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Diagnosis (Berl). 2019 Mar 16. pii: /j/dx.ahead-of-print/dx-2018-0081/dx-2018-0081.xml. doi: 10.1515/dx-2018-0081. [Epub ahead of print]

Teaching novice clinicians how to reduce diagnostic waste and errors by applying the Toyota Production System.

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Department of Medicine, University of Florida, Gainesville, FL, USA.
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.


Background Diagnostic waste, defined as the ordering of low value tests, increases cost, causes delays, increases complexity, and reduces reliability. The Toyota Production System (TPS) is a powerful approach for process improvement that has not been applied to the diagnostic process. We describe a curriculum based on tools and principles of TPS that provides medical students with an approach for reducing diagnostic waste and improving patient management. Methods A 2-day elective course "Fixing Healthcare Delivery" was offered to medical students at the University of Florida, Gainesville. A section within the course had three learning objectives related to TPS: (1) define value in health care; (2) describe how diagnostic waste leads to time delays and diagnostic errors; and (3) apply sequential and iterative value streams for patient management. Instruction methods included videos, readings, and online quizzes followed by a 2-h seminar with facilitated discussion and active problem solving. Results During the 3 years the course was offered students (nā€‰=ā€‰25) achieved average scores of 95% on a pre-seminar test of manufacturing principles applied to the diagnostic and management process. Course evaluations averaged 4.94 out of 5 (nā€‰=ā€‰31). Conclusions Students appreciated the application of the TPS principles to the diagnostic process and expressed the desire to apply these manufacturing principles in their future diagnostic and management decision-making.


Lean; Toyota Production System; diagnostic error; diagnostic waste; patient safety; value streams


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