Key Points About Kaizen from Japanese Hospitals, Going Back in December


I've gone to Japan twice now with Kaizen Institute to study Lean with healthcare professionals from around the world. I first went in 2012, as a paid attendee, and I went back in 2014 as a partner and co-facilitator to teach and lead discussions during the trip.

Both trips were fantastic experiences, and I've not only seen Japan but I've connected with peers from countries including Canada, Belgium, The Netherlands, Saudi Arabia (an Egyptian doctor), Denmark, Poland, Finland, Malaysia, Singapore, the Philippines, and Indonesia. I have many great memories from these trips, along with new friends and colleagues who I continue to keep in touch with.

We're again organizing a Lean Healthcare Study Trip to Japan, which will take place December 6 to 12 in Nagoya and Tokyo. Learn more via this website and register via Kaizen Institute.

lean kaizen japan

Kaizen in Japanese Hospitals

The Kaizen approach to continuous improvement is important to me, of course. The Japanese hospitals we've visited have a strong tradition of practicing Total Quality Management. Some are now embracing Kaizen as “daily continuous improvement” in addition to their six-month-long TQM projects.

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A few quotes and comments from various visits in 2014, related to Kaizen:

“Kaizen is autonomous and voluntary.”

Kaizen tends to be self directed (we see this at Franciscan St. Francis and other American health systems). Front-line staff are given a lot of latitude to identify and solve problems that matter to them and their patients. Yes, we want to get some alignment to goals and the organization's True North, but autonomy is important for getting enthusiasm and participation.

Kaizen should also be “voluntary,” in the sense that leaders are relying on intrinsic motivation. In my experience, we don't build a culture of continuous improvement by requiring participation or setting quotas and targets, such as “everybody must do two Kaizens this year.”

“It's difficult to do Kaizen when it feels forced.”

When Kaizen isn't voluntary, people will maybe just go through the motions to tick the box. We won't have a “Kaizen spirit” in the organization (as Pascal Dennis describes).

“It's important to make improvement continuous.”

Many of our approaches to improvement (in Japanese hospitals or elsewhere) are more episodic or sporadic, including quality circle projects and Rapid Improvement Events. We can still do those formal projects, but can also do daily Kaizen, focused also on small improvements.

“Limited space, so we have to be creative.”

Japan has many crowded urban spaces, but I don't remember any American hospitals complaining about having too much space, either. Instead of asking for “more people, more space, and more money,” we need to “use creativity before capital,” as Lean thinkers tend to say.

“Make work as easy as possible.”

Traditional productivity mindsets would want people to work harder or work faster. With Lean and Kaizen, we accomplish more when the work is easier. There's less stress, less fatigue, better quality, and higher productivity… as the result of making work easier. We reduce waste instead of asking people to jump through hoops faster.

“We are always trying Kaizen.”

This is the ideal state, as described by one Japanese hospital. We see this at Franciscan St. Francis, where it's become the norm and the daily routine to point out problems and to solve them. A Japanese hospital also said, “Kaizen can be done on daily basis within your team” but some issues are broader and can't be solved within the team… making them a good candidate for a QC/TQM project.

“Many hospitals have tried Kaizen, but quit. It's hard.”

This is understandable. This happens in hospitals (or factories) in other countries too. Kaizen requires persistence and dedication.

But, then again, when you make Kaizen fun, provide energizing leadership, and tap into intrinsic motivation, Kaizen can be a perpetual motion machine that keeps going…

Is It Necessary to Go to Japan?

When asked, “Do I need to go to Japan?”, I had always said “No, you can learn Lean and appreciate it from learning here in the U.S.” Even after going twice, I'd still agree you don't NEED to go to Japan. Hospitals like Virginia Mason Medical Center and Seattle Children's Hospital send lots of people to Japan (to visit factories, not hospitals, by the way). Organizations like ThedaCare don't do any of that, they learn locally and within the U.S.

As I wrote about here, Lean isn't so much a set of Japanese ideas as much as it's a set of ideas that keep going back and forth across the Pacific. American hospitals go to visit Toyota in Japan. Some Japanese hospitals travel to Seattle to learn Lean from hospitals there… instead of taking advantage of local Toyota resources. Why? Because the Japanese hospitals have as much of a bias against learning from outside industries as hospitals in other countries! Interesting, eh?

The question is, “Do you WANT to go to Japan?” If you can afford to go (the trip is a bit of a splurge for an organization or an individual), it's worth it.

It's not just the factory and hospital visits, but the opportunity to explore a vibrant and unique culture, while talking about Lean with a global group, people who are trying to improve and transform their health systems. In a trip like this, you get to learn directly from Toyota. You get to see the good aspects (and challenges) of Japanese hospitals. You get to have a lot of fun as you learn from our hosts and fellow participants. I'm really excited to go back.

Fun, Food, and Previous Posts

Here's a collage of a few random non-Lean-related pictures from last time (yes, food and drink is important in Japan, as you can see in these photos!).

Screen Shot 2015-07-28 at 5.45.25 AM

Here are some past blog posts about my trips to Japan:

Again, if you'd like to learn more about our September trip, visit

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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. Mark – thanks for sharing your reflections on Lean thinking in Japan.

    Your comment that “Japanese hospitals have as much of a bias against learning from outside industries as hospitals in other countries” is my experience as well. I’ve found it fascinating in the past seven months that I’ve been living in Japan that learn that Lean thinking is almost absent in Japanese hospitals. I’ve written about my observations about Lean in Japanese hospitals as well:

    I encourage others to come to Japan for deeper learning about Lean. The opportunity to see Lean deeply practiced at Toyota and other organization, and to better understand what elements of Lean are or are not inherently Japanese, are fantastic learning experiences.

    I look forward to seeing you in Tokyo in September!


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