When people hear I'm leading another Lean Healthcare study trip to Japan, they often ask:
“Are Japanese hospitals more Lean than American hospitals?”
It's a fair question–but not a simple one to answer.
I mean, the short and simple answer is, “No… not generally.”
But, it's tempting to assume that, because the Toyota Production System (TPS) originated in Japan, Japanese hospitals would naturally be the global leaders in Lean healthcare. But that assumption overlooks the real complexity–and the real learning opportunity–of going to Japan.
Lean Thinking: Designed, Not Inherited
First, let's acknowledge that TPS was influenced by ideas from around the world. Toyota leaders learned from Henry Ford's flow production, were inspired by supermarket inventory systems in the U.S., and were deeply impacted by the work of Dr. W. Edwards Deming and Walter Shewhart on statistical quality and systems thinking.
What Toyota built was a deliberate management system. It wasn't something that came naturally–it was engineered and cultivated over decades. It evolved over time. The same holds true for Lean in healthcare, whether you're in Japan, the U.S., or anywhere else.
And Toyota has successfully spread its philosophy and management system to its factories around the world. And, again, it can spread into healthcare and other industries.
So Are Japanese Hospitals More Lean?
Some are. Many are not.
In posts like “Visiting Two Japanese Hospitals With an Eye for Lean” and “Key Points About Kaizen From Japanese Hospitals”, I've shared how Japanese hospitals can demonstrate remarkable Lean practices–especially around standardization, patient service, and respect for front-line staff.
But I've also heard about challenges: rigid hierarchies, slow decision-making, and reluctance to speak up about problems. This seems to be the case in the “typical” Japanese company–not just hospitals. These cultural barriers are real–and they're exactly why systems like the andon cord were created.
In “Andon Cords at the Toyota Takaoka Plant: It Doesn't Come Naturally”, I reflect on how speaking up to stop the line is a countercultural act, even at Toyota. Lean wasn't easy in Japan either.
Why Visiting Japan Still Matters
And yet… Japan is absolutely worth visiting. Here's why:
- In some ways, Lean thinking feels easier in Japan. There's often a deep respect for customers and employees, a deep appreciation for craftsmanship (including in sushi making), and a cultural comfort with following standard work and routine.
- At the same time, some aspects of Lean are harder. For example, Lean encourages people to speak up about problems–but in Japanese culture, there's often social pressure not to disturb harmony or question authority.
An example of customer focus and respect from my last trip:
The power of a Japan visit is in that tension. As I wrote in “Japan Tour Reflections: Artifacts vs. Thinking”, the goal isn't to copy tools–it's to sharpen our thinking.
That tension–between what's easier and what's harder–offers rich insight for any leader or improvement practitioner.
As I reflected in “Andon Cords at the Toyota Takaota Plant – It Doesn't Come Naturally?”, the andon cord is powerful not because it's easy to use, but because the system is designed to make it easier to overcome cultural barriers.
What About the U.S.?
Some American hospitals have gone deeper into Lean than many of their Japanese counterparts.
- Virginia Mason in Seattle built the Virginia Mason Production System, adapting TPS to improve patient safety, flow, and quality.
- UMass Memorial Health has embedded Lean into its management system, with daily huddles, visual controls, and a strong improvement culture led by Dr. Eric Dickson. I shared some of their practices in this podcast episode.
- Cleveland Clinic has invested in Lean-based daily management, standardization, and system-level thinking. Check out these episodes.
These organizations show that Lean is possible anywhere, when leaders commit and systems support improvement.
What About the Rest of the World?
Lean healthcare is a global movement, with pockets of excellence found in so many places.
- In the UK, the NHS has pursued various Lean initiatives with mixed results–success often depends on leadership continuity and frontline engagement.
- In the Netherlands, several hospitals have made Lean a foundation for quality care, supported by national training programs and academic partnerships.
- In Brazil, hospitals like SÃrio-Libanês in São Paulo have become international benchmarks for using Lean to drive both clinical and financial improvement.
And perhaps most meaningfully, Japanese hospitals are learning from American ones, too. I've seen hospitals in Tokyo and Nagoya cite U.S. systems like Virginia Mason or Seattle Children's as their inspiration.
So, Who's “More Lean”?
Rather than asking which country is more Lean, a better question is:
“Where are the best examples of Lean thinking and leadership?”
You'll find those in pockets of excellence, not entire nations. And you'll find that success depends far more on intention and leadership than on location.
Join Me in Japan–Not for Perfection, But for Perspective
So why go to Japan?
Not because it's a Lean utopia. It's not.
But because it stretches your thinking. It helps you see Lean–not just in tools and techniques, but in subtle cues, in systems of respect, in the tension between tradition and progress. And that contrast–between what's familiar and what's different–is what helps us learn the most.
If you're interested in joining me for a future trip, you can read more about our Lean Healthcare Accelerator Experiences.
Final Thought:
Lean isn't something you inherit–it's something you build, deliberately and continuously, wherever you are.
Whether you're in Tokyo, Boston, Toronto, Bangkok, Amsterdam, or São Paulo, Lean is about cultivating systems that support people in solving problems and improving care.
And that work is never finished–only improved.
If you'd like to join me on a future visit, check out JapanLeanTrip.com. I'd love to help you see what Lean looks like from another angle–and come back home with sharper questions, not just neater notes.
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Let’s work together to build a culture of continuous improvement and psychological safety. If you're a leader looking to create lasting change—not just projects—I help organizations:
- Engage people at all levels in sustainable improvement
- Shift from fear of mistakes to learning from them
- Apply Lean thinking in practical, people-centered ways
Interested in coaching or a keynote talk? Let’s start a conversation.
