Toyota Process and How It Relates to Healthcare

Introduction 

The Toyota process is a manufacturing model created for efficient design and the proper oversight of large-scale operations. The model helped catapult Toyota Corporation from a small vehicle producer to the world's third-biggest car manufacturer by the end of the 1980s. Numerous car manufacturers in Japan emulated Toyota's model, and after a few decades of fine-tuning, it became known as the Japanese technique to production. Later, it was defined as lean manufacturing due to its capacity to perform so much more with fewer resources than conventional techniques. In recent years, the Toyota process has been utilized in numerous manufacturing plants in the US and globally with considerable success such that lean manufacturing has become the dominant production model. 

Background 

US manufacturing was in a state of crisis in the mid-1980s. Various US entities were losing their market share to a group of Japanese competitors they had previously dismissed as second-class producers. Products of greater quality and lower cost were flooding the marketplace, and US consumers were purchasing them. American firms responded by focusing on comprehending their customers' needs and boosting product quality in ways that mattered to the customers. The quality of US products significantly improved, and costs were controlled, but the Japanese firms outperformed their American rivals. Many researchers traveled to Japan to investigate the secret of the firms' success. A team of MIT researchers discovered the different production systems utilized by the Japanese. They dubbed it 'lean manufacturing' since the goods were made at a higher quality at half the typical cost of traditional techniques (Liker, 2011). In addition, the goods were made in half the time of the other techniques. The exposure of the US companies to the Toyota production model led to key changes with the entities adopting lean manufacturing techniques. Since then, productivity improvements, increased customer satisfaction, reduced worker turnover, and falling defect rates have been realized. 

Scholars have described lean manufacturing on two levels. The high level considers lean manufacturing as a philosophy that discourages any type of waste while striving to eradicate defects and achieve perfection. The majority of the descriptions move beyond the high-level description to an interlinked set of activities that comprise general material flow in the plant, comprehensive equipment design, and human resource practices. The goals of the Toyota process are to utilize as few resources as possible to manufacture the desired amount of goods at the greatest quality level. The outcome is a mass production framework that yields quality products with minimal expenses. 

Principles of Toyota Process 

The Toyota production process has key principles that govern lean manufacturing practices. A key principle is using the pull system to reduce overproduction. Lean manufacturing focuses on providing the customer with what they want when they require the products. In this case, work in process is minimized, and only small amounts of every product are kept in the warehouse. There is also an emphasis on responding to the daily changes in client demand instead of depending on computer systems to monitor wasteful inventory (Liker, 2011). Another key principle is Heijunka which means leveling out the workload. Lean production focuses on reducing the overburden to individuals and equipment. There is also the elimination of unevenness in the manufacturing schedule. 

Another principle is building a culture focused on solving problems to ensure quality at the first time. In lean production, customer quality drives value proposition. There is an emphasis on using all the modern quality assurance techniques that are currently available to ensure that the quality metric is achieved in the right way at the first time. Lean manufacturers ensure that their equipment is capable of identifying problems and stopping automatically when they need to. There are visual systems that inform project leaders that a machine requires maintenance. The notion of Jidoka, that is, intelligent machines, is the cornerstone of guaranteeing quality. Realizing Jidoka entails creating and improving systems manually until they are safe and reliable (Liker, 2011). Initially, engineers carefully build every new line element by hand to accurate specifications, then they slowly simplify operations via continuous improvement. Lean manufacturing emphasizes the building of support systems to quickly resolve issues and set up countermeasures. 

