That being said, Sunday (12/2/2007) was spent relearning to "see" more clearly in the fashion of lots of observations with hand drawn records. Identifying systems waste to eliminate it takes practice; we're getting practice, lots of practice.

A visit to the Toyota Commemorative Museum of Industry and Technology provided some important lessons in lean methodology. First and foremost, true growth as an organization needs to occur by iterative innovations acquired through patience and persistence, basically everyday continuous quality improvement.

Although we don't make cars at Children's, we have an equally complex and arguably more important product to produce, namely safe, efficient, high-quality health care. These represent universal goals for any health-care organization striving to be the best.

To paraphrase a founder of the Toyota organization, it is honorable to make things; it is equally honorable to make things better. Your Children's teams from Orthopedic Surgery, General Surgery and Critical Care Medicine are learning how to make health-care delivery better.

A simple, yet intense visit to a museum to learn about breakthroughs in the textile and automobile industries proved that we can identify what works and make it better. This will happen if we are willing to take some chances, realizing that even failure is worth the experience, and even the most grandiose systems usually have humble beginnings.

It seems apparent that inclusion of more visual clues along our burgeoning value streams at Children's will foster built-in quality for everything we do. An important auditory clue, the voice of the customer, is reflected in our ongoing commitment to include family-centered care in all process improvement initiatives.

When you hear that a group of us is in Japan, you might think that it sounds like we're on vacation. However, this is not a boondoggle waste of time and money. We're putting in long hours and we actually are learning to provide improved health care, because all of us think this is important. Meanwhile, our hosts, the Japanese people, are always smiling and gracious, but they are everywhere and they are more than plentiful.

Surprisingly, preparations for Christmas in Nagoya are nearly as nutso as in Seattle. Everyone seems to enjoy the warm toilet seats.

The food is intriguing and seemingly healthy, although some of us are a bit squeamish about all of the raw food courses we are encountering. Occasional entrees are reminiscent of a 3% saline infusion for cerebral edema; perhaps that explains why everyone seems to have reset their biological clocks in a timely manner.