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Teach doctors economics, not Toyota’s management fads

BMJ 2010; 340 doi: (Published 18 March 2010) Cite this as: BMJ 2010;340:c1507
  1. Cam Donaldson, Health Foundation chair in health economics, National Institute for Health Research senior investigator,
  2. Angela Bate, lecturer in health economics
  1. 1Institute of Health and Society, Newcastle University
  1. Correspondence to: C Donaldson cam.donaldson{at}

    No one will be gloating over the troubles of the car manufacturer Toyota with respect to its mass recalls because of faulty brake and accelerator pedals. The situation has caused great distress and potential serious harm among Toyota customers. Typically, there will be much schadenfreude over the efforts spent on trying to adapt the famous and much respected Toyota Production System (TPS) to the NHS and other healthcare organisations around the world (see BMJ 2008;337:a824, doi:10.1136/bmj.a824).

    The principles of “lean thinking,” of which the TPS is but one exemplar, are not changed by Toyota’s woes. How can we argue against designing processes of care that eliminate waste and encourage standard working, saving valuable healthcare resources that can then be used to meet other needs? Nevertheless, the schadenfreude experienced by some may have an element of validity to it. As health economists, we admit to such feelings and want to explain our three main reasons.

    Firstly, Toyota’s …

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