Another major principle of the Toyota process is the creation of a continuous process flow to reveal hidden problems. In lean manufacturing, work processes are redesigned to ensure high value-added flow. There is a focus on reducing the amount of time that a task is left unattended. Flow is created to ensure the quick transfer of material and information with process linking common to ensure problems are identified immediately. In lean organizations, flow is made evident throughout the entity's culture. Downline clients in the production process are provided with what they need when they require it. Another major principle is using visual control to ensure no problems are hidden. Lean production emphasizes the use of simple visual indicators to assist individuals to recognize whether they are performing their tasks properly or deviating from the standard condition. There is an emphasis on creating simple visual systems at the locations where tasks are completed to guarantee flow and pull. Reports are reduced to a single piece of paper in most cases, even when crucial financial decisions are made. The Toyota process model emphasizes hinging the managerial decisions on a long-term view even at the cost of the short-run financial objectives. In this case, the lean philosophy emphasizes growing the entity towards a defined purpose that is greater than earning returns. It also stresses the essence of generating value for not only the customer but also the society and economy. 

Another vital principle of the Toyota process s the use of only reliable technology that meets the needs of the people and the entity’s processes. The lean concept emphasizes using technology to support individuals rather than replacing them. New technology is typically unreliable and, for this reason, actual tests must be conducted before implementing the new technology. The lean concept also emphasizes the rejection or modification of technology that disrupts the entity's stability or culture. The Toyota process also stresses the principle of growing leaders who comprehend the work philosophy. Leaders should be grown within the entity rather than sourced externally. They should be role models for the entity's way of conducting business and must comprehend the daily works processes in an in-depth manner. The lean philosophy, the cornerstone of the Toyota process, also emphasizes the development of exceptional individuals and teams that follow the entity's philosophy (Liker, 2011). A stable culture in which the entity’s values are broadly shared should be developed. Individuals and teams should be trained extensively within the corporate philosophy to realize impressive results. The lean philosophy also supports the creation of cross-functional teams to boost quality and flow by resolving technical issues. Another major principle of the Toyota process is respecting the expanded network of vendors and partners by assisting them to improve. The lean entity should challenge its business partners to grow and improve as a means of showing them that the entity values them. Another principle of the Toyota process is Genchi Genbutsu which means thoroughly comprehending the situation. According to the Toyota model, processes can be improved by visiting the source and confirming data instead of theorizing based on the views of others. The managers should base their decisions on the data which they verify personally. The Toyota process also emphasizes decision-making through consensus and the thorough consideration of all options. Nemawashi is the concept of discussing issues and potential solutions with the affected individuals to gather their ideas and identify the forward path. The decisions should be implemented rapidly. According to the Toyota process, once a stable process has been established, the entity should utilize continuous improvement resources to identify the source of inefficiencies before applying countermeasures (Liker, 2011). The entity should devise processes that lack inventory to allow all individuals to see the wasted time. Kaizen or continuous improvement can be carried out once the entity’s waste is exposed. Waste can be in the form of excess stock, irrelevant processing procedures, and defective items. All the waste components combine to form more waste which impacts the management of the entity. The organizational knowledge base should be protected through the development of stable individuals and meticulous succession systems. Lastly, the Toyota process also encourages the transformation of the entity into a learning organization through Hansei and Kaizen, which stand for relentless reflection and continuous improvement, respectively. 

Thesis Statement 

The Toyota process is related to healthcare since lean tools such as visual management, the 5S approach, and the Kanban approach have been implemented in the healthcare setting to reduce different types of waste, including defects, waiting, excess production, inventory, excess processing, human potential, motion, and transportation. 

