To the Editor: The authors of the recent MJA article “Making cars and making health care: a critical review”1 have misunderstood the importance of process design in a service as complex as health care delivery. They state that the Toyota “lean thinking” model has been “accepted somewhat uncritically” in health.1 In fact, the opposite is true. Work practices and roles in conservative institutions such as public hospitals have changed minimally over many years. Cutting-edge medical technology is delivered within an archaic work practice model that fosters inefficiency, frustration and unnecessary expense. Inefficient work practices give skilled clinicians less time with their patients — not more.