Applying Toyota Production System Principles in a Critical Care Unit

Virginia Mason Medical Center
Seattle, Washington, USA



Shirley Sherman, RN, CCRN, Assistant Nurse Manager, Day-to-Day Leader IHI Collaborative
Penny Gilliatt, RN, CCRN, Preceptor Coordinator and Assistant Nurse Manager
Lori Tyler, RN, MN, CCRN, CNS, Critical Care and Telemetry
Joe Streiff, RRT, Manager, Respiratory Therapy
Robert Hase, RRT, Manager, Respiratory Therapy
Michael Westley, MD, Medical Director, Critical Care and Respiratory Therapy
David Kregenow, MD, Critical Care Intensivist/Pulmonary Medicine
Rosemary Tempel, RNC, Project Manager, Clinical Quality Improvement



Use rapid tests of change to assess the value of various Toyota Production System (TPS) principles applied in Critical Care and Operating Room locations that may lead to more highly reliable, safer patient care.



  • Compliance rates with patient safety goals
  • Rate of improvement over time
  • Ability to maintain gains


  • Standardize locations of mechanical ventilators to ensure adequate supplies and save space.
  • Simplify and standardize routine anesthesia set-up using a shadow board.
  • Use redundancy, self-checks, and successive checks to assure Ventilator Bundle implementation to reduce ventilator-associated pneumonia (VAP).
  • Develop and implement a checklist and apply “stop-the-line” to assure Central Line Bundle use.
  • Use simple visual controls to reduce intensive insulin infusion associated with hypoglycemia.
  • Hold weekly, local leader safety rounds as a successive check  to assess staff/system performance with key safety initiatives and seek further opportunities for improvement.








Summary of Results / Lessons Learned / Next Steps

  • Encouraging innovation and participation in patient safety and process improvement work has changed our culture.
  • Maintaining the gains, spreading successful work, and improving reliability are done by local leaders using direct observation and team building activities.
  • Make processes simple, part of daily work, and value-added for the patient leads to success.
  • Standardized work processes enable new staff to join the workforce faster, and provide incentives to long-term staff (extra time, ease of mind).


Contact Information

Michael Westley, MD, FCCP
Medical Director, Critical Care
Virginia Mason Medical Center


[Storyboard presentation at IHI's 2nd Annual International Summit on Redesigning Hospital Care, June 2006]

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