Literature Review 

Existing research points to the adoption of the Toyota process in the healthcare field. Furman and Caplan (2007) examined the application of the Toyota Production System to reduce errors in a healthcare facility through a patient safety alert system. According to the authors, Virginia Mason Medical Centre implemented the Toyota process in 2002. The healthcare facility adopted a Patient Safety Alert system in which the healthcare practitioner was required to make an immediate report when they encountered a scenario that was likely to harm a patient. The system also required the practitioner to stop any activity that could lead to further harm. As per the authors, the alert system could prevent the nurse from conducting further practices if it was deemed that the practice could lead to patient harm. Key features of the alert system implemented at the healthcare facility included a policy statement, management commitment, a 24-hour telephone service, and dedicated resources. The results of the adoption of the system resulted in an increase in alert reports to more than 6000 by the end of 2006. Twenty percent of the reports were received from managers, while eight percent were received from physicians. Forty-four percent were received from the nurses, while twenty-three percent were received from nonclinical support staff. The majority of the reports were processed within a day and were resolved within fourteen to twenty-one days. The healthcare facility adapted the Toyota process to its setting through a method of zero defects. The implementation of the alert system increased the number of safety issues resolved at the healthcare facility and reduced the time it took to resolve them, according to the researchers. Collins, Muthusamy, and Carr (2014) explored the implementation challenges of the Toyota Production System (TPS) in healthcare institutions. According to the authors, the rules of the system can be applied in the healthcare field to guarantee improvements in patient safety and healthcare quality. A key TPS rule is that all work should be significantly specified to the schedule, scope, and outcome. In healthcare, this rule is applied through the specification of patient treatment through documentation. The patient outcomes and events are noted. Another TPS rule is that each client-vendor connection must be direct, and there should be a clear yes-or-no way to issue requests and obtain responses. In the healthcare field, the patient-nurse interaction is typically direct, and communication should be precise therefore highlighting how the Toyota process is related to healthcare. According to TPS, the pathway for each product or service must be direct. In healthcare, the clinical pathway for every treatment is guaranteed through best practice. Another rule of TPS is that any improvement must be carried out in accordance with the scientific technique under the instruction of a professional (Collins, Muthusamy & Carr, 2014). In the healthcare field, quality improvement is overseen by an internal autonomous body that guarantees that improvements are compliant with the patient safety objectives. According to the authors, the TPS philosophies can be easily applied in healthcare organizations. For instance, in improving patient recognition accuracy, the healthcare entity can create a special treatment plan for every patient. The improvement of the safety of using medicines can be guaranteed by creating and following a particular pathway to recognize variations. The authors concluded that TPS principles could be integrated into current healthcare planning and oversight systems. Rona and Saint-Martin (2014) explored the pursuit of perfection in healthcare through the application of the Toyota process to medicine. According to the authors, production processes, the focus of the TPS have key similarities with admitting a patient, visiting a clinic, undergoing surgery, or issuing a bill. The authors believe that TPS principles and tools may be adopted by the Virginia Mason Medical Center in its production system, which is intended to make the institution a quality leader. According to the authors, the healthcare institution adopted the TPS philosophies to ensure the entity put the customer first and realized the best quality and highest staff satisfaction. The implementation of the TPS principles in the healthcare facility resulted in the reduction of space occupied, staff walking distance, defects, lead time, and work-in-process units. Burkitt et al. (2009) examined the impact of a TPS quality improvement program on perioperative antibiotic therapy. The researchers implemented a multi-varied intervention to reduce hospital-acquired infections on a surgical unit at the Veterans Affairs level. The domestic computerized healthcare