The "Training Within Industry" program was a U.S. government program during World War II that focused on ramping up war production. The methodology for creating job instructions, managing continuous improvement, and training employees became the foundation for Toyota's approach to Standardized Work as it was taught to them after the war.

The TWI approach was also used in healthcare during the war. The approach is being utilized today in a growing number of hospitals as that history is rediscovered.

The TWI Institute has resources and historical documents about TWI in healthcare.

The Lean Enterprise Institute's webinar "A Roadmap to Lean Healthcare Success" with John Toussaint, MD, CEO of the ThedaCare Center for Healthcare Value, drew thousands of Lean Thinkers from North America and around the world who had more questions than we could answer in 60 minutes.

Most of the questions fell into several themes such as leadership, sustaining gains, involving people, and the A3 management process. What follows are your questions representing those themes and Dr. Toussaint’s follow-up replies.

Dr. Toussaint will go into even more details about lean healthcare at the 4th Annual Lean Healthcare Transformation Summit, June 5-6, 2013, in Orlando, FL.

This article highlights hospitals that are eliminating waste in healthcare. The author writes: "Researchers believe there is 30 percent "quality waste" in U.S. health care; that is, unnecessary costs due to care that is inappropriate, inefficient or unsafe." The CEO of Heartland Health, Lowell Kruse, said: "You have to build a culture that relentlessly attacks broken business processes; for example, standardizing a confusing welter of surgical supplies. And, of course, your physicians and employees have to regard these activities and countless others as a benefit to patients rather than a threat to profits." In Appleton, Wisconsin, Dr. John Toussaint insists that "quality waste" adds up to a stunning 40 to 50 percent of costs. Until recently Toussaint ran ThedaCare, whose systematic efforts to improve care and lower costs were profiled in a case study by Harvard Business School superstar expert Michael Porter. The column also makes allusion to the partnership between the LEI and the ThedaCare Center for Healthcare Value.

 

This article documents improvements in the British Columbia health system in cataract surgery. Lean methods were applied to reduce waste and improve patient care. One documented savings in the story was a $450k reduction in unnecessary anesthesia expense, using local sedation when full anesthesia was not really necessary (a good example of eliminating the waste of "overprocessing"). There are a number of quots from surgeons and hospital leaders, as well as some discussion of improving flow through the emergency department value stream and improvements in a nursing station. (Published by The Globe and Mail. Access requires subscription.)

In this article from the International Journal of Emergency Medicine, the authors make the case for additional experimentation with Lean methods and further research into the benefits and results. They conclude "While further research is necessary, it appears that the increasing embrace of lean thinking and related methodologies to the health-care environment is warranted and results in improved patient care metrics, greater efficiency, and ultimately happier and healthier patients."

A healthcare manager writing in the Puget Sound Business Journal answers the question, How does lean apply to healthcare?

The Mayo Clinic in Rochester, MN., is famous for the quality of its healthcare, but is using lean concepts to further enhance processes affecting quality, safety, and service. (Use links provided in the story to see larger versions of the value-stream maps.)

This article from the medical journal The Lancet, from 2006, talks about Virgina Mason Medical Center and Park Nicollet adapted lean and Toyota practices and management methods.

The article is an overview of how Lean applies in healthcare and what some of the leading organizations are accomplishing with Lean. The article features ThedaCare (including the story of how a manufacturing, Ariens, helped get them started), Denver Health, and Elkhart General Hospital.

Results cited include:

• ThedaCare has reduced "door to balloon" time from 91 minutes to 37 minutes
• Post-cardiac-surgery length of stay was reduced from 6.2 days to 4.8 days at ThedaCare
• Denver Health generated an additional $520,000 since 2007, using Lean to create more capacity
• Denver Health boosted revenue by $2.3 million by improving processes so they billed for all of the care they provided
• Denver Health has reduced costs by a total of $28.6 million

In some ways, healthcare in China is much different from the U.S. With a 6,500-bed hospital, China’s scale is very different. But during a visit, Dr. John Toussaint, former CEO of ThedaCare, saw the same “silo thinking” that afflicts U.S. hospitals.