1. Thompson, Debra N. MSN, RN
  2. Wolf, Gail A. DSN, RN, FAAN
  3. Spear, Steven J. DBA


Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)-a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care.


University of Pittsburgh Medical Center (UPMC) Health System, one of the largest and most comprehensive integrated delivery systems in the nation, is facing unprecedented challenges in maintaining its workforce, reducing error rates, improving quality, and raising staff morale. UPMC confronts these problems, as do all healthcare providers today, in an atmosphere of declining reimbursement and rising patient expectations complicated by nationwide nursing shortages. Yet, through nominal group processes (NGP), UPMC found that the systems that should enable nurses to rise to these challenges have become roadblocks to delivering efficient effective patient care.