Creating and sustaining a Lean culture of continuous process improvement.

Lean is the automobile manufacturing production system of the Toyota Motor Corporation that many businesses have been trying to reproduce for over 30 years.1,2 To desire the benefits of Lean requires direct extrapolation or some parallel of Toyota’s manufacturing-based production methods of efficiency and process improvement to different work environments. This is not as easy as it may seem, especially in health care. Most imitators of Lean use a top-down directed approach to projects by using selected improvement and work design tools often wielded by quality professionals or consultants. I believe this misses the critical element of Toyota’s success, namely creating a workplace culture that is educated, engaged, trusted, structured, and incentivized to participate in the work at all levels of a Lean enterprise. Therefore, a successful Lean culture of continuous improvement is a work environment in which the leader can walk away and empowered employees can sustain themselves in pursuing higher quality targets by implementing continuous process improvements. As Henry Ford once said, “Quality is doing it right when no one is looking.”3 Sounds like a manager’s dream, doesn’t it? Jeffrey Liker, PhD, cautions that over 90% of those who attempt Lean fail (personal communication, 2009). But why? Because success in Lean derives from the culture of Toyota, which is founded in the management principles of W. Edwards Deming and the personal philosophy of the company’s founders, the Toyoda family.4,5 One comes up short without mirroring that cultural base, consisting of a philosophy, a supportive management system, and intelligent approaches to engaging employees to continuously define and eliminate wastes inherent in non–value processes. One is then left with making sporadic process improvements usually at management’s direction. This contrasts with Toyota’s culture, which is dedicated to developing human talent throughout the organization to participate in continuously improving the enterprise. Ergo, success is defined not just by performance or financial metrics but by an engaged workforce producing thousands of process improvements and continually striving for higher targets of quality. If culture is the key, getting started shows good intent but it is said that culture change takes about a decade to establish. Do not be frustrated. Lean success takes time, so to consider Lean as a short-term solution to an acute management crisis would be misguided. In the Henry Ford Health System (Detroit, MI), we have been focused for the past 8 years on transforming our laboratory culture to foster continuous improvement. We have done this by adapting the philosophies of Henry Ford, W. Edwards Deming, and Toyota to evolve a health care version of a Lean culture. This adaptation to health care has been sustained over time and proven to empower our employees to own the quality of their work.4-10 I would like to share with you what we have learned in pursuing our vision of a functional culture of continuous improvement across a large system of medical laboratories in the Henry Ford Health System.