Toyota Lean Manufacturing systems include a process called ‘Andon’. 

Andon is a ‘stop the line’ process which permits an assembly line worker to pause or stop the assembly line when a problem or defect is identified. 

Andon is a terminal escalation tool which relies on the individual to exert a decisive and definitive act.

In contrast, ‘Ten Thousand Feet’ is an early graded escalation tool which draws the team together and refocuses attention to the task at hand. 

It can also be used to flag concerns. 

Right from the beginning of ‘Below Ten Thousand’ we realised healthcare inhabits central paradigms of both lean manufacturing precision, and aeronautical risk management and safety.  

Our thinking was triggered by a Professor of Surgery who disliked the parallels our idea bore with the airline industry.

John and I mindmapped his resistance on the theatre library whiteboard. 

I clearly remember two branches of the mindmap:

Aeronautical and manufacturing;

And we puzzled over why anyone would want to resist the adoption of a no-cost harm free safety measure merely on the basis of a superficial personal dislike. 

Therefore we remain adamant that the Kaizen-style properties intrinsic to both these industries have a place in healthcare. 

Our aim was for ‘Ten Thousand Feet’ to serve to effect the appropriate team behavioural responses necessary to enhance the safety of the clinical operating environment.

The act of advocating for ‘Below Ten Thousand’  reminds us of our ethical commitment to an overarching safety culture.

But in the end, if needs be, we must halt or stop the line. 


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