Canadian hospitals inspired by Toyota unfazed by recent troubles

MONTREAL — Toyota may be rapidly becoming a byword for corporate misadventure, but Canadian hospitals are not yet ready to slam the brakes on health-care initiatives inspired by the Japanese carmaker.

MONTREAL — Toyota may be rapidly becoming a byword for corporate misadventure, but Canadian hospitals are not yet ready to slam the brakes on health-care initiatives inspired by the Japanese carmaker.

A handful of hospitals across the country have in recent years modelled new management practices after the fabled workplace culture fashioned by Toyota’s founder, Sakichi Toyoda.

The so-called Toyota Production System has spawned a cottage industry of sorts among management consultants eager to apply its focus on worker input to all manner of industries.

Quebec Health Minister Yves Bolduc made waves when, upon taking the job in 2008, he claimed the “Toyota Way” would help ease the burden on the province’s over-stretched health-care system.

But Toyota’s recall of 8.5 million vehicles because of a dangerous accelerator-pedal defect has given some pause about the wisdom of following its example.

“There’s a lesson there for us,” said Dr. Michel Tetreault, president and CEO of St. Boniface General Hospital in Winnipeg. “We have try to figure out what went wrong with Toyota.”

Along with hospitals in Quebec, New Brunswick and the Ontario cities of Kingston and Windsor, St. Boniface is among those that have undertaken Toyota-inspired reforms, also known as the “lean” health-care approach.

The idea is to focus hospital processes on the patient, stripping away anything that doesn’t serve that end.

It has been used to deal with such perennial health-care problems as emergency-room overcrowding by deleting unnecessary red tape.

Hospitals in Britain and the United States have been incorporating Toyoda’s insights for several years and studies have identified successes that include, in one case, reducing registration times from 60 minutes to zero.

At St. Boniface, Tetreault says Toyota-inspired methods allowed them to reduce by half the average time patients with chest pains have to wait for a cardiogram — to 14 minutes from a half-hour.

“The idea isn’t making a better process, the idea is getting a better patient result,” he said.

“If that’s not your starting point, you can go off in all sorts of wrong directions. You can do the best operation in the world in five minutes, but if its on the wrong patient you’ve got a problem.”

But Toyota’s recent troubles have stirred debate among advocates of its methods in the health-care sector.

The consensus appears to be that Toyota stopped worrying about making the best cars possible and became obsessed instead by becoming the largest car manufacturer in the world.

“Toyota’s rapid growth meant they started cutting corners,” said Sylvain Landry, a professor at the Universite de Montreal who specializes in hospital logistics.

“They didn’t provide their employees with enough training, they multiplied their number of factories around the world too quickly and put a lot of pressure. They distanced themselves from the core elements of the Toyota System.”

The danger, for Landry, is that hospitals reject Toyota’s methods before giving them a chance to take root.

“It’s not the fashion of the year,” he said. “It’s long-term institutional learning and I think Toyota’s misadventures are reminding us of that.”

In Quebec, Bolduc and his staff have faced criticism recently over increasingly long wait times at Montreal emergency rooms.

It’s hospitals such as these that can benefit from the Toyota approach, which improves the way emergency rooms interacts with other areas of the hospital, Landry said.

“You can’t throw the baby out with the bath water,” he added. “We have to be careful not to become too cynical about the Toyota system.”

For Tetreault, the beauty of the Toyota system lies in its refusal to lay blame on one given person.

He points to the problems at Hotel-Dieu Grace Hospital in Windsor, where a patient is suing doctors after they removed a healthy breast in the mistaken belief it was cancerous.

“You can be tempted to make that a person issue, that this surgeon was either dumb, lazy, tired or undertrained,” Tetreault said.

“Or you can look at the system and the processes and ask what safeguards were in place for this not to happen?”

So as Canadian hospitals go full speed ahead applying Toyota’s mantra, some of the carmaker’s executives may be left wondering why they didn’t follow their own advice.