record system was utilized to recognize patients going through the twenty-five most common processes and identify the alterations in proper antibiotic therapy and length of stay. The results showed that more than 2500 surgical admissions were identified from the domestic computerized healthcare records. The percentage of surgical admissions using the proper perioperative antibiotics was considerably greater in 2004 after the inception of the TPS program than in the previous four years. There were improvements in conformity with the antibiotic therapy period instead of proper antibiotic selection. The authors concluded that the TPS use led to a quality improvement program that was linked with a rise in proper perioperative antibiotic therapy among patients who underwent surgery. Van Goubergen and Lambert (2012) explored the application of the TPS tools and philosophy at the Ghent University Hospital. According to the authors, waste reduction can be achieved through the implementation of lean tools following the identification of a value stream. Lean tools were adopted in the dermatology section of the Ghent University Hospital, and it realized significant benefits, including waste reduction. The department implemented a single piece flow in the physician consultation value stream, and there was a decrease in the time needed per patient. It also adopted load-leveling, otherwise known as Heijunka, in the physician consultation value stream (Van Goubergen & Lambert, 2012). The department ensured that the arrival pattern underwent load leveling. In addition, variability was reduced through the improved matching of capacity and demand. The department adopted flexible staffing to ensure that a capacity safeguard was used to deal with fluctuations of incoming patients. The department eliminated waste and increased the capacity of patients served by implementing standard work for the practitioners. It implemented a standard work schedule by requiring the physicians to call patients during the reserved duration. The exact times when the physicians communicate with their patients were decided together by the two parties. The eradication of the variability led to the decrease in the number of useless calls made by patients at the reception desk. In addition, patient satisfaction increased since the patients could easily communicate with their physicians at the agreed times. The department also implemented the TPS by supporting continuous improvement with performance boards, 5S implementation, and visual management. It started sharing information regarding its performance with all individuals to promote increased involvement and commitment from the members. The authors concluded that TPS tools could be successfully applied in healthcare settings with impressive results. Spagnol, Min, and Newbold (2013) examined the challenges and improvements with regard to lean principles in the healthcare segment. According to the authors, waste reduction can be achieved through the use of lean principles and tools. The implementation of the lean philosophy has had a positive effect on cost, quality, and delivery of services in the healthcare sector. The adoption of lean principles in healthcare is focused on the patient and entails time and comfort as the primary performance measures of the Toyota process. There is an emphasis on ensuring a multi-skilled team cares for the patient and the latter’s involvement in the Toyota process. The lean tools used in the healthcare setting include the Kaizen blitz and the value stream mapping framework. The Kaizen blitz is a five-day workshop that focuses on identifying problems in the current processes and providing suggestions for quick changes (Spagnol, Min & Newbold, 2013). The value stream mapping framework assists in eradicating wasteful practices through the active involvement of all concerned parties. The map in the value streaming mapping structure should analyze healthcare service accessibility, interaction with the healthcare entity, and patient involvement. The authors concluded that healthcare entities should adopt lean principles to achieve waste reduction outcomes. Rutledge, Xu, and Simpson (2010) investigated the application of the TPS in the improvement of primary laboratory practices in Seattle Children’s Hospital. The healthcare facility employed a consultant to coach the healthcare practitioners on lean principles. The primary aim of the adoption of lean principles was the elimination of waste at the laboratory. The TPS principles utilized include visual management control, one-piece flow, FIFO method for specimens, balanced distribution of work, standard work, reliable methods, and standing operations. The trained workers at the facility adopted changes supported by the data gathered during direct observation