Is Toyota steering American health care industry the wrong way?

The quality shortcomings in America's health care system often take a back seat to the issues of cost and access. That the spotlight most often falls on these latter issues makes sense since the number of Americans that cannot afford basic health care is startling. Yet the evidence demonstrating America's quality gap is also surprising. According to a 2003 study published by a leading health researcher (who I happen to work for), Americans receive recommended care barely half (54.9 percent) the time they visit a provider. This is embarrassing in a system that takes pride in being the "best in the world," and many health care workers are striving to find fixes for these quality shortcomings.The "Toyota Production System" (TPS) is one of these fixes. Developed from the work of W. Edwards Deming and refined in Toyota plants, TPS aims to improve quality by "designing out overburden and inconsistency, and eliminating waste" (according to Wikipedia). It relies on statistical analysis, culture change, and continual improvement. If you've heard someone mention business buzzwords like "lean manufacturing," "six sigma quality," or "kaizen," they were probably talking about TPS. Health care providers are using the Toyota system in various ways. Some are streamlining processes in waiting rooms, others are working to reduce waste in operating suites and emergency rooms. Intermountain Healthcare in Utah is an example. This hospital system has implemented TPS and was profiled in the NY Times a few months ago.

Although TPS has brought providers like Intermountain acclaim for improved quality, they must avoid over-reliance on the Toyota system. If these producers of health care become too committed to efficiency and waste reduction they might eliminate the barriers restricting ineffective or defective care measures. This is what happened with Toyota. The car maker installed the same gas pedal across various models before realizing it was too long to clear floor mats. Recalling 8 million cars is a headache and a serious hit to Toyota's bottom line but the fallout pales in comparison to what might happen if a health care provider faced a similar situation - imagine a recall of 8 million of artificial hips or heart valves. To avoid this, American health care providers should continue to study both Toyota's successes and its shortcomings.

If you're interested in learning more about the quality shortcomings in American medicine, check out the study published in the New England Journal of Medicine by Elizabeth McGlynn titled, "The Quality of Health Care Delivered to Adults in the United States." More on Toyota's Quality Management can be found on Wikipedia by searching for "The Toyota Way." The NY Times article on Intermountain appeared in the November 3, 2009 edition of the Times' Sunday Magazine.

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