Comments on: How Many Hospitals Have Quit Lean Efforts?

By: Brad Power

Brad Power — Wed, 11 Aug 2010 10:58:24 +0000

On the original question of failure statistics: John Kotter (author of Managing Change) writes about his research on organizational change initiatives of all types and quotes a 30% success rate. Michael Hammer (co-founder of business reengineering) used to quote 10% unqualified success, an additional 20% qualified success, and 70% didn’t realize targeted results from reengineering efforts. I believe there are fundamental forces in organizations that make any sustained change problematic, including traditional mindsets, the disruption of change, competing demands for attention, strategic irrelevance, and traditional management processes.

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By: Mark Graban

Mark Graban — Tue, 10 Aug 2010 12:44:39 +0000

John M. – you seem like a reasonable fellow. Trust me, I share your concerns as you articulated so well. Part of my beef with Prof. Seddon is that he seems to take glee and joy in the failures of lean that he screams about in his newsletter and articles. That’s part of where we get off the rails. Thanks for reading and participating.

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By: John Matthews

John Matthews — Tue, 10 Aug 2010 10:38:44 +0000

Much as I would like to continue taking part in this discussion, circumstances dictate otherwise for the time being. So I hope you will indulge me one final time so that I can summarize my thoughts on this topic.
John Seddon is very worried (as am I and many others) about the number of lean initiatives that are failing around the world, including some very large organisations whose subsequent problems are receiving widespread adverse and seriously damaging publicity. The cause is pretty much always down to management’s – and their consultant’s – inability to change their mind-sets and their historical organisational cultures. Commonly managers fail to recognize that they need to transform themselves every bit as much as they expect their staff to change. There is a tendency to use inappropriate measures (such as arbitrary targets) and attempts made to incorporate lean tools into their autocratic, dysfunctional systems, much like the big auto companies did when they tried to ‘copy’ Toyota for decades without success.
There is a real danger that lean will end up on the scrap heap of tried-and-found-to-be-wanting fads in the eyes of those that desperately need it most.
Having studied these failing lean ventures, Seddon has come up with certain ideas and methods which he believes are best suited to addressing this problem.
I would recommend that you read Seddon’s latest book (Systems Thinking in the Public Sector: The Failure of the Reform Regime..and a Manifesto For A Better Way) and look at the two websites he maintains. Much of the content is not healthcare related but don’t let that put you off: the subject matter is eminently transferable.
Another option would be to read what a well respected writer on lean thinking, John Bicheno, has to say in his book “The Lean Toolbox for Service Systems” where he includes a clear summary of Seddon’s approach, giving an insight into how it differs from other lean practitioners in several important ways, and why it is worth learning about. The answers to many of the questions you ask, Walter, will – I believe – become clearer should you choose to follow the above suggestions.
This is why I made my original entry to this blog: to inform participants about his work so that you could read about it and make up your own minds. Surely it makes sense to be as informed as possible about ideas related to what does, and what doesn’t work when trying to implement lean/systems thinking?
In the spirit of Taiichi Ohno I shall now withdraw in order to let you all get on with your important learning. My only parting shot is to thank you for this opportunity and to convey to you all my best wishes in all your future endeavours.

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By: Mark Graban

Mark Graban — Mon, 09 Aug 2010 22:31:49 +0000

Walter – great questions, plenty for all of us to continue thinking about. Yes, there is plenty of that dynamic amongst lean consultants – whose approach (which “flavor of lean”) is best, etc.

Seddon used to call his work lean service, now he seems to have gone out of his way to invent his own creation that’s different… but it seems not to be that wildly different. It’s a flavor of lean. So that’s an extra level of brazenness, perhaps, to create his own field or to co-opt the name “systems thinking” (which has roots tied to Dr. Deming, Peter Senge, and others).

“How does a company know whether (1) the system is ineffective, (2) they’ve not applied it correctly, or (3) they just haven’t given it enough time?”

Great questions. I’ll, again, put this out there: Some organizations and some leaders (and some consultants) are able to make Lean work (and it’s often a combination of those factors). Some organizations struggle mightily to change and understand Lean at a deep enough level to be successful…

The variation in results can mean there’s a variation in how they went about Lean or even variation in what they did.

My beef with the John Seddon crowd is the use of absolutes – “lean never works,” stuff like that. It’s a falsely overly absolute statement. So I’ll call them on that.

Do I wish them ill or their clients ill? No, of course not. Anyone who brings quality improvement and a better workplace to people deserves praise. I wish they would just focus on that instead of their big focus on tearing down “lean” to their own benefit.

If hospitals hear their “lean doesn’t work in healthcare (or services)” mantra and then the hospital doesn’t even try Lean, then one could argue John Seddon has done a great disservice to the hospital, their employees, and their patients. Lean CAN work and lean DOES work. That’s why I take offense when they say it does not. This stuff is far more important than the turf battle that the Seddon crowd started with their attacks on Lean.

