Does a UK Hospital "Have Boondoggle?"


Fury Over 84 000 pound NHS Trip To Japan (from The Northern Echo)

With apologies to the Got Boondoggle? lean blog, this story is about a group of NHS hospital executives and physicians taking a study trip to Toyota in Japan. Maybe they got the idea from our country's Virgina Mason Medical Center and their trips.

The trip is being criticized (“criticised” I guess) by some who feel that's not a good use of funds that could go to direct patient care (although the spending was defending as coming from specific training funds, not patient care — but still, I can see the point that the money COULD have been allocated to the patient care bucket, even if it had NOT been).

Families of patients denied drugs on the NHS, as well as two GPs, have criticised the trip to study Toyota's “lean management” techniques at a time when cash-strapped health authorities are trying to cut costs.

But the North-East Strategic Health Authority stood by the decision last night, insisting that the lessons learnt would save money and make the NHS more efficient.

Last month's visit cost £84,000 to fly a 14-strong team to Japan. Officials said the cash came from “central training funds”.

I can certainly understand the NHS position that learning about Lean and the Toyota Production System *is* a good investment. But, do they really have to go to Japan to learn this? Does anybody have to go that far? Some critics suggested they could have visited local UK Nissan or Toyota factories, or other NHS hospitals that are using Lean already.

“…the decision to send a team to Japan was taken because there were no similar examples locally or nationally.”

At the First Global Lean Healthcare Summit alone, you had three examples of Lean success — NHS Bolton Hospital, Unipart, and Tesco.

I can understand people CHOOSING to go to Japan, but to say you HAD to doesn't ring true to me.

Another critic said:

Dr Andrew Saunderson, who recently retired as a GP after working in Spennymoor, County Durham, for 34 years, said: “It strikes me there must be easier ways of getting this information – the internet for example.

“I have to be convinced that a trip to Japan will tell you how they do things. It may not be transferable to our culture, and the technique of making cars is an entirely different process from caring for people.”

Now that critic's not even convinced that Lean isn't “just a Japanese thing” or “just a manufacturing thing.” Common misunderstandings that we have to educate people about.

Who do you go visit when you're learning about Lean? Click “comments” to tell us. How far have you been able to travel to see a “Lean” factory? Would you find value in going to Japan, given language barriers? I've never been to Japan, myself. Would you recommend that Lean students try to visit Toyota Georgetown (TMMK) instead? Was the trip described in this article a “boondoggle?”

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. We have a network of small companies within 150 miles that are new to Lean. We rotate through each plant on a monthly basis, as part of a Lean Discussion Forum.

    Our parent corporation has Lean activities at plants approximately 700 miles from my facility that we travel to.

    The Corporate Office has brought in personnel from TMMK to present during Lean training sessions at our corporate training center. That was highly valuable.

    In my opinion, there is a lot that can be learned within the US, as there are a lot of consulting firms whose members are made up of previous Toyota or Danaher employees. Those people have a wealth of knowledge that can and should be “gleaned” before someone would plan a trip overseas. I don’t know if the UK has similar opportunities.

  2. That’s great that you have that network, Mike. We had a similar network in Phoenix that met quarterly (I assume it’s still going).

    I know there are good Lean examples in the UK, I wonder if the hospital didn’t know about them or had already exhausted those sources. Maybe they should focus on experimenting with Lean rather than just learning (learn by doing).

    Toyota’s UK plant was ranked most efficient in Europe, in 2000, at least.

  3. I’m with you. Even after having heard the Virginia Mason folks talk about visiting Japan, I don’t get it. I don’t understand why an oversees trip is necessary to understand how the Lean philosophy works. Now, having said that, I think that getting out of your building (and your comfort zone)has considerable value. I just don’t see why going to a foreign country adds value to the trip.

  4. Paying 84K GBP to send 14 people to Japan – that’s 6k GBP or about US$12k . This is about twice as much as we at Gemba charge for similar one week trips to Japan. Perhaps it was a two week trip for the NHS folks. For just over US$1200 per day (assuming 10 days at US$12k), all expenses included, there is no better full-body Lean education you can get.

    If you could “one piece flow” this experience and do local trips of one day duration for just $1200 per day that would be better. However, there is simply no place in the world right now where you can spend 5+ days seeing high quality Lean enterprises in action, walk their gemba and discuss with their executives how they did it, day after day.

    You can fly to Seattle and pay $5000 to take a group of 8 or so people to tour Virginia Mason Medical Center and meet their CEO. If you’re on the east coast of the US, that’s a day there, a day back, so 3 days for one day of visiting. Go to Japan is a day there and day back, with 5 to 10 days of learning in between.

    Sure it’s “batch” learning, but batch (or kanban) is what you do when the distances between processes are too far to be practical to flow one piece.

    Not only that, most US / US / EU companies advanced on the Lean journey do not open their doors as readily as Japanese companies do. Why is that? There are several reasons, including a desire to share their knowledge and contribute to society by helping other companies on their Lean path, pride that guests from overseas are coming to benchmark them, and motivation to keep doing Lean so they can be “worthy” in the future of international visitors. It’s a different mindset.

    It was not Gemba who took the NHS group to Japan by the way, but we would happily and be fully able to explain to UK taxpayers who this is a wise investment in their nation’s long-term health.

  5. Whilst I agree with Jon that going to see the heart of toyota IS a good thing, I have to suggest that £84K IS excessive given that within a 200mile radius of that hospital trust, in the UK there are TWO toyota plants, a Nissan plant, (all of which have been the most efficient in Europe at some point) a Honda Plant, Two BMW plants, and countless other very good lean businesses, and some very good hosptial trusts already implementing & delivering lean improvements. There is also the UK arm of the Lean institute home to Mr Dan Jones in Cardiff University, which has also just run a Lean healthcare conference in the UK. On top of that, there are NUMEROUS, GOVERNMENT funded agencies set up to help businesses in the path to becoming leaner.
    I am sure that my hard earned taxes would have been better spent having either the same people get a wider view of lean in action in a UK environment, OR, a lot more people from that trust getting exposed to lean. I am sure this would have been considerably more effective, and would have drawn significantly less criticism of something that was essentially going in the right direction, if poorly implemented.


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