The Impact of Toyota’s Quality Problems on “Lean Healthcare”?


As I'm traveling back from Sweden today, I think I'll be catching up on the web reaction to Toyota's major quality problems and recalls. I am not a Toyota insider and I don't claim to know what happened or what Toyota will do. All I can write about is public perception and how this impacts our efforts to spread the Toyota Production System and “Lean” to healthcare.

It's disappointing how the mainstream media and the web can't separate Toyota from “lean manufacturing.” Remember, the term “lean ” does not come from Toyota. It was coined by Jon Krafcik of the Womack / Jones / Roos team that wrote The Machine That Changed the World: The Story of Lean Production.

While the term “lean” has negative connotations, one advantage of defining a term “lean” and a set of principles is that we can separate “what Toyota does” from the lean methodology. The Wall Street Journal, once again, demonstrates that their writers don't understand lean at all. Normally, each year, they trot out a new article about how “just in time” doesn't work. (other links here).

“Just in time” parts delivery from suppliers is a practice often associated with lean, but it's a minor piece. Lean is really a management philosophy and improvement process. This time, the WSJ is blaming the use of common parts – a cost savings move where the same accelerator and other parts are used across multiple models, since who really cares if a Camry gas pedal looks like that of a Matrix? (A good perspective on this can also be found here from Northwestern's Kellogg school).

Whether JIT or common parts, the WSJ is looking at what Toyota (and other car makers) does and they can't separate that from lean. GM uses common parts (arguably, one practice that contribute to Saab's problems). Toyota clearly failed. But saying Toyota, the people and the company, failed is not the same as saying lean failed. Just because Toyota does something doesn't make it lean.

Toyota's failure does not discredit lean or even the Toyota Production System. As John Shook wrote recently, he learned early to separate the System (the ideal) with what Toyota actually does. There is often a gap. In this case, there's a major gap, where Toyota clearly hasn't lived up to its quality reputation and a lot of people have died.

That said, Toyota's (the company) failures and the resulting public perception impacts us in the lean world. If public perception falls too much, are we worried about lean sounding like the “Yugo Production System” or the “Pinto Production System“?? On the surface, it sounds like exactly NOT the kind of thing to bring into healthcare.

The reality is that lean methods for quality improvement are saving lives in healthcare – providing more timely care and reducing errors and infection rates. It would be a real shame if Toyota's problems lead to less adoption of lean in healthcare. In your hospital. you probably have your skeptics about lean — are they gleefully seizing this moment to say, “See, I told you Toyota isn't perfect!” That sort of argument might not be logically true, but it has emotional appeal, I'm sure. Will that interfere with your lean progress? Time will tell…

I've always told training classes that Toyota isn't perfect. They are human. Maybe that's the best lesson there – to recognize our human nature. Will people naturally overreact to the Toyota problems to discredit lean? Sure. But, in healthcare, are we not also human and fallible? Isn't that realization more of a reason to have better systems – methods like mistake proofing and checklists?

How are you prepared to address these issues when people ask you about Toyota's recent problems?

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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. There is a difference between the failure in the system design and a failure in the system execution. Every system is composed mostly of people, who are fallible. The ability to live and breath the right behaviors every day is nearly impossible. Toyota, and everyone else for that matter, fail to live their principles on a regular basis. Doctors fail to uphold their oath, even though they try. Companies fail to live their values. Husband and wives fail to live to their vows.

    Toyota still has the lowest rate of creating defects. It just happens, between their growth, part commonization (which I argued on one blog may be the opposite of lean), and dumb luck, that one of Toyota’s failures happened to be MASSIVE, both in terms of size and in terms of severity. Having been an automotive engineer many years ago, there is no worse phrase than “unintended acceleration.” It’s a horrible thing. It’s probably worse than brake failure. It’s very hard to diagnose.

    Let’s just hope that their planned fixes are sufficient and no one else dies as a result.
    .-= Jamie Flinchbaugh ´s last blog ..Measurement Misnomers, and Toyota Dealership Problems =-.

