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Establishing operational stability—developing human infrastructure
  1. Max A Gomez,
  2. Ernest J Byers,
  3. Preston Stingley,
  4. Robert M Sheridan,
  5. Joshua A Hirsch
  1. Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to M A Gomez, Massachusetts General Hospital, 175 Cambridge Street Suite 200, Boston, MA 02129, USA; mgomezii{at}


Over the past year, Toyota has come under harsh scrutiny as a result of several recalls. These well publicized mishaps have not only done damage to Toyota's otherwise sterling reputation for quality but have also called into question the assertions from a phalanx of followers that Toyota's production system (generically referred to as TPS or Lean) is the best method by which to structure one's systems of operation. In this article, we discuss how Toyota, faced with the pressure to grow its business, did not appropriately cadence this growth with the continued development and maintenance of the process capabilities (vis a vis the development of human infrastructure) needed to adequately support that growth. We draw parallels between the pressure Toyota faced to grow its business and the pressure neurointerventional practices face to grow theirs, and offer a methodology to support that growth without sacrificing quality.

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  • Competing interests None.

  • Provenance and peer review Commissioned; not externally peer reviewed.