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True enough, which is why Toyota’s approach is being tested in groups with enough size to make it work.• The Virginia Mason Medical Center in Seattle, consisting of 480 doctors, a 336 bed hospital, and a regional network of neighborhood clinics, has been working on perfecting and applying Toyota’s manufacturing to health care since 2002.

In physiican practices, you need some sort of organizational critical mass to make a Toyota-type philosophy work.

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I contend if doctors are to take control of their practices and to make them grow, prosper, and improve, they must innovate, or government, health plans, and health systems will control their practices for them. Virginia Mason’s senior executives have traveled multiple times to Japan to see how Toyota does it. Garry Kaplan, Chairman and CEO of the medical centers said, “We've done two trips to Japan, and will do another in the near future," These trips and subsequent ones were about learning the techniques of what's called "lean manufacturing," and then applying them to health care.

In a talk I gave in January in Orlando, I quoted an e-mail message sent to me by George Halvorson, chief executive officer of Kaiser Permantente, in which he predicted, “Science and process engineering will help bring health care per capita costs down before we reach the breaking point.”I pray this is so. If current trends continue, health care as proportion of GDP will rise to 40%, by 2050. Cutting this spending may be where the Toyota model of quality improvement and cost control through innovation enters the picture. “Lean” mans doing only what’s needed, taking the fluff out of processes, and eliminating waste. Edward Deming, an American statistician who pioneered the quality control and continuous improvement movement in Japan, estimated as much as 40% of a company’s expenses result from waste – from poorly designed systems and processes.3 The Deming approach has worked for Virginia Mason, who have slashed 40% to 50% of costs related to respiratory inventory supplies and space needed to provide other services.

Science and process engineering had better work to reduce costs, or the U. That would break our system of financing health through employers, pension funds, and Medicare/Medicaid. A cartoon character of a race-driver on the cover of the February cover of explains how Toyota has conquered the universal care world:• DO KILLER CONSUMER RESEARCH ! The radiation oncology staff has cut the time from patient check in to leaving the department from 42 to 15 minutes, and the time spent waiting for chemotherapy has been reduced from 4 hours to 90 minutes.• The Park Nicollet Clinic in Minneapolis, one of the largest multispecialty clinics in the U. with over 960 physicians in 45 specialties and subspecialties, has achieved similarly impressive results using the Toyota Practice System (TPS), also called the “lean model.” The basic idea is to implement standardized processes across the clinic to end waste, reduce costs, and improve quality and safety.

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As Daniel Mc Fadden, a Nobel Laureate from the University of California, cogently notes, “In terms of health delivered per dollar of cost, our system is grotesquely inefficient. Our neighbor Canada’s single payer system costs ,165 per person per year, about half our expenditure, or 10% of GNP.” Mc Fadden adds, not kindly, “Most Americans are aware that our health-care system is in deep trouble, a dog’s breakfast of private providers and insurers that has weak incentives for quality control and cost containment.”But how to ensure quality and contain costs? In 2006, Park Nicollet announced it had saved million in the previous two years, Among other things, Park Nicollet changed its old “batching”system of seeing patient in groups of five to a “waterfall” system in which patients arrive and depart one at a time in a continuous flow.

2 Doctors are required to understand how Toyota manufactures cars.

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