The ideas, principles, and methods that we'd recognize as “Lean” aren't exclusively of Japanese origin. Many of us, myself included, draw inspiration from Toyota, reading books about them and visiting their factories. For me, I've had a chance to visit Toyota plants in Japan, California, and Texas, and the story is very consistent.
This approach works well for Toyota in different countries and it works well in different industries, including healthcare. Lean is not a way of building cars better… it's a way of managing, leading, and improving better.
Toyota learned from the early books of Henry Ford. An American, Dr. W. Edwards Deming was incredibly influential to Toyota and other Japanese companies. It's probably fair to say that the Toyota management system is a combination of some early Henry Ford ideas, Dr. Deming, and their own innovations. This approach is not predicated on the Japanese national or social culture… since the roots are not all Japanese, these ideas work in other countries, and it's not naturally easy to “be Lean” in Japan.
We see great Lean thinkers in other countries and there's evidence that not all Japanese companies (or hospitals) are somehow inherently Lean.
So, the great news is that we can learn from each other.
A number of American hospitals take trips to Japan to learn about Lean. These include Virginia Mason Medical Center, Seattle Children's Hospital, and Salem Health. ThedaCare has not gone this route, choosing to visit and learn from manufacturing companies in Wisconsin and around the U.S., along with learning through the Healthcare Value Network efforts. After my own two trips, I'd conclude that going to Japan is fascinating and a great experience, but it's not absolutely necessary as a way to learn Lean.
During my trips, I found it useful to visit both factories and hospitals and I know the physicians and healthcare leaders from the world agreed.
Visiting factories stretches people's minds because it forces them to think through Lean in an unfamiliar setting. I know of at least one hospital system that goes to Japan and refuses to visit any of their hospitals for a number of reasons. When you know hospitals really well and you visit other hospitals, you run the risk of focusing on the hospital details, such as this hospital is different than yours, or you end up asking detailed clinical questions that don't have anything to do with Lean
Also, if you went and only visited hospitals, you'd have to protect against the “benchmarking trap” where hospitals go and visit and try to copy specific practices or artifacts instead of looking for deeper underlying principles to learn from.
Two of the hospitals we visited in this most recent trip explained how they learned about Lean by visiting hospitals in the United States (in Seattle and Boston). One was inspired to start their Lean journey when Dr. Gary Kaplan, the CEO of Virginia Mason Medical Center visited and gave a talk about Lean. I've anecdotally heard stories about other Japanese hospitals flying to Seattle to see Lean healthcare first hand.
So, Virginia Mason flies to Japan to learn from Japanese factories and some Japanese hospitals fly to Seattle to learn from Virginia Mason… but they don't necessarily visit Toyota in Japan. Why? Some say, “We're different, we're not a factory.” I think the world is better off for having these exchanges, even if there is extra travel cost involved. Virginia Mason could learn only from local Seattle manufacturers, like Boeing and Genie. The Japanese hospitals could take a short trip to Toyota City.
In one other interesting example of lessons going back and forth, I met a woman in Japan who worked in Virginia Mason's “kaizen promotion office”(KPO) for many years. She was born in Japan and is bi-lingual. She's currently living and working back in Japan, as the assistant KPO director at a hospital.
There are, clearly, cultural differences between Japan and other countries. But Lean principles are pretty universal. People want to provide the best patient care and they want to be listened to. I was asked to give a presentation about global Lean healthcare trends at one of the Japanese hospitals. During the Q&A time, the hospital CEO asked me, “Japan is a group-oriented culture. How does Lean work in the United States when it's a more individual-focused culture?”
I replied that Americans are willing to work in teams. We love team sports. We participate in teams at work when we have goals that are shared and when we have good leadership. It's an important part of the Japanese culture to maintain harmony, which often means people don't make waves or point out problems. That's one way in which a “Lean culture” is not exactly the same as Japan's culture. And Lean isn't exactly the same as the Western culture… yet Lean works. As we learn more from each other, we'll find more common ground in the problems we are trying to solve and the better patient care that we're trying to delivery.
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