A big part of the rigor of the trip is that our senseis demand a daily detailed "debrief' of our tours. Individually and by team we are asked each day to describe our overall impressions and key learnings, to identify the lean principles we saw demonstrated, and to identify the possible implications for Children's.

On Saturday in Kyoto we each presented our impressions about particular companies and visits from our first week in Japan. This approach led to each of our tour experiences being described three separate times by three different people.

Now you might say this is redundant or re-work, a form of muda! But it was actually a great example of the power of iteration. It was an eye-opening experience to hear the different perspectives and insights as people talked about essentially the same thing. With each new description we learned more.

So what have we learned? We've learned that lean is all about the scientific method, that transparency and visibility of data and results are integral to continuous improvement, that the best way to put patients and families first is to ensure that our people are respected for their opinions and well supported in their work...and much, much more---especially that iterative, continuous improvement is hard, hard work.

Monday we spent with Toyota. As Georgeann Hagland put it: "It was--in a word--awesome!"

At Toyota we found a clean and quiet manufacturing environment, ballet-like in its flow of people, material, information, and of course, cars. Toyota is a company that is forward-thinking and strategic, yet focused on the tiniest details to ensure that its customers receive defect-free products and its people have what they need to safely do their best work.

Here's what Joe Rutledge had to say: "We began at the Toyota museum (our first Sunday) where we saw the history of the company and learned more about two concepts we will bring to Children's: error-proofing and incremental changes. We ended our tour at Toyota headquarters which took us to the future, a journey, just like at Children's, enabled by the mature principles of the Toyota Production System."

On a personal note, this has been an exhausting, challenging, invigorating experience. Whether at the factories, on planes, trains, or buses, or over food and libations, we have not stopped talking about our learnings and their applications to Children's.

Though certain "wa" disturbing members of our team might be banished by local authorities until they learn to be more "demure," our time here has been a fantastic cultural, as well as lean learning opportunity. We're committed to making the best of that opportunity upon our return.

See you soon.....