Managers and clinical staff interested in lean healthcare often stall at the same point: 'We want to adopt lean thinking but want to call it something else. 'Lean' is hard to sell to our staff.'

"The first thing they say is: 'We don't produce cars - patients are not cars, they are individuals.'"

In 1867 Sakichi Toyoda designed a weaving loom to stop automatically when the weft broke. This saved the weaver, his mother, from doing useless work. His son Kiichiro Toyoda, who founded Toyota, used the same philosophy to respect the workers and stop them wasting their time and resources. Toyota staff are trained to spot waste and empowered to eliminate it. Production is very slick, or "lean" as the method's gurus Dan Jones and Jim Womack described it.

Human resources

In its early days the Toyota production system was called the Respect for Humanity system. Waste is disrespectful of humanity because it squanders scarce resources.

Waste is disrespectful of people if it asks them to do perform tasks with no value. Those teams who have undertaken a value stream map and calculated the value-added component of work compared with the non-value-added component will have been shocked at the amount of waste in the system, often as much as 40 per cent. Calculating from the patients' perspective can reveal as little as 5 per cent value added.

Doing less

For hardworking staff, this is a huge shock. Traditionally we have tried to improve the part of the system that is adding value by asking staff to do more, rather than removing the waste.

Leaders of change must respect the frontline experts - they see the waste every day. Staff need to be empowered to remove the waste and increase the percentage of value-added component.

If we provide what we consider a solution without looking at the root cause, all we do is put a sticking plaster over the problem.

Patient journey

Waste is disrespectful to patients because it asks them to endure processes that add no value. Until we map the end-to-end journey from the patients' perspective, we cannot fully understand the process they are going through.

In the US, 100,000 lives are lost to medical error and 90,000 to healthcare-acquired infections a year: equivalent to the 11 September attacks happening every week. When the Pittsburgh regional health initiative started to adopt the Toyota production system, an idea to come out of the programme was the "Zero Goal" (removing the waste of defects). Out of respect for patients, they challenged their thinking to ask: how many errors are acceptable? Who would volunteer to be harmed?

Adapting the lean philosophy

While adopting the Toyota production system as its improvement methodology, Pittsburgh regional health initiative called it Perfecting Patient Care.

We need to see lean improvement not as a set of tools, but understand the lean philosophy, adopting respect for people and partners as one of the core principles.

Would the same conversations have taken place if Toyota had kept their original title of a "Respect for Humanity" system?

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