and work measurement. The main laboratory was remodeled to facilitate the new workflow. The results showed that three main changes were realized from the lean implementation project. The 5S framework was adopted, and the workers established standard work and constructed an automated work cell. The new physical layout at the laboratory, in addition to workflow changes, led to the reduction in walking distance and specimen travel distance. Standard work establishment allowed the laboratory workers to benefit from consistent work while reducing wait time. The work cell’s efficiency was maximized through lean principles. The cycle time permitted the work cell to receive specimens in standardized batches. The implementation of the lean philosophy led to the improvement in staff efficiency and productivity by twenty percent. The main laboratory footprint was decreased by twenty-five percent, leading to the creation of new space for the expansion of the specialty laboratory. The authors concluded that the adoption of lean principles reduced the laboratory’s recurrent costs. Printezis and Gopalakrishnan (2007) explored quality management in healthcare. The authors offer real-life examples of the application of TPS tools and principles in the healthcare sector. One of the healthcare facilities that adopted the tools and principles is Deaconess Glover Hospital, situated in Boston. In the healthcare facility, one of the senior physicians observed that ambiguity was significant enough to impact patient safety. He, together with the hospital administrators, decided to adopt the TPS to reduce ambiguity-linked errors. They selected a pilot site in charge of drug administration, a process that offers medicine to patients on a daily basis. At the pilot site, there were disruptions from nurses from daily duty to acquire missing materials. There was variability in requesting and offering one dose of medicine, including the non-routine processes involved. TPS principles were utilized through standardization to limit the nurses' chaotic practices. Moreover, simplification and automation were promoted through connection redesign to address the information flow issues (Printezis & Gopalakrishnan, 2007). The pathway was also redesigned to offer simplicity and focus. The adoption of the lean tools resulted in a significant decrease in the wrong administration of the medicine. Another healthcare facility that adopted the lean methodology includes Intermountain Health Care, situated in Salt Lake City. In the healthcare facility, there was a study of the turnaround times of the institution's pathology laboratory. The effectiveness of two lean tools, including value stream mapping and A3 reporting, were tested. The two tools were applied to a scenario focused on the turnaround duration of pathologists' reports. The value stream mapping adopted in the anatomical pathology laboratory showed inconsistent work procedures and labeling errors. The A3 approach was used to analyze the complex workflow to identify the problematic areas and potential solutions. The use of the two lean tools allowed the facility to realize a two-day turnaround goal. The authors also examined the application of TPS in the University of Pittsburgh Medical Center. The TPS methodology was used to eliminate errors at the facility. Previously, laboratory practices were batched, and there was a strong emphasis on turnaround times. Resultantly, quality was sacrificed. The adoption of TPS led to the real-time detection of pathology errors. The root-cause analysis allowed the workers the opportunity to create a learning line and solve problems. The A3 approach comprising four steps was utilized in resolving the problems. TPS adoption in the healthcare facility led to the overall decrease in errors. The Western Pennsylvania Hospital is another facility that adopted TPS principles. The TPS tools were adopted in the pre-surgery nursing unit of the healthcare facility. The hospital administrators determined that any uncertainty level in the preparation of individuals for surgery could lead to delays that cost three hundred dollars per minute (Printezis & Gopalakrishnan, 2007). The TPS tools allowed the hospital to clearly define pathways, connections, and tasks. Resultantly, ambiguities were minimized, leading to quicker turnaround times, a decrease in costs, and fewer errors. According to the authors, the Community Medical Center located in Missoula also implemented TPS principles such as the A3 approach, the 5-why RCA, and value stream mapping. The adoption of TPS led to the forty percent decrease in medical errors, for instance, missing medication notification. The authors concluded that TPS adoption in healthcare could result in numerous benefits, including reduced errors and improved workflow. 