  2. Hi Mark,

    I always find it interesting when people try to associate a concept, a way of thinking or even a belief with individuals or organizations. The consequence is that we try to simply copy and paste what they do and when it does not work as expected we know who to blame.
    What’s unfortunate is that most Lean practitioners feed that thinking by designing their training and coaching based on the same thinking. Take for example training, most material start with a history of Toyota and TPS followed by a brief description of Value and waste and then it’s tool after tool!!! Wouldn’t it make more sense to have the training focus more on questions that will get participants to challenge their current way of thinking and feel the need to try a different way??? Wouldn’t that get the participants to own their transformation?

    I personally see positives in the current events, from one side those practitioners who have been selling Lean as the Toyota Method or a proven set of tools will now have to be ready to face push back and go back to the real principles behind Lean.
    And from another side, theses events will filter the organizations who claim to be on the Lean journey without real commitment.
    In coaching we say that you can only coach people who are ready for change.


  3. A big organizational problem I’ve encountered is that many people, especially managers, will only adopt what they consider to be a “proven” methodology. When you try to explain to them why we need a new way of thinking or a new theory of management, they say, “Show me examples of where it works.” The phrase, “A new way of thinking,” is perversely interpreted as: “You’re trying to brainwash me.” The word “theory” is illogically transformed by poor deductive reasoning into: “So you can’t show me where it works, therefore it works only in books, but not in real life.” After all, it’s “only” a theory. Translation: It’s academic nonsense. And so some well-meaning advocates will then provide the example, e.g.,Toyota, as “proof” that it will work for us. This is unfortunate.

    As any good student of the philosophy of science or of Deming knows, examples don’t “prove” that something is “true,” only at best that something can hold or can work under some set of conditions. You can provide countless examples of a theory working, but it takes just one counterexample to “disprove” it (at least in the universal sense–one can always adjust a theory to accommodate exceptions). I can find millions of examples of humans with two legs, but this is of course not proof that all humans have two legs.

    My point is that despite my admonitions not to do so, other managers and change agents in my organization have advocated lean/TPS as a “proven system.” They’ve done this to convince recalcitrant people of the need to accept lean. I’ve argued, to no avail, against this practice, that it is an example of a poor thinking habit which discourages exploration, discovery, experimentation, and deep learning, while encouraging mindless copying and superficial pseudo-learning; it is short-term thinking.

    Now my worst case fears are becoming manifest; the cynics are using the current situation as a counterargument, and having a great time doing so. And what’s really bad is this is pushing those who have been unsure but who might have bought in, into the valley of the lost. It’s going to be a long climb bringing them back up. I could use some cliff notes…

  4. A couple quick thoughts. How important is it that the so-called mainstream media gets it or not? Any news story only has 800 words or so to tell a sliver of what’s happening, and then move on. The WSJ may now and then write about a successful organization that happens to have gone lean, but they’re mostly looking for the next new thing. Any company whose lean efforts are hurt by Toyota’s design failure, by a CEO who doesn’t want to hear about Toyota anymore, or who takes pleasure in their perceived comeuppance, wasn’t going to make much progress anyway.

  5. I find it terribly unfortunate that the mainstream business press is using this incident against the whole concept of Lean. I am not particularly concerned as to whether the term Lean is associated with Toyota or Womack. What I would like to see is learned people such as yourself illuminating on how Toyota is executing their response. I am not so sure that the problem was forseeable but that is an argument for engineers. Nevertheless, Toyota is taking the issue seriously and ceasing production in a big way to effect the repairs or whatever it is they will announce. Things can go wrong and this appears to be the authoring of a great case study on how a Lean type practioner would go about effecting a solid and respectable response. Good on them! There was another excellent example in Canada last year where the consequences were very serious at Maple Leaf foods. This was not a Lean story but a health and sterilization issue which could potentially impact hundreds of food processing establishments. Unfortunately the press predominantly focused on every single tidbit that made the organization look ineffective at sterilizing equipment. Maple Leaf also completely shut down facilities and undertook to clean and test then clean and retest again and again until they ferreted out what they believed to be the ultimate source of the problem. The bacteria had migrated deep inside the mechanical components of certain models of meat slicers where it was sheltered from the rigorous sanitization procedures. The CEO publicly, through all major media modes, kept the public informed and up to date throughout the whole process which garnered much public respect. Toyota will also need to conduct themselves in this transparent manner to maintain respect in the market place.
    This is a perfect opportunity for the rest of us to educate the naysayers who we all encounter when introducing “Lean.”
    Thanks for keeping the dialog alive folks,

  6. Thanks for the thoughtful comments.

    I agree that those who would only try to learn from lean because Toyota does it or because some other hospital does it has only minimal committment.

