When HPP is guiding our clients through their LEAN Healthcare transformation, none of the concepts is more important than learning to recognize the characteristics of an Ideal process. Once this recognition is attained and the ‘gaps’ identified between the current condition and the Ideal, our attention must shift to “How do we get there?”. Fortunately, we have some help available to develop a solid strategy. The history of Toyota’s winning culture can give us a clear ‘roadmap’ to follow! 

Steve Spear and Kent Bowen in their infamous 1999 Harvard Business Review article ‘Decoding the DNA of the Toyota Production System’ articulated the difficulties in understanding the basics of the Toyota system. Fortunately, they also took on the challenge to describe how the Toyota’s system works. They did this through a description of the four principles or rules that Toyota uses to teach the scientific method to workers at every level of the organization. Spear and Bowen contend that these 4 rules form the essence of Toyota’s system and are fundamental to an improvement strategy that moves regular work toward the Ideal. Sometimes I think that there is a perception that these rules have a sense of ‘mystery’ attached to them. The reality is that they are quite straightforward! 

Let’s take a closer look at the 4 Rules:

  • RULE #1: According to Rule #1, all work must be specified according to content, sequence, timing and outcome. At Toyota, it is clearly recognized that process variation can lead to potential quality concerns. Pre-specification of work helps to limit variation and just as importantly, will set a necessary ‘baseline’ for future improvement work. Through specification of the expected successful outcome, staff will easily be able to recognize both defect free and defective outcomes.
  • RULE #2: The second rule explains how the people involved in a work process should connect with one another. Simply put, Rule #2 states that every connection in the process must be direct and binary (yes/no responses). Direct connections also typically deliver significantly less customer frustration. This rule is particularly appropriate to the “request for service” processes so prevalent in healthcare.
  • RULE #3: This rule specifies that every service process must flow along a simple, specified path. The specified pathways should involve as few steps, people and delays as possible. This concept of ‘continuous flow’ is vital to approaching the goal of an Ideal process. Spear and Bowen also believe that by requiring that every pathway in a process is specified, this rule positions the organization to conduct an improvement ‘experiment’ each time the path is used!
  • RULE #4: Rule #4 stipulates that process improvement must be done based on the scientific method, under the guidance of a coach and by  those doing the work closest to the problem. This implies that ‘frontline’ workers are empowered (and expected) to make improvements to their own jobs. Their supervisors are responsible to provide both direction and assistance to this effort as coaches.

You will recognize that Rules 1 through 3 are really ‘work and system design’ related, while Rule 4 truly ‘sets the stage’ for the continuous improvement effort that must exist to get the process closer to the Ideal! As you can see, there really is no ‘mystery’ here. Embrace these 4 rules and you, and your improvement team, will be moving closer to the Ideal!

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.

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