Method 

The Toyota Production System has been widely utilized in the manufacturing field. Its adoption in the manufacturing sector has seen manufacturing companies realize substantial cost savings. The production of quality products has also been guaranteed due to the adoption of various principles such as Kaizen, Jidoka, and Genchi Genbutsu. The numerous benefits mean that the Toyota process is sought after by entities in industries other than the manufacturing industry. This research study will seek to answer the following research question. 

How does the Toyota process relate to the healthcare field? 

The method utilized in this qualitative research is content analysis. In this respect, qualitative data will be assessed to identify key themes such as quality and waste reduction in healthcare through the application of TPS. 

Results and Discussion 

The Toyota process is related to healthcare through the lean tools and principles adopted to improve quality and reduce waste. The lean tools highlight the processes that add value by reducing waste. The elimination of waste results in the improvement in healthcare quality. In the healthcare field, waste is eliminated by first identifying the type of wastes by going to Gemba, that is, the source of value creation (Graban, 2016). In healthcare facilities, the different types of wastes that can limit value creation include defects, excess production, waiting, inventory, excess processing, motion, human potential, and transportation. The waste of defects entails the work activities that are not performed right the first time. For instance, a form may be incorrectly filled, or food may be dropped on the ground in the cafeteria. The causes of such defects may include illegible handwriting, incorrect decimal notation, or mistakes in the process of providing medicine to patients. Process defects incorporate procedures that go wrong, leading to workarounds. Such defects typically result in the nurses' time wastage in redoing the procedures correctly. The waste of excess production entails too much production of a specific product or outcome. In the healthcare field, the waste of overproduction occurs when unnecessary lab test results are produced. Such lab tests overproduce information that might not be useful or might lead to cost increments. In addition, the patient may become anemic if the nurse draws too much blood for the blood tests. Pharmacies in healthcare entities produce medications for patients and nurses. The waste of overproduction can occur when medications are delivered too early. Some of the medicine may be returned to the pharmacy due to the change in orders or discharge of patients (Graban, 2016). Early charting prior to care provision is another case of overproduction. If a healthcare practitioner records medicine administration for various patients in advance, as a specific batch, the practitioner might believe that they are efficient. Regardless, defects can be realized if the practitioner becomes sidetracked and the medicine is not administered as planned, specifically if it is near a shift change and the next practitioner perceives that the patient was given their last dose. The waste of transportation entails excess product movement in a system. In various facilities, this waste occurs when the phlebotomist moves from one room to another, collecting additional specimens. The waste of waiting occurs when the healthcare employees wait as a result of systemic issues or uneven workloads. Poor scheduling practices and process problems cause patients to wait for appointments. Physical products, including blood specimens, medicines, and surgical instruments, spend a considerable time waiting rather than undergoing value-added processing. Such waiting is attributed to the inexistence of FIFO or department-based batching. Healthcare worker waiting occurs when there are process defects, upstream procedure delays, and low patient volumes. The operating rooms, emergency department, or radiology departments are likely to be most affected by employee waiting due to uneven workloads. The waste of inventory occurs when there is an excessive number of materials, equipment, and supplies at the healthcare facility (Graban, 2016). The waste of motion is concerned with the distance covered by healthcare employees while performing various duties. An example of such a waste is unnecessary walking by the healthcare practitioner. Such a problem is attributed to the poor layout of the healthcare facility. The waste of overprocessing occurs when a healthcare practitioner is performing unnecessary work. Overprocessing arises from miscommunications in the transfers between individuals or departments. The waste of human potential occurs when healthcare professionals are not performing work that can improve their skills or careers. Such type of waste can arise when healthcare practitioners are not working up to their licensure level. For instance, nurses may carry out work that can be performed by nursing assistants. 

The lean methodology is an essential tool in the identification of the eight types of waste. When waste is identified, corrective action can be taken to eliminate them. The Toyota process through the lean tools provides ways of eliminating the wastes. Visual management is one of the lean tools that can be used in achieving waste reduction in healthcare entities. The primary aim of visual management is to reduce waste by exposing problems to ensure they are fixed. Visual management emphasizes Jidoka, which means being informed of an abnormality and resolving issues immediately as they emerge (Graban, 2016). Numerous entities have a tendency o hiding problems rather than dealing with them. Visual management is a mindset that ensures that all the entity’s processes are visual and the problems are noticeable to ensure improvements are made. Visual management plays a key role in diminishing information deficits in the workplace. In a workplace where information is scarce, individuals ask many questions repeatedly. The queries regarding missing information result in time wastage and delays. Such occurrences are common in healthcare entities. They are based on the lack of information, and as a result, there is a need for visual management. In addition to making the problems visible, visual management also emphasizes managing the problematic situations and reacting as required in the short run. There is also an emphasis on solving the root issues of the identified problems over the long run. Hospitals typically utilize visual management to recognize the patients' status or their needs leading to effective real-time decision-making and reduction of errors. Tracking boards are utilized in identifying which rooms are unoccupied or to inform family members of where the patients are currently situated in the value stream. Healthcare entities place charts in wall holders that showcase how many individuals are waiting for each doctor. Additionally, there are vivid visual indicators that illustrate whether the patient is ready or is still undergoing an X-ray. Visual management has been used to eliminate the waste of waiting and transportation. In one children's hospital, some of the children are required to undergo sonograms and MRIs. Most patients have a single modality to visit, and workers can only observe their schedule for their modality. Parents might leave with their children when they do not fully comprehend the scheduled care plan. In such a scenario, the equipment becomes idle, and the scheduling staff have to redo their work. In addition, there is wasted transportation and delays in care. The radiology department devised a simple visual management tool to eliminate waste. When a specific child has two modalities to attend, the department’s employees bundle two color-coded cards and clips them to the child’s shirt. In this case, the employees are informed of the initial modality that the patient should shift to a second procedure. The workers at the facility were able to resolve the information deficit and eliminate wastes of waiting, inventory, and transportation. 

