Three Questions

Three Questions

What does a Toyota-trained sensei ask?

“A sensei trained in the Toyota approach to Lean production asks three questions about just about everything:  1. What is the process?  2.  How can you tell if it is working?  3. What are you doing to improve it (if it is working)?”  (David Mann Creating a Lean Culture (CRC Press, 3rd edition, 2015, p. 301).   

In his 2015 book, Mann describes a management system to systematically ask and answer the sensei's questions in an organization.  The questions apply to specific work operations buried inside a value stream as well as to organization strategy development and deployment.  

What does a user of the Model for Improvement ask?

Someone trained to use the Model for Improvement asks these three question about almost everything:  1.  What are we trying to accomplish?  2. How will we know that a change is an improvement?  3.  What change can we make that will result in an improvement?

The Model for Improvement explicitly marries the three questions to the Plan-Do-Study-Act test cycle. 

Similarities and Differences

The second and third questions in each set match.

Question 2 concerns measurement.   Question 3 concerns changes to improve.   Toyota question 3 does add an important twist:  if the process is not working, then the immediate action is to make the process work.   In other words, fix the process so it produces products or services according to the process intent or design.   I know people argue whether this fixing work is “true” improvement; however, getting a process to reliably work as designed at minimum means better efficiency.   I count that as improvement.

The first questions frame the inquiry probed by the subsequent questions.   These questions differ.

The Model for Improvement question 1 applies to any situation.   The question applies equally to a one-time event, a complex system or a specific production process that cycles regularly.

In IHI work that applies the Model for Improvement, we often target systems for improvement.   One of my current IHI projects, Pursuing Equity, articulates and applies a theory of change to help health care organizations decrease health disparities and inequities.   We are working with eight health care organizations; each contains a complex network of direct care and support processes.  Part of the Pursuing Equity effort involves specific projects, like reducing disparities in cancer-screening between groups, stratified by race, ethnicity, language preference and insurance status.   Each project itself encompasses a system of people, equipment, facilities, and processes.  

The Toyota question shows the central importance of process to anyone who tries to improve production.   Recurring steps—a production process--characterize production systems.  The cover of Mann’s book makes the point graphically.   He shows Lean management system’s three components—visual controls, standard accountability process and leader standard work—cycling around a circle labeled “Process Focus!”  Go observe, make a diagram:   the Toyota question drives you to understand the work at the heart of production.

Ultimately in IHI work, we need to ask Toyota question 1 as well as the Model for Improvement question 1.  To reduce disparities in cancer screening for a population of patients, we must get to the level of specific work by clinicians and staff interacting with patients and families.  We need to identify one or more processes to translate intention into action.  Once we have described and understood the process or processes, we’re well-placed to ask questions 2 and 3 and apply test cycles (Plan-Do-Study-Act) to actually improve care.






Bundles in Health Care:  Practice Field for Standardized Work and Daily Management

Bundles in Health Care: Practice Field for Standardized Work and Daily Management

Historical Note on Statistical and Technical Control

Historical Note on Statistical and Technical Control