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This is a Spanish version. Chronicles the initial efforts to teach a health care organization to manage itself according to the principles of the Toyota Production System (TPS). Describes the decision and dilemmas that arose from the implementation experiment. Builds on Bowen and Spear's earlier research in industrial settings. They found that TPS is an integrated approach to designing, doing, and improving the work of individual people and of groups of people working collaboratively to produce and deliver goods, services, and information. The Deaconess-Glover Hospital project tested the efficacy of the TPS in a nonindustrial setting (ie, health care) and also offered insight into how to convert an organization, managed by its existing management system to one managed by TPS principles. This case provides background on Deaconess-Glover Hospital and on the TPS teacher, John Kenagy. Describes how Kenagy observed the work at the hospital to understand the system. Given how Kenagy gathered data and based on what he directly observed, what should he recommend to managers about their next step?