By 
[Toyota]
Chances are, when you think about Toyota, you aren’t thinking about sight—much less the preservation of it. And yet, for the hundreds of patients who were waiting to receive critical optic care at The Harbor-UCLA Medical Center, there is a very real, very powerful connection.
They have been touched by “The Toyota Effect.”
The manufacturing giant has launched a mini-series, called The Toyota Effect, to document collaborative work taking place between Toyota’s Chief Production Officers and other manufacturers, community organizations and nonprofits. Motivated by a long-held philosophy that “when good ideas are shared, great things can happen,” Toyota entered into a partnership with The Harbor-UCLA Medical Center, a county-owned facility, to help mend a broken healthcare system—a system that had resulted in a backlogged surgical roster spanning several hundred names.
After completing a comprehensive assessment, Toyota’s officers worked with the center’s staff to help them apply Toyota’s own tried-and-true methods of production, called the Toyota Production System, to their day-to-day routines. The goal? To allow the staff to simply accomplish more when serving the underserved. Needless to say, Toyota’s part philosophical, part technical system thrived within the healthcare environment, and the center thrived with it.
Click here to see those changes come to life in Toyota’s mini-film on The Harbor-UCLA Medical Center.
Of course, we were interested in the success story and curious about the way in which the center’s nurses and physicians were able to streamline their daily regimens using the Toyota Production System. So we ran a few questions of our own by two of the dedicated folks over at The Harbor-UCLA Medical Center: Pradeep S. Prasad, MD, Chief of Ophthalmology, and Susan Black, Chief Improvement Officer. Here’s what they had to say.
Pradeep S. Prasad, MD
What did Toyota’s officers see that the hospital administration hadn’t?
Toyota was able to identify specific targets for improvement as well as systemic weaknesses, some of which the hospital administration was aware of and others they were not. I think the most important thing Toyota helped us do was to not only help us identify problems, but to develop a strategy to address them.
Did the nurses and the physicians experience a similar degree of change—either in their routine or in their environment?
Yes, I think both the nurses and the doctors have felt the rewards of these changes equally. We have a busy clinic, but it’s no longer chaotic. There is order and a clear definition of roles. This makes for a much better work environment for all.
Has the ability to accomplish more, and on behalf of more patients, visibly improved the staff’s morale?
Absolutely. This project has been going on for nearly two years, and we have since hit a new normal. When we think back to the old system, I think many of us look at each other and wonder how we were ever able to function. With that said, I don’t think any of us feel like our work is done. There is an enthusiasm to continue to improve, and more importantly, there is a feeling that we have the tools and support from hospital administration to achieve those goals.
Susan Black, Chief Improvement Officer
What does the system’s success mean for nurses? Do you think the improvement in overall function and order has the potential to expand a nurse’s role?
One of the most powerful things that has happened is that traditional barriers between disciplines have been broken down. Before, staff thought in terms of only their work and what they had to get done. Nurses thought about the nursing role, physicians thought about their work and so on. Now, the thinking has evolved to consider the whole process and how individual work contributes to the entire process—transforming the nurse’s role.
This thinking has helped the clinic staff to become a more integrated team, working together toward a common goal to improve the care delivery processes for the patients we serve. Participating hands-on to improve work processes has definitely improved the morale of the staff.
What is your response to critics who believe that highly standardized practices cripple a nurse’s critical thinking?
While there may be critics who believe that highly standardized practices cripple a nurse’s critical thinking or judgment, I could not disagree more. Standard work is the “current best thinking” on how to perform a process. It is not a policy written in stone. Rather, it’s a living document that can and should be updated frequently. Nurses are empowered to find better ways to do their work and, if a new way is found and if it’s faster, easier, better, then the standard work is revised and the new way becomes the standard for everyone.
Instead of crippling a nurse’s role or judgment, I believe that standardization does just the opposite. It gets everyone on the same page and then challenges the creativity of the individuals who work within the process to improve upon it.
While the need for order is a clear parallel, how does a production system that was developed in a factory hold up in an environment that is inherently unpredictable? Could this system be applied with the same degree of success to, say, an ER?
Absolutely! Before a patient ever gets to the expert care provided in a clinical setting, such as an emergency department, there are many processes that the patient goes through—from initial assessment to obtaining tests and procedures to guide diagnosis, to disposition home or admittance to the hospital. While every patient is treated individually, standardizing how these processes are performed brings predictability and reliability to an inherently unpredictable environment.
Other key tools utilized in the Toyota Production System, such as visual controls, can improve communication within the care team. Also, ensuring that staff have the supplies they need when and where they need them can save staff precious time looking for supplies—time in environments like the ED can save lives.
A key factor in deploying the Toyota Production System to any area is recognizing that the individuals who do the work know best how to improve it. It starts with learning to see and teach others to see the waste in their environment, then empowering the staff that work in the process to develop the standard work and improve it.
This post was created in partnership with Toyota. All opinions expressed in the post are Scrubs editors’ own and not those of Toyota.
