"Just In Time Patients??"


Medical Leave — Offshore Medicine — Fast Company

Interesting read here in the latest issue of Fast Company about a hospital in Thailand and one of the visionaries, Ruben Toral, who wants to globalize healthcare. The idea of patients flying halfway around the world for elective surgeries, taking advantage of lower labor rates, isn't exactly new.

“For someone such as Toral, the hypertrophied medical-industrial complex is just begging for a dose of disruptive innovation. He calls his vision the “Toyota-ization of health care,” a metaphor so vast that it contains multiple readings, some fit for industry conferences and others he'll cop to only in confidence.”

I'm not really sure what he means by that, Toyota-ization. Maybe one analogy is to compare the current American hospital industry to the Big Three automakers in the 1970's? Toyota, Honda, and others brought new competition to the market, bringing better quality AND lower costs. Much as the Big Three didn't believe you could have high quality and low cost (many thought Toyota was “dumping” products illegally below cost i the U.S.), you often have people in healthcare who don't believe you can have high quality and low cost.

There's often a mindset that healthcare is immune to “offshoring.” Not that I'm advocating the practice of shipping people halfway around the world for medical care, but it will be interesting to see if this creates a crisis — creating competition that creates more of a need for change. This can maybe spur improvements in quality AND cost in U.S. healthcare? These “medical tourism” hospitals are supposedly very clean and safe, run to very high standards.

“In order to ensure continuity of care,” he goes on, “you'll never leave the system. What could be better than telling an American patient they're going overseas to an American-owned hospital? They're going to discover the same supply-chain advantages Toyota did when it created just-in-time manufacturing. We're going to have the same thing — just-in-time patients. Hospitals are not going to spend any more money or any more time in the movement of that patient through the system than is necessary. They're going to get the patient in, get them on that global platform, and get them back. Now, how do they do that in a fast, efficient way where quality is kept, efficiency is gained, and prices don't go up? It's classic manufacturing and logistics.”

The supply chain efficiency he describes sounds like local efficiency — the idea of reducing waste reducing waste (eliminating patient flow time that is more “than is necessary”). But what about the supply chain at the global level? Toyota's approach is to be close to the customers. This approach, shipping customers halfway around the world, seems more like the notion of building product in China, shipping it halfway around the world. That's not necessarily Lean. Wouldn't it count as more movement than necessary, getting on a plane from Texas and flying to Thailand?

Toyota builds factories close to their customers (as evidenced by their North American expansion). Wouldn't a truly Lean medical model involve high quality care close to the customer, without waste or unnecessary time or expense? Flying everyone to Asia doesn't seem like a root cause solution to our problems with healthcare costs and quality.

It's interesting to think about, this global “patient chain.” What would happen if the only care provided here in the U.S. were true emergency care? What if anything planned or non-emergent were being done in high-quality facilities in low-cost countries?

I'm not sure what it is, but I'm not sure it's “Lean” or something worth invoking the name of Toyota for, as Toral does. What do you think – about medical tourism, in general, or the somewhat shaky association to Toyota?

Subscribe via RSS | Lean Blog Main Page | Podcast | Twitter @MarkGraban

Please check out my main blog page at www.leanblog.org

The RSS feed content you are reading is copyrighted by the author, Mark Graban.

, , , on the author's copyright.

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

Did you like this post? Make sure you don't miss a post or podcast — Subscribe to get notified about posts via email daily or weekly.

Check out my latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation:

Get New Posts Sent To You

Select list(s):
Previous articleNursing Shortage Easing?
Next article"Real Lean," Volumes 1 and 2
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. “Toyota builds factories close to their customers (as evidenced by their North American expansion)”…if one were to follow the components of an American-made Toyota vehicle all the way down the supply chain, through multiple levels, I wonder what % of the total value-added would be in the U.S.? Same question, of course, for the U.S. automakers.

  2. Why dont they build a cruise ship hospital?? No flying neccesary for the patients. Drive to your nearest port, board,get operated on in international waters and recuperate for a few weeks in the carribean or pacific islands!!

    IM sure im not the first person to think of this.

  3. Toyota was able to come here and build plants that avoided the UAW after NUMMI because of the restrictive work rules. I am not sure any hospitals built here could escape the AMA, so offshoring is probably necessary.

  4. Mark,

    I’m no expert on the globalization of healthcare and the cost/benefit ratio but I think the analogy to Toyota is way off base. First of all the “entity” in health-care is the patient, the “resource” the staff/hospital and the “process” the procedures. By Mr. Toral’s analogy he intends to make the resources far away (to achieve a cost savings) and move the entity all over the world for multiple processes. I can’t think of a more un-lean condition.

    To be kind, I’ll say that Mr. Toral is loosing track of the concept of the patient as the entity. Often, people in healthcare consider the providers as the people that need to be running lean, whereas, it’s keeping the patient moving through the system smoothly and quickly that creates efficiency. Minimizing the resources required is part of that streamlining process. The cynic in me, however, suspects that the motivation may be more marketing than lean thinking.


  5. To David, I think the answer is “it depends.” The WSJ had an article last year that compared a Toyota Sienna van to a Ford Mustang:

    “Yet, by a crucial measure, the Sienna is far more American than the Mustang. Statistics from the National Highway Traffic Safety Administration that were publicized in “Auto Industry Update: 2006,” a presentation by Farmington Hills, Mich., research company CSM Worldwide, show only 65% of the content of a Ford Mustang comes from the U.S. or Canada. Ford Motor Co. buys the rest of the Mustang’s parts abroad. By contrast, the Sienna, sold by Japan’s Toyota Motor Corp., is assembled in Indiana with 90% local components.”

  6. Our patients at WorldMed Assist, a medical tourism company, have quite a different experience than what Mark says: “Hospitals are not going to spend any more money or any more time in the movement of that patient through the system than is necessary. They’re going to get the patient in, get them on that global platform, and get them back. Now, how do they do that in a fast, efficient…”
    For example, our patients find that the pre-op tests are WAY more extensive than they’d find in the U.S.; they stay in the hospital until recovery is absolutely ensured; and the medical team pays them far more attention than they’d get at home. The very last analogy any of them would use is feeling part of a supply chain.

    One recent patient, Jerry Mead of Illinois, had bilateral hip replacement in India for which his hospital stay for both surgeries and physical therapy was 24 days. Imagine a U.S. hospital keeping a patient for 24 days for orthopedic surgery!

  7. Robbie – thanks for the comment. What you quoted weren’t my words, but the words of the person I was quoting, Ruben Toral.


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.