At the new hospital, running through all the tasks, they were able to return to productivity in just nine weeks, a dramatic difference based on the learning context.

DM: So instead of learning how the IT system was designed, you need to learn how to use it to do your job.


JR: One thing here is most places are dissatisfied with their current system and feel once they get a new system it will all be better. But they misdiagnose the problem. They largely blame a failure of technology. In my experience, the providers of these new IT systems are really good at designing them and creating functionality. But if you're unable to surface the problems with how people learn, it becomes really easy to misunderstand.

We change the teaching program. Reduce the classroom stuff and make it about how people do their work. Some of our clients, with the big vendors, you buy the whole training package. And that puts the health care organization at a disadvantage. Because they accept that there is no way to teach other than walking people through the manual. We now have clients that design the teaching program themselves, which is an advantage. They make the experience more relevant for the end users. We don't help them understand the functionality. It's all about [clinicians] taking care of patients. That's our emphasis. Learning how to use the functionality properly in the context of how you meet your patients' needs and your customers' needs, there's a great opportunity.

DM: Where does the name Rule 4 Consulting come from?

JR: It's the fourth rule of the Toyota production system.

DM: The quality improvement system.

JR: Right. Rule 4 says that all improvements be made in accordance with the scientific method and guidance of the teacher and as "low" as possible in the organization. While "low" is not a flattering way to put it, we engage people who are closest to the work. So rather than the job of leaders being to fix the work of people they lead, it is to coach and develop their skills.

DM: Did you see that latest Toyota headline with the driver in California? It's so ironic that they are famous for their quality improvement system that is so widely respected in industry as well as health care. Their greatest contribution may end up being in quality management and not in cars at all.

JR: It is awkward when I tell people what I do. They hadn't had a recall till two years ago. People weren't aware of Toyota's success. And hospitals thought we were crazy and said "we aren't working on cars we are working on people." But the principles are perfectly applicable. People are growing more accepting of quality principles in health care. I am sure we will learn from the new [Toyota] failures.

More Voices