Toyota Helps Children’s Health Dallas Reduce Some CLABSI Infections 75%


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I've long been appreciative of the work that Toyota does, through their non-profit TSSC subsidiary, to help non-profits and community organizations improve.

The latest example of that is some work done at Children's Health in my other backyard, in Dallas:

Children's Health Joins Forces with Toyota to Improve Patient Safety and Quality of Care

As it says in the release:

“Through a collaboration with Toyota, Children's HealthSM, the leading pediatric health system in North Texas, announced today it has successfully reduced rates of central line-associated blood stream infections (CLABSIs) by 75 percent with patients in the gastroenterology unit.”

This is really important work and these are fantastic results.

Dr. Rick Shannon used Lean / Toyota methods to similarly reduce CLABSI rates at multiple health systems, as we discussed in this podcast a few years back:

Back to the improvement work at Children's:

The teams worked together to identify unintended process breakdowns. Through TSSC's process methodology and expertise, Children's Health determined the immediate environment of care is vital in the process of maintaining cleanliness of the central line.”

I'm not surprised that they found “unintended process breakdowns.” Healthcare quality problems often aren't the result of people not knowing what to do… and these problems are certainly not the result of people not caring or so-called “bad apples.”

What gets in the way of people doing the right work the right way at the right time? It could be supply chain issues. It could be general conditions of overwork caused by there being too much waste in their daily work.

As we typically see in reports of Toyota's work with non-profits and suppliers, they don't come in to tell people how to do their work. They have an improvement process that they teach that allows those doing the work (and their leaders) to discover problems and to work together on systemic improvement.

From the article:

“Children's Health invited us into their units to see the clinical processes firsthand, and together we were able to implement a program that we hope can be a model process,” said Jamie Bonini, vice president of TSSC. “By leveraging the methods of the Toyota Production System, like problem solving, standardization and rigorous training, we are pleased to help make life better for children in our new home in Texas.”

Toyota, of course, recently opened up their new North American headquarters in nearby Plano.

We've seen Toyota's collaborative approach in their work with UCLA-Harbor Medical Center:

I also blogged about this here, with a different video being produced:

And TSSC has done similar work with a food bank and efforts to provide relief after Hurricane Sandy:

Back to the Children's story:

“By the end of 2017, Children's Health will roll out improved practices from the collaboration system-wide, ultimately empowering team members to implement improved care processes to prevent infections across multiple hospital units.”

I'm curious to see how the “roll out” will be managed. In some organizations, an internal “roll out” of best practices isn't always well received.

ThedaCare has had an effective process, tough, where an “alpha” unit (the first unit to create a new method) shares it with another unit, the “beta.” The beta unit can choose to adopt (or adapt) the alpha method and has an obligation to try to improve the alpha method so that learning and improvement can be shared back to the alpha unit.

That takes longer than a simple organizational “copy and paste,” but it's more effective.

I hope TSSC and Children's are using a method like ThedaCare's that spreads practices AND empowers team members along the way.

Again, from the article:

“Additionally, Children's Health plans to share its findings with other health care systems across the country in hopes of reducing preventable harm to children everywhere.”

I hope that other hospitals are willing to adopt not just the new practices for managing central lines… but are also willing to adopt the improvement methods advocated by Toyota and TSSC.

As this release says, Toyota has been helping organizations for 25 years now. Again, I thank them for this work and for giving back to our local DFW community and beyond.

As a final note, I've had the opportunity to do some Lean consulting work previously with Children's back when I worked for ValuMetrix Services when it was a part of Johnson & Johnson. I coached improvement teams in the laboratory and radiology.

Some of that lab improvement work was written up in an article:

Since Children's isn't too far away, I've been able to continue making some pro-bono follow up visits in recent years to provide some ongoing coaching. It's great to see that the lab and radiology have sustained the work we did together — sustaining the methods and the results — and, more importantly, continuing to improve.

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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. I’m also curious to know if everyone affected by “roll out improved practices” believes in the changes. The article did note, “The teams worked together to identify unintended process breakdowns.” That could mean different things.

    • Yeah, the article is vague, but I’ll hope for the best for them. It would be a shame if there was significant backsliding after Toyota exits the equation… the bet way to ensure sustainment, I think, is to fully engage people at all levels. This would include fully engaging people in the “roll out” departments so they don’t feel “rolled over.”

  2. This article by Toyota has some more details:

    TPS for the Children

    Go and See

    In keeping with the TPS principle of genchi genbutu (or “go and see”), Dickson spent time at each hospital observing and taking notes. That unbiased perspective proved to be the turning point. In each case, healthcare practitioners were following the proper steps to ensure they were germ free. But the rooms in which the children were being treated? That was a very different story.

    See the link for more details and some photos.

    Another interesting quote:

    “What they thought was the problem and what was actually the problem turned out to be very different things,” says Dickson. “There’s no way we would have figured it out if we hadn’t spent time at each site and talked with the nurses on the floor.”

    The power of going to see (and talk and listen)!


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