Going to Japan to Study Lean in November – Any Advice or Questions?


I had previously blogged about this Lean healthcare study trip to Japan, but I'm really excited that it's coming up soon! I depart in just over a week and I'm sure the trip will give me plenty to share and blog about here.

This will be my first trip to Japan, as a tourist or as a professional. So, I'm glad the good folks from Kaizen Institute are organizing and leading the trip.

I'm curious if any of my readers have gone to study Toyota and other organizations in Japan? If so, what advice do you have? I'm going with good shoes and open eyes — and an open mind.

I've previously blogged about the Japan experiences of people in healthcare and software:

And, my friend and fellow blogger, Kevin Meyer, wrote about his experiences:

Our group will be healthcare professionals from around the world, all converging on Japan to learn, study, and discuss as much about Lean and TPS as we can. We're visiting Toyota and another manufacturing company, two hospitals, and two other service sector organizations.

We will have a lot of discussions about what we're seeing and hearing — and how it relates back to healthcare organizations in our own countries. The point isn't to copy assembly lines, but to learn from great management practices and improvement methods. What mindsets will we hear about and see in practice at “the gemba?”

What experiences do you have to share, if you've gone before? Or, what questions would you expect me to come back with answers about?

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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. A primary challenge for the some TPS experts that have moved from manufacturing to healthcare is how to deal with processes that can’t be seen or assessed in a glance.

    I would be interested to know how TPS is visually managed in the Lean hospitals in Japan.

    Also, we know that Toyota uses IE types on their factory floors. Do the hospitals also use IEs and if so, how are they used?

    It sounds like a fantastic trip and am looking forward to you sharing your insights!

    • Great questions.

      I am really curious about the two hospitals we are seeing. They are supposed to be two of the best in the application of Lean/TPS in Japanese hospitals. I hear, anecdotally, that they haven’t embraced Lean Healthcare as much as we have in the U.S. and other countries. That said, there is a book out there about “5S” in Japanese hospitals (I put 5S in quotes, because that term is often used in lieu of broader “Lean” practices there, it seems).

      You’re right that the process (and often the waste and the harm) is pretty invisible or hard to see in healthcare…

    • Back in 2012, I saw some 5S and visual management in the two hospitals, but it was hardly a universal practice throughout the facilities. We saw some outstanding 5S examples and some areas that were just as disorganized and cluttered as a typical hospital anywhere else.

      Some 5S cutouts in a drawer:

      Click for Larger View

  2. I’ll be interested to hear how you view the value of the trip. I know the study group trips to Japan are done by many groups, but my question is value vs. cost – in other words, does the value gained by seeing Toyota (and others) in Japan justify the cost of international travel?

    • Yes, that’s one thing I’m going to gauge Dean, the value and what’s learned given the cost and travel wear and tear.

      In the past, I’ve been a bit of a skeptic about Japan trips, honestly. Some well-known Lean hospitals have sent many many people to Japan and that’s a huge cost. I’ve always wondered:

      1) Why not visit a good local Lean company (like Boeing, if they count)

      2) Why not visit Toyota in the U.S. or Canada??

      I’ve never felt a huge gaping hole in my resume that I’ve never been to Japan. That said, my curiosity factor is high and I’m going to Japan for a number of reasons – to see the country and experience the culture (and food) but also to learn a lot professionally.

      I’ll be blogging about it :-)

    • I found the trip to be very valuable. I’d still recommend to people that you should go because you *want* to go, not because you feel like you *need* to go. You can learn a lot about Lean by visiting excellent American factories and American hospitals. Going to Japan is a luxury… a great way to cash in accumulated air miles.

      That said, I learned A TON about the difference between “Lean culture” and “Japan business culture.” For example, it’s very Japanese to not speak up and make waves (maintain harmony)… so the idea of pulling an andon cord seems very un-Japanese… maybe it’s easier to pull a cord than speak up. Either way, Toyota has worked very hard to create the corporate culture they think is right for them.

      See this post.

      Lean doesn’t seem “easier” or “more intuitive” or “more natural” because of being Japanese. That said, there are some cultural traits that help, like discipline and other factors.

  3. Am reading several words…see, view, eyes….take videos and pictures for all us multi-modal learners! What an amazing opportunity! Slowly but surely, the Lean Global Community is evolving.

  4. I did some training at the Honsha plant for several weeks. Hopefully you can see that plant. That is where it really started to blossom. I had a great experience and learned so much from the management side.

  5. I am jealous. However, have a good time.

    I am not sure this is easy to gauge but I am inquisitive of how engaged the Japanese workforce is. We always talk about it as a reason for Lean and credit the eastern culture for part of it. However, objectively are the workers more engaged? Is it a result of Lean?

    From a healthcare perspective:
    Do they have Visual Idea boards like you depict in Healthcare Kaizen?
    How visual are the other hospital settings?
    Are nurses empowered there as much as here?
    Administratively, is paper flow at a minimum or do you see overflowing boxes?
    Might be hard to tell but are the Doctors’ handwriting any better?

    • Sorry for not answering this sooner. No, I didn’t see “visual idea boards.” In fact, I saw a classic suggestion box in one hospital. I asked about it and there didn’t seem to be great enthusiasm about it.

      Click for a Larger View

      I heard more about longer-term team-based quality improvement projects…

      I couldn’t tell about the handwriting :-) I do recall seeing traditional paper charts.

      • Text on the signs:

        (via Dan Markovitz):

        The big letters say: “Suggestion box” (or actually, “The honorable opinion box”)

        The small letters say, “Please let us hear everyone’s voice”

        (via another friend):

        “Please share your voices with us / Opinion Box”

  6. Hello Mark,
    I hope you have a great time and remember to take slip on shoes. I have taken quite a few trips during the 19 years that I worked for Toyota. I learned something every time I went and also met life long friends. I would advise you to visit at least one of the body makers and not just a Toyota plant. Also while in a Toyota plant visit it’s medical site, I was really impressed not having to use it myself but accompanying a co-worker. Also I would go prepared with list, I can send you one that I put together while doing a benchmarking trip for all the NA Toyota plants (A, B, M) shops. Last but not least enjoy the culture and the people, it will give you some really good insght. By the way, I have been impressed with Cincinnati Children’s hospital, recently been there and notice some good kaizen activities there.

  7. I would be interested in how software is being used how it is helping or hurting. How software is used by those dealing directly with the patients? How is software used by others? Are they forced to constrain their processes to meet what the software allows? Do hospitals… have software development (or software customization) staff to allow the software to be used to meet business needs or do they just have to deal with whatever the software provided requires. If they do software development (including software customization) do they use agile software development or lean software development methods?

    Do they have any really neat simple uses of technology or software? Do they have cool robotics stuff that is actually useful today?

    • I will look again this time John. I recall seeing traditional paper charts in binders. I’m curious to see if they have EMR/EHR systems. I don’t remember seeing any cool technology in the factories.

  8. Mark, I’m very excited to hear about what you learn from your experiences over there.

    I lived in Japan for a couple years, so my advice is mostly about the food – since that’s what I miss the most.

    A couple good restaurant chains that are inexpensive but delicious are CoCo Ichibanya (I recommend the Tonkatsu on Curry), and Yoshinoya (I recommend the pork rice bowl). One surprise I discovered, the 7-Elevens do not have slurpees, which shocked me. Nevertheless, everything is delicious there, so be adventurous.

    Most of all, enjoy the culture – and soak everything in. Again, I’m excited to hear what you think.


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