Previous Lean Healthcare blogs have discussed the basic principles of the Toyota Production System in detail. Like Toyota’s own improvement efforts, we can apply Spear and Bowen’s 4 Rules in Use to move any healthcare value stream as close as possible to an ideal condition. However, from a training perspective, the 4 Rules are perhaps, not as explicit as one could hope for. This leads to the question, how do the workers in Toyota’s own operations learn to do standard work?

Interestingly, Spear and Bowen also tell us that Toyota’s managers don’t directly tell their associates how to do standard work! They use a teaching approach that allows their workers to discover the rules as a consequence of solving problems. This is, of course, an extension of the ‘old and reliable’ Socratic teaching methodology. Spear and Bowen have observed that at Toyota, the supervisor teaching a person standard work will come to the work site and while the person is doing their job, ask the following:

• How do you do this work?
• How do you know that you are doing it correctly?
• How do you know that the outcome is free from defects?
• What do you do if you have a problem?

This process of continual questioning is the catalyst for providing the worker with opportunities to achieve deeper insights into their specific work. Through this questioning approach to training, Toyota workers continually gain an implicit and deep understanding of the standard activities required in their work.

Most importantly, Spear and Bowen maintain that the Toyota Production System has so far only been successfully transferred when managers are able and willing to engage in this process of questioning that facilitates learning by doing! If this is the case, how many of us who are attempting to ‘cement our culture’ to Lean Healthcare concepts and tools are operating in this fashion? If Toyota’s sixty years of Lean success demands that worker’s are educated in this manner, how can those of us who are just beginning our Lean Healthcare journey train our associates in our standard work otherwise?

As we have said many times before in this blog, successful Lean transformation begins and ends with Leadership.  One of the most critical parts of that role to changing culture is the development and training of your staff in not only how to do the work but also how to think about the work.

This week’s blog was written by HPP consultant and engineer David Krebs.  David, a Six Sigma certified engineer, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA. David is also a Licensed Professional Engineer in the state of Tennessee, with over 30 years of experience in a variety of process and systems intensive industries, as part of firms in the U.S, Germany, and France.  David has achieved and maintained QS-9000 and ISO-14001 certification & received Nissans’ “Quality Master Award” on three occasions.  He holds a Bachelor of Science degree in Mechanical Engineering from the University of Detroit & an MBA from the University of Notre Dame.