    There are deeper issues here about tools and thinking, probably deserves a new post where we can discuss approaches of teaching, learning, and doing.

    One problem with the “you just need to think differently” approach is not that it sounds like brainwashing or a cult, it often reeks of snobbery. A vague “you need new thinking” sort of sounds like “you are stupid.”

    Thinking is good. Thinking differently might be better… but as Dr. Deming would ask, “By what method?” right?

  7. Using the problems at Toyota in an attempt to discredit or undermine the worth of Lean is just sinister. Most of the popular frameworks that are around today (and I’ll lump Lean into this pot for just a moment) are good enough the way they are. What needs fixing is our expectations from them and what we use them for.

    One of the key things that isn’t getting addressed is how Toyota has evolved over time. Are these the same people? No. Are the market conditions the same? No. One could make the case that they are both radically different.

    Any organization that doesn’t take how the organization itself and its personnel are evolving into account is going to hit a wall at some point. Rather than looking for who/what to blame, I’d rather look at this as a wake up call for ongoing, intentional development.

    Any failures that Toyota experiences now doesn’t diminish what they accomplished using Lean methods. The main trick now is to identify what to let go of that’s no longer working and what needs to get put in place that will help them move forward as the organization they are now.

    Of course, I may be wrong… :-)
    .-= Kenneth (“kengon”) Gonzalez ´s last blog ..Welcome to =-.

  8. I still do not understand how ‘Lean’ continues to receive credit for basic engineering practice.

    Having said that, I do not understand how ‘Lean’ is blamed for an undocumented and spurious behavior of an automobile part.

    Perhaps lean has no accommodation for design robustness.

  9. Rearden, I agree with your first two points. Much of the “lean” work I have done in hospitals was really basic Industrial Engineering 101.

    That said, “lean” is not just engineering tools, but also a management system. Hospitals are embracing both pieces of this equation.

    Hospitals are often lacking in both categories: 1) basic process engineering and 2) having any semblance of a management “system.” So lean is helpful and hearing of the success from other hospitals inspires them to improve. This is mostly a good thing.

  10. Several comments on the above, but I’ll be brief:

    I strive to remain mindful of the fact that every “news organization” is a business. Those businesses are all trying to make money by reporting what is “new”, not necessarily what is true. If they can sell advertising consistently, usually by demonstrating that people will access their medium, then they will succeed. I first learned this lesson when I was at the scene of “breaking news” in the 80’s while deployed to the Sixth Fleet. I was puzzled, but amused at the “news” that came out of the event.

    I’ve recently faced numerous challenges to my advocacy of Crew Resource Management principles and techniques as a logical extension of lean thinking, mostly due to the Northwest (Delta) Airlines overfly of Minneapolis. “If this stuff is so good, then why can’t the pilots find the airport where they’re supposed to land?”

    Similar to the issue at hand, the remarks are largely based upon fear, envy, or ignorance. The simple answer is that CRM actually made this event a non-event (zero fatalities, injuries, damage, and very few itinerary delays) because the flight attendant knew it was her job to call the cockpit and question something that didn’t seem normal, thereby alerting the cockpit crew that they were logging extra flight time.

    While I am merely an initiate when it comes lean thinking and methodology (though I’ll be getting smarter in the next two days thanks to Mark), I have to believe that Toyota will return to the tools, systems, and thinking that have served them well over the past 60 years. Those of you who are further down the road than me will know more, but wouldn’t A3 problem solving, “5 Why’s”, and a focus on what’s right, not who’s right be a significant part of the response?

    I enjoy this blog, and especially the thoughtful comments from all of you because it increases my understanding. Thank you.

  11. I am not a Toyota insider, but it seems to me as far as the tools are concerned Toyota did exactly what they were supposed to. They stopped the line. They also stopped sales etc., they found a problem, and are putting countermeasures in place and at the same time they aren’t continuing to make defective cars. So, the andon pull seems to be working exactly as it should. Would it be preferrd to use the push system and just keep on producing to fix them later?