Another lean technique that is being used in healthcare to eliminate waste is the 5S approach that entails sorting, storage, shining, standardization, and sustenance. The approach results in waste reduction through improved workplace organization and visual oversight. The main goal of the 5S approach is to offer quality patient care in the most effective manner. In healthcare facilities, 5S improvements have been found effective through the reduction in the amount of wasted time in the typical eight-hour shift covered by nurses. The wasted time was found to have reduced from 3.5 hours to only 1 hour daily (Graban, 2016). 5S is utilized as a lean technique to begin engaging staff in minimal improvements as a stepping stone to tackling greater challenges, thus resulting in workplace revitalization. The initial step in the 5S approach is sorting. In this stage, one should look for objects that are no longer required. Such objects take up valuable space, and the healthcare facility ends up being bigger than it needs to be. This scenario results in excessive construction and maintenance costs. The large workspace results in excess walking by the employee in addition to other forms of waste. Sorting ensures that broken equipment and expired supplies are separated from working equipment and fresh supplies. In the sorting process, the workers can also identify required items that are not easily available in the workplace. The second step in the 5S approach is storage. In this step, the workers identify how frequently every item is used. In every department, the items that are used frequently should be stored closest to the usage point. If the items are utilized by multiple individuals in one area, there should be multiple storage points. The items that are frequently used should be stored in appropriate ergonomic zones, for instance, benchtops and shelves (Graban, 2016). In one Japanese healthcare facility, nurses carried a standardized bag around their waist that allowed them to access frequently used items at all times. The items carried in their bags entailed hand sanitizer, alcohol swabs, and pens. In this case, the nurses avoided unnecessary employee walking. The third step in the 5S approach is shining. After the unnecessary items are removed and the remaining items are stored, the focus shifts to cleanliness. Healthcare departments typically depend on a centralized housekeeping department for cleaning. The pursuit of cleanliness is aligned with infection control in the healthcare setting. Cleaning allows the hospital to inspect objects and equipment and, as a result, discover structural problems immediately. The fourth step of the 5S framework is standardization, a key feature of lean healthcare facilities. After the best locations for the specific items are determined, the focus shifts to ensuring that the items are always stored in the defined locations. Standardization can occur in a department or across departments. Benefits are brought to employees who operate in different units. In one healthcare facility, the automated supply shelves in various outpatient units were organized differently and, as a result, were not standardized. The practitioners who worked in different units became frustrated since they wasted time when finding their bearings in a different unit. If the facility used standardized shelves, wastage could be avoided since customized space could be available based on the requirements of a specific unit. Standardization is beneficial since it leads to more proactive problem-solving. At Avera Health, the hospital administrators were able to standardize airway carts (Graban, 2016). Previously, the different regional centers had different ways of utilizing their airway devices. The healthcare facility adopted a standardized airway cart that allowed patients to receive airway care hence reducing delays and boosting care. The last step in the 5S approach is sustenance. There is a huge need for continually improving the healthcare facility’s workplace organization. The department implementing the 5S approach requires a formal audit plan to allow the leaders to identify whether the new standards are being followed. In this respect, the continuous use of the 5S approach ensures that the healthcare entity achieves its goals of reduction in waste. 

