Quality of care is increasingly being incorporated as a priority for medical institutions around the globe. There have been a number of industry methods applied to healthcare settings but perhaps one of the most promising is the Toyota Production System (TPS). Virginia Mason Medical Center (VMMC) in Seattle was among the first healthcare institutions to apply the TPS method under the leadership of Dr. Gary Kaplan. The TPS will be examined as it applies to healthcare and specifically, its application by VMMC as outlined in the case report, will be evaluated.

Dr. Kaplan took over as CEO of VMMC in 2000 and he inherited the numerous problems facing VMMC. The first was economic. The VMMC had lost money for the first time in its history in 1998 and 1999. The center had already begun to cut costs in areas such as research and academic travel. Economic pressure was magnified by the heavy competition in the area, which contained several hospitals. Eventually, difficulties also began to adversely affect staff morale. Resistance to change was also embedded in the culture at VMMC. This reluctance to change was exemplified by the implicit compact with physicians outlined in the case study. Physicians felt they could work independently and seemed hesitant to make sacrifices for the greater good. Kaplan is quoted in the case by saying, “…. each physician felt, “I’m entitled to patients, I’m protected from the environment by administrators, and I can do whatever I want, whenever I want to – I’m a professional”. This point of view makes teamwork and sacrifice for the VMMC vision quite difficult. It puts physicians at the center of healthcare instead of patients. It also highlights an attitude that is not conducive to cultural change. Kaplan later recalls how one surgeon initially refused to travel to Japan to learn about TPS first hand. Once Kaplan began to implement sweeping change at VMMC, other problems surfaced. It was apparent that previous quality initiatives such as Total Quality Management (TQM) had exposed both cultural problems and disconnect between administrators and other VMMC workers. Also, its relative lack of demonstrable efficacy left employees skeptical of other techniques. One executive describes TQM in the case by saying “…a bunch of administrators meeting…and handing it down to the rest of us.” Instead of quality being embedded as a cultural belief, it was seen as a burden. There was also concern that more efficient systems may lead to layoffs (REF). Of course, this might have impaired implementation of any new quality framework. Finally, there was a sense that standardized quality measures were simply not applicable to patients who are all quite unique. This left some physicians disillusioned enough to eventually leave VMMC entirely.

In addition to significant issues within VMMC, healthcare had just been awakened to a major problem by the Institute of Medicine who published the fact that up to 98000 people in the United States of America were dying from medical error annually (IOM, 2010). This alarming study reiterated the need for a focus on quality and safety in health care. Kaplan realized that widespread change was necessary to adapt to future pressures and decided that TPS might be the best tool for transforming VMMC. TPS was created by Toyota Motor Corporation engineer Taiichi Ohno in response to economic downturn and the requirement to cut costs. Sometimes referred to as lean manufacturing, TPS first identifies the needs of the customer and improves processes by removing any identifiable waste (varkey et al). The basic components of each manufacturing step are identified with process mapping and any step that does not add value is labeled as waste or “muda” and removed. The resulting process is standardized, implemented and subjected to a process of continual improvement called “kaizen” in Japanese (Mccarthy 2008). Additional tools to help materialize this theory included the “andon” cord. A worker who