Dr. Steven Spear interview, Part 2: Healthcare


An outline of interview highlights

Applying Toyota Production System tools in healthcare. How?

What is the essence of what Toyota does?

Toyota focuses on discovery. When Toyota ran into problems they quickly developed counter-measures to correct them. As an example Ohno developed Just-In-Time to address the problem of desynchronization upstream and downstream to the factory. Developed Kanban rules:
If the customer needed something they had to go get it
Until asked the supplier cannot provide it
Toyota was creating hundreds of tools throughout the years.

How TPS has been interpreted over the last several years. It’s been compressed down. Companies will say “we are doing lean …how so? We have done a value stream map, we have eliminated muda and on the remaining value adding steps we have installed pulls. At each step we have created a production cell with standard work and four or five S. Well what else are you doing? When we complete that step I move on to another process.

Here is the problem with that. When Toyota created those particular tools they did it because they did not have reliable and capable production processes. Those tools can be very helpful when you step out of manufacturing to things that look like manufacturing. You can use a checklist when you have: work that is reasonably repetitive, done in high volume, reasonable low variety, requests for work are not brand new, something you have seen before. It works in that setting, but then you get into some of these other problems when you have non-repeating, low volume, high variety and brand new requests.

Healthcare is structured in silos, by discipline and specialty creating problems with handoffs, waste, rework and system reliability issues. The healthcare system requires specialists to focus on the every evolving science, but who owns the handoffs?

Healthcare has become much more complex in the last fifty years, causing many more handoffs.

The physician is placed in a “hero mode” but his/her great efforts do not guarantee a successful outcome (though it could guarantee a poor outcome).

Selling the value of TPS to healthcare frequently has not been done well. Rarely is it stated that we want to make successful outcome easier to physicians, nurse, administration.

TPS will detect abnormalities quickly.

Poka yoke and healthcare

Healthcare in the next few years..a prediction

The current healthcare problem is largely due to budget. Cost are too high and TPS focuses on reducing waste and therefore costs.

New publications coming from Dr. Spear:

Collaboration with physician about the lack of concern in healthcare

Book McGraw-Hill about complex work being managed better.

Links to Dr. Spear articles:

Decoding the DNA of the Toyota Production System, Harvard Business Review, September 1999

Learning to Lead at Toyota, Harvard Business Review, May 2004

Fixing Healthcare from the Inside, Today, Harvard Business Review, September 2005

Using Real-Time Problem Solving to Eliminate Central Line Infections
Joint Commission Journal on Quality and Patient Safety
Volume 32, Number 9, September 2006 , pp. 479-487(9)

Ambiguity and Workarounds as Contributors to Medical Error Annals of Internal Medicine (free download)
2005; 142: 627-630

The essence of just-in-time: embedding diagnostic tests in work-systems to achieve operational excellence
Production Planning and Control, Volume 13, Number 8, December 2002 , pp. 754-767(14)


  1. Randy Dunn

    Interested in additional Lean HealthCare literature…could you advise…thanks

  2. steve spear

    There are several sources. You might check the website for the Institute for Healthcare Improvement (www.ihi.org). The Annals of Internal Medicine (www.annals.org) ran a series called “Quality Grand Rounds” that was a series of case studies about medical error. It should be required reading. Dr. Mark Schidhofer and I had an article in that series: Ambiguity and Workarounds as Contributors to Medical Error. Also, the Joint Commission Journal on Quality and Patient Safety is an interesting source. See an article lead authored by Richard Shannon about Elminitaing Central Line Infections. Then there is the Fixing Healthcare… article from Harvard Businedss Review in 2005.

    Thanks for the question. I hope this response is helpful.
    Steve Spear

Leave a Comment

  • (will not be published)