If Your Hospital Wants to “Implement Lean,” You Need to Learn This Lesson from Toyota
TL;DR: Lean Hospital Staffing vs. Toyota's Lean Approach
Hospitals (common practice):
- Send staff home early when census is low (“flexing”)
- Treat labor as a variable cost to cut in the short term
- Lose improvement time, morale, and trust
- Call this “Lean,” even when it undermines safety and learning
Toyota (true Lean thinking):
- Keeps employees working and paid during slowdowns
- Uses downtime for training, problem-solving, and kaizen
- Invests in people as long-term partners, not disposable costs
- Builds quality, resilience, and loyalty over time
Bottom line:
If hospitals want to practice Lean–not just cut costs–they need to rethink staffing the way Toyota does: as a long-term investment in people, safety, and improvement.
That contrast helps explain why I've long questioned hospital “flexing” practices–and why Toyota's approach offers a more faithful model of Lean in practice.
Nearly a decade later, hospitals are still “flexing” staff during slow periods — a sign that this Lean lesson from Toyota remains widely misunderstood.
Why Hospital “Flexing” Conflicts with Lean Thinking
I've written before about 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?
A Side-by-Side Comparison: Hospitals vs. Toyota
Let's 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 are 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.
How Toyota Handles Downtime Without Sending People Home
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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“It's a Choice”: Why Toyota Doesn't Treat Downtime as a Crisis
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.
What Hospitals Can Learn from Toyota–Without Becoming Toyota
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.
Related Reading About Layoffs and Alternatives
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