This project proposes a test of the application of well-established principles of the Toyota Production System (TPS), or lean manufacturing, to health care delivery. Transferability has been limited by the system's roots in manufacturing, its reliance on manufacturing-based tools and metrics, and the difficulty of defining comparable approaches and metrics for service settings. Drawing on recent work suggesting actionable principles for the application of the TPS, the project proposes to address the following questions: (1) Can the principles of the TPS improve health care delivery? (2) If so, what implementation strategies are more likely to lead to success? Based on answers to these questions, the project will develop a user-friendly set of tools and training materials to help health care institutions nationwide improve through application of the principles of lean manufacturing. The proposed work will be carried out as a collaborative project between Community Medical Center of Missoula, MT, and Montana State University. Using participant-observation, journaling, products of redesign efforts, and interviews, the researchers propose to explore cultural and psychological barriers to TPS in healthcare, and assess the organizational strategies and the effectiveness of tools and exercises used, as well as the progress of shifts in individuals and groups required for TPS implementation. This project holds great promise for significant and lasting theoretical and practical outcomes, both through expanding knowledge of production methods in an important service industry and deepening understanding of efficient design and management emphasizing quality improvement. Potential practical benefits in improving the quality and efficiency of health care delivery are very large.
