The Transformation Process

The process of transforming to a structured culture of continuous quality improvement is a defined one in Toyota. It begins with training of top management, agreement and definition of the quality mission and goals, team leader training in process improvement, identification of quality targets, then learning by doing at the 'shop floor' level in a model line area. In this scheme it is the Team Leader who is responsible for immediate patch fixes on the shop floor and more sustained process redesign through data-based PDCA change. The team member, who is on the automated line, is responsible for calling attention to the defects encountered or stopping the line so they can be fixed.

In healthcare, we don’t have a shop floor or an automated model line producing cars. But we do have analogous opportunities for highly educated and trained workers themselves, not just Team Leaders, to become engaged in the process of improvement at the level of the work, wherever that may be-- at the bedside, the clinic, the laboratory bench, the radiology suite, the emergency room, the ICU, the OR, the kitchen, etc.

The figure below depicts our Henry Ford Production System (HFPS) model for cultural transformation in healthcare. First the leaders train as a cohesive group, then the team members are trained and are empowered to work together in a defined structure before 'learning by doing.'  We find it is far more effective to train the team rather than the individual. We also include the requirement for workplace metrics of performance expectation and variability that Team Leaders and Team Members own.  This serves to frame the ongoing identification of quality target goals for teams to achieve. A defined structure with Team Leaders and Customer-Supplier meetings fosters the ability of teams to improve processes horizontally as the work flows, across existing silos of control. Structure also enables us to more effectively succeed with key Deming management principles #6-#9 that foster managers and team members to behave differently when encountering problems that they can now resolve in a blameless manner.

6. Institute modern methods of training on the job

7. Institute modern methods of supervision & leadership

8. Drive out fear

9. Break down barriers between departments