    As far as the cultural elements and root cause analysis, I am assuming many of you remember the floor mat recall for many of the same vehichles. In my mind I can see Toyota hearing of the gas pedal thing, looking into it and finding that the floor mat can cause the stuck accelerator issue. This is a repeatable cause, that will cause the same symptoms. Root cause #1 found and countermeasures in place. Then people continue to have the problem, so there is another root cause to the “same” problem. Just imagine what you would do if you were in Toyota’s place, it would be super frustrating, but what could you have done to prevent it? If they are producing the accelerator modules to spec, and they are working fine for years only to find out that occasionally less than 1% doesn’t work right, how could they have foreseen this or prevented this? I don’t know the answers, and I don’t know if the numbers etc. are correct, but this is how I see it in my mind. I don’t think that this is a “lean” failure by any means, and I don’t think it shows that Toyota’s system is broken, or that Toyota needs to make drastic changes. I would ask as practitioners and change agents, what can we learn from this?

  12. Mark why would anyone really expect more from reporters. How can you spend your school time doing nothing but learning how to write, and your work life writing. To actually know about something takes being envolved in it. We have thousands of reporters giving their opinions on everything, yet how many of those repoters ever had a real job doing anything about what they are commenting on. Lets get real, anyone with a decent memory knows how often the Wall Street Journal boosted about all the smart business moves their Wall Street banker buddies were pulling. Well many those buddies are has beens today. In the past they sung the praises of Enron, Tyco, and others. The news stories like weather forecast are wrong more often than they are right.

    We in the real world soon forget most of their genius suggestions, before we finish reading the page.

    Only the truly committed should get envolved in Lean, trying to do it half way leads to GM. Toyota has done what they needed to and more than most of their competition would do. In the end they will come out of it stronger then ever.

    Being in the Canadian food industry most of my working life. I have seen two major recalls work out to the companies benefit. First Nestle recalled a lot of baby formula publicly when they knew that not a single can had left their warehouse. They opted to put the safety of babies ahead of profit. Their reward was a double digit increase in marketshare. Maple Leaf had a problem, they identified it, solved it, and showd it to everyone. The end result is that they are still the biggest player in the field, and they retained their share of the market.

    People accept their will be problems, after all businesses are run by humans (and we are all less than perfect). Customers want to see how you react to problems, Toyota, like both Nestle, and Maple Leaf, reacted in favour of the consumer. Only enterprises that perpetually deny their problem lose customer respect and marketshare.

  13. Most likely they could have moved sooner, but accelarator pedals getting stuck in not something new. The truth is that it used to happen quite often. Being in my 50s I grew up in th era before electronic everything. Back then the pedal where attached to a shielded metal cable, which in turn was hooked to the carborator. With time these cables got water in them and rust would make them stick. When that happened you put the vehicle into neutral and coasted to a stop. No one ever sued anyone over it it just happened.

    Unfortunately today you have to totally idiot proof everything or face being sued. The end result is that although Toyota could have changed the pedal design, the vehicle was never supposed to last for ever or not need to be maintain. People that panic instead of reacting to a situation get themselves into trouble other people handle with ease. The real solution lies in people becoming better drivers and using their brain when something goes wrong.

  14. Thanks for taking an early lead on this topic Mark. I think you set the tone for an open and honest dialogue, instead of a witch hunt.

    I have been resisting writing about the Toyota case because so little is actually know about the defect itself, and cause and effect isn’t clear. But I have been getting enough questions about it. I don’t think this changes anything about Toyota’s success. They still have dramatically fewer recalls than others. And of course no one that knows lean would say they were anything close to perfect.

    I did write up some of my thoughts and lessons in observing the story on my blog here:
    .-= Jamie Flinchbaugh ´s last blog ..The Fall of the Mighty Toyota =-.

  15. I started with “Just in Time” back in the 80s so I have a little time with Lean and other processes. Six Sigma is very sound engineering practice and can be proven my modeling and computer simulation. The main problem with Lean is that your assembled team will come up with a fix or change that has no problems. More people on the team the better the solution. This is the same deal as lots of monkeys on key boards will write a novel. All solutions to manufacturing problems come from the basic design of the product and its assembly. The tools available to us today should be utilized no matter who is on the “Team”. Never do anything that cannot be reversed easily on the suggestion of lean unless you have done the Six Sigma, Problem Analysis, FEA, Computer simulation of equipment and factory flow. Lean has a place as a tool not as the end all method. See W. Edward Deming’s work which led to Lean.


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