forgive and overlook other flaws and cheapness? Is Toyota giving the market the quality they desire at their price they are willing to pay?

I wouldn't spend my own money on a Prius after my experience. What do you think?

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