Training Within Healthcare


Training Within Healthcare (TWI Newsletter)PDF File

It's been a busy week, helping spread the word about Lean healthcare in Puerto Rico, something I'll be able to blog about soon. So, I'll be lazy and post an article I already wrote as a blog post.

The link at the top here is a post I wrote recently for the TWI Newsletter about the opportunities for use of the “TWI” method in healthcare. I'm using some methods, such as Job Breakdown Sheets, with very good success in hospitals and patient care settings. But there's potential to do much more. One hospital in the western U.S. told me they are researching TWI in conjunction with their Lean efforts and one leader there called this “the holy grail” for healthcare process improvement.

My article begins:

Training Within Industry (TWI) is thought of most commonly as a method used in manufacturing and shop floor environments. It is less commonly known that, by 1944 at the latest, the TWI materials had been adapted for use in healthcare settings. Today's hospitals still can benefit from the principles and methods explained in these World War II era manuals.

In 1944, the War Production Board published a 12-page healthcare addendum to the core TWI materials. The basic TWI methodology is sound but requires an adaptation in terminology. For example, if the term “production” is replaced with “patient care,” the TWI materials fit well in a hospital. The word “tools” is more appropriately replaced with “instruments” or “equipment,” and “head nurse” is a much better term than “gang boss.”

Please join me at the upcoming TWI Summit being held May 12-13 in Mason, OH (a Cincinnati suburb). I'll be part of the presentation team in what looks like another outstanding lineup of sessions. The agenda includes sessions on some recent historical findings, job safety, a new “Quick ‘n Easy Kaizen” program in the traditional “J” format, and a host of company case studies. Please note the attached flyer which highlights a special discount I can offer as a Summit presenter. Hope to see you at the Summit!

If you have any experiences of your own with TWI that I can consolidate and help share in my presentation, please email me at mark (at) Even if you can share what you're doing or considering on an anonymous basis, it will help me build the case that I'm not the only one who sees the potential here. I'm finding many old articles in nursing professional journals from 1944 to 1946… so everything old is new again?

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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. Hi Mark,

    You need to get in contact with Mark Warren at Tesla2. He will be at the TWI Summit as well. One of his most recent finds was in the British postwar archives: TWI Job Instruction for Nursing. I also (finally) picked up a copy of the Red Cross Nursing Program Guide for Home Care. Many of the administrators of this program were trained by TWI trainers during the war, but I fear much of the standardized training methods have sadly been lost. At any rate, you may find the materials that Mark Warren interesting.

    Go to TWI Blog and click on the link in the sidebar “Join to Access TWI Materials”. You will find much of the “new” stuff there.


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