Another lean technique that can be used in eliminating waste of inventory is the Kanban approach, which builds on the philosophies of standardized work, visual management, and 5S. The approach allows healthcare entities to manage their supplies and stock. In most cases, Kanban is a physical signal, including a paper document or plastic bin that shows reorder points and reorder levels. It can also include an electronic signal that is obtained from a computer system. The Kanban approach can be utilized in pulling materials from a central supply room to the usage point. The Kanban pull signal is designed to be visual and simple. Healthcare institutions such as Park Nicollet Health Services have implemented Kanban in more than 65 hospital departments and 30 clinic departments since the mid-2000s (Graban, 2016). The facility has created and continuously used more than sixty thousand Kanban cards that are employed in signaling the replenishment of their main supplies. Nine hundred items are replenished on average through the approach. The main materials department liaises with departments to establish Kanban with the material specialists placing orders and restocking the departments from the central storeroom. The healthcare facility estimates it has saved more than one million dollars within a three-year period after adopting the lean approach. The replenishment of the supplies has enabled the entity to keep its employees busy, and as a result, it has managed to eliminate wastes of waiting that are associated with idle time. The Kanban approach is beneficial since it reduces the disruptions to healthcare employees and their workflow. In this respect, healthcare facilities can avoid having stressed and frustrated employees. 

Conclusion and Recommendations 

Overall, the Toyota process, otherwise known as lean manufacturing, is related to healthcare given the application of lean tools and philosophies in various healthcare settings to improve efficiency and quality while eliminating wastes. The Toyota process is a common quality improvement technique employed in the manufacturing industry. This research has focused on the adoption of TPS tools and concepts in the healthcare industry. The literature review reveals that various healthcare facilities have adopted TPS tools and principles to improve efficiency, workflow, healthcare quality while eliminating errors and wastes. The healthcare sector is facing high consumer expectations, which have necessitated the adoption of TPS tools and interventions. The content analysis carried out in this research reveals that the relation between the Toyota process and healthcare is evident through lean tools such as the 5S approach, Kanban approach, and visual management, all designed to reduce wastes that are common in the healthcare sector. The different types of wastes that are common in the healthcare field include defects, waiting, excess production, inventory, excess processing, human potential, motion, and transportation. Visual management has been applied in healthcare institutions to recognize such wastes before deciding on the most appropriate corrective action. Such types of waste are recognized at Gemba, which is the place of value creation. Visual management ensures that all the hospital’s processes are visual and the problems are evident to ensure improvements are made. In this case, waste reduction efforts can be implemented effectively. The 5S approach that entails sorting, storage, shining, standardization, and sustenance is another lean tool that has been used in waste reduction in healthcare facilities. Sorting items ensures that the unnecessary items are eliminated, leading to the creation of valuable space for meaningful activities. Storage, cleanliness, and standardization ensure that workflow efficiencies are realized at the healthcare facility since the workers can easily access the required items when they need them. Sustenance ensures that the prior four steps are repeated to maximize waste reduction in a healthcare facility. The Kanban approach is another lean tool that has been applied in healthcare entities to realize waste reduction. It is used in assisting healthcare facilities to manage their supplies and stock. Hospitals using Kanban are able to reduce cases of stockout while preventing overstocking. In this respect, the healthcare entity is able to reduce inventory wastages since it holds the proper level of stock it requires. 

Currently, healthcare entities, payers, and providers are developing new models for patient care which should be aligned with the emerging payment methods. There are other emerging healthcare technologies that are being adopted to improve the patients' health outcomes. It is recommended that in-depth research be carried out on TPS tools that can assist healthcare entities to realize quality improvements and waste reduction in light of the changes in the healthcare sector. The TPS tools being adopted should be compatible with the new technology being introduced in the healthcare field. In addition, it is also recommended that national standards for TPS application in healthcare be adopted to ensure widespread adoption of the Toyota process in US-based healthcare entities. The creation of the standards would assist small healthcare providers to adopt TPS tools and principles in their practices. In this scenario, hospital administrators and healthcare practitioners seeking to understand and implement the Toyota process can have their needs met. 

References 

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