We have been struck by the friendliness and service oriented culture of the Japanese people. We have also been (not surprisingly!) very impressed with Toyota's long term commitment to continuous improvement and how that commitment has been instrumental in Toyota's evolution from a loom maker and textile producer to the world's leading car company.

Our value stream review has helped us identify three principles that we see as important for Children's future.

First, as guidelines of care are developed for all of our specialties they must extend throughout our system, i.e., from the outpatient (e.g., ED and Ambulatory) to the inpatient setting and to home care. Much better coordinated care will result.

Second, patient rounds must be conducted in a standard way from service to service, 24 x 7 x 365. This way families, clinicians and staff will know what to expect and it will help reduce the waste of waiting associated with rounds. Ultimately we want "standard work" to be the way we practice and work throughout Children's.

Last, but not least, our clinical areas need to develop "pull" systems so that instead of patients being "pushed" to a clinic or patient care unit, those areas will be responsible for pulling patients to appointments and beds. This will help reduce appointment waits and inpatient length of stay.

"It is amazing to see the parallels between the manufacturing process and our value streams. We are seeing how we can make our jobs easier by reflecting on our processes and eliminating waste," said Darren Migita. "The end result of this effort will be safer and more accessible care for our patients and families."

How will we do this? Things we are learning and will bring back to Children's are tools, especially sketching (really!) to enhance our powers of observation. With these and other lean tools we are committing to accelerate our continuous improvement efforts. As we continue our CPI journey in Japan we are more and more excited about our potential for great improvement at Children's.

On a personal note, while we often don't know what we're eating, we are enjoying it....Joe Rutledge, leader of our Microbiology value stream team, is helping to guide us in making wise food choices.

More in a few days....