If Your Hospital Wants to “Implement Lean,” You Need to Learn This Lesson from Toyota


I've written before about the subject of hospitals “flexing” nurses and employees. I've criticized flexing (or the practice of sending employees home early because patient census is low) and I've pointed out that it's not keeping with “Lean” principles to “save money” by sending people home early.

See these posts:

Is This The One Question That Determines If You're Truly a Lean-Thinking Hospital?

The Emperor's Sacred Cow's New Clothes – “Flexing” Hospital Staff

Where Do Hospitals Get the Idea that Lean is Only About Cost Reduction?

Lets compare hospital practices (whether driven by traditional cost cutting mindsets or a misunderstanding of Lean) with how Toyota operates.

Toyota has a long track record of not relying on layoffs to save money — over the long term or on a daily basis. During long production slowdowns (due to the recession or the Japan tsunami), Toyota plants don't lay workers off.

Toyota plants pay workers to do things like training and process improvement projects (ala “Kaizen”). Toyota isn't just paying people to be nice or respectful, they investing in their future. It's Principle #1 of “The Toyota Way” that says to make decisions for the long term, even at the expense of the short term.

Two weeks ago, there were some pretty bad storms in San Antonio. See this news story:

Production remains idle while storm damage repairs continue at Toyota plant

A storm ripped part of the factory roof off.

From the article:

“Two days after the storm, Toyota Motor Manufacturing Texas reported that both of the plants two shifts will remain in a non-production capacity.”

That's a fancy way of saying, “We aren't building any trucks.”

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Hospitals often say they are “forced” to send staff home early when there aren't as many patients as expected. Is Toyota “forced” to send employees home or keep them home? Of course not — it's a choice!

And Toyota chooses to have people come to work, and they are paid for non-production activities. Hospitals could choose to do the same!

“Although production is idle, plant employees are being given options to come to work, take personal time off or take the day off unpaid.

The plant's cafeteria is not operation but those that report to work are being asked to plan accordingly and are being given projects, tasks and training.”

It's an investment in future quality and future productivity. It's also an investment in employee morale, realizing that the company feels responsible for providing a full paycheck.

If hospitals want to “implement Lean,” they need to do more to learn lessons like this one.

By the way, it wasn't long before the plant started ramping production back up, planning to use overtime to make up for lost production for the one full day that was lost.

Toyota Invests In Workers Instead of Laying Them Off

To Layoff or Not To Layoff — That Really is a Question

GM Blames Layoffs on the Japan Earthquake and JIT; Should Instead Look in Mirror

Photo courtesy of Toyota

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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. Comment from LinkedIn:

    Ken Robinette: It is not only Toyota, look back at the actions post 9/11/2001, One airline did something very different than all the others. Can you guess who, what and how it turned out?


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