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By: Walter Reade

Walter Reade — Mon, 09 Aug 2010 22:11:55 +0000

What an interesting topic!

I am not an expert, and I don’t suggest that I have any solutions. But I’d like to share a few thoughts.

First, a minor point – to Mark’s observation about John Seddon: Lean doesn’t work, hire me – that seems to be his mantra. I’ve met very few consultants that don’t have this mantra. “Not getting results? You just had the wrong tool. We can help you with that.” Any it’s easy for management to fall for this line, since it implies an easy fix. Anyway, that’s been my experience. (But, of course, I’ve met some outstanding consultants, too.)

To the topic being discussed – I’m really trying to wrap my head around how one would go about evaluating the general efficacy of an improvement system, program, tool, management framework, etc. Is it the success rate across various companies and industries? How does one measure success? How do you even evaluate whether the system, program, tool, etc., was applied correctly? I’m totally at a loss with this. Any criteria I come up with can easily be dismantled.

For example, pick any failed improvement effort over the last few decades. You’ll always hear the practitioners and consultants claim it wasn’t implemented or applied correctly. Maybe that’s true, but does that matter? If it is too hard to get results with the system, is the fault in the system?

If ISO 9000 or Six Sigma or Lean or TOC or Systems Thinking didn’t get the results we expected, what then? Try harder? Try a new system? Hire different consultants?

How does a company know whether (1) the system is ineffective, (2) they’ve not applied it correctly, or (3) they just haven’t given it enough time?

This is a challenging question to answer because of many different confounding factors, both internal and external to a corporation.

Thoughts anyone?

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By: John Matthews

John Matthews — Mon, 09 Aug 2010 21:02:23 +0000

My disappointment was with the direction the discussion was taking. I will answer your latest comments, but not now. I need to retire and do other things. Look forward to communicating again soon.

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By: Mark Graban

Mark Graban — Mon, 09 Aug 2010 20:54:05 +0000

John – Sorry to disappoint you.

You say “looking at key organisational demand flows and capability as a starting point”

- That’s called value stream mapping and looking at customer demand. This is covered pretty well in the book “Making Hospitals Work” in a pretty direct way.

- Failure demand = defects and rework. John has coined his own phrase here.

This is all core lean thinking, I’d argue (dispassionately).

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By: John Matthews

John Matthews — Mon, 09 Aug 2010 20:45:26 +0000

Alright. I was hoping we could begin to discuss issues dispationately, but apparently that is not going to happen. You seem to have moved from your original statement that Seddon has some excellent ideas to a stream of vituperation and insult, on a par with what you complain about in him. By the way, I have seen no reference to failure demand (as he describes it) – or any other description of it in your book or others until long after John started talking about it. Moreover looking at key organisational demand flows and capability as a starting point is conspicuous by its absence in most lean writing I have come across. Which is why I thought it would be interesting for your contributors to look him up. I don’t know about the others, but I would still like to discuss the issues dispationately. Sadly, I am beginning to wonder if you can or if you are just intent on getting a sense of personal insult off your chest. Sorry to be so blunt – it is a reflection of my own disappointment.

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By: Mark Graban

Mark Graban — Mon, 09 Aug 2010 20:03:07 +0000

I’m not taking it personally, John. I’m defending a methodology that I know to be a good one – Lean. Do organizations often “fail” with Lean? Yes – is that the fault of the organization or of Lean? You say Lean is counterintuitive – exactly why it so often fails. The same would have to be true of the counterintuitive systems thinking of John Seddon, right?

You disagree with what about John Seddon, that he shouldn’t tone down his rhetoric? He seems to love riling people up, so I shouldn’t give him the satisfaction, but just because some people find him objectionable doesn’t make him Socrates or something.

The idea of looking at demand or even failure demand isn’t a unique discovery of John Seddon. This is something I’d consider a core part of the Lean approach – understand demand and takt time (oh wait, Seddon says that doesn’t apply to healthcare) and then understand defects in the process that lead to phone calls, rework, etc. (what he coins as “failure demand” and repeats incessantly).

I don’t see the point in trying to communicate with John directly. I’d expect to get nothing but insults in return. I’ve tried having discussions with his man in the U.S. and he doesn’t listen or budge from his extreme position that “lean doesn’t work in services” (a position that is laughably untrue) so it isn’t worth my time to try to engage directly, frankly.

Everything else you said makes sense, so I don’t know what else to say. It worries you that I didn’t respond? Why?

There is much common ground between good Lean Thinking and Systems Thinking. It’s Seddon who is driving the unnecessary wedge… for what seems like selfish reasons, or that’s all we can surmise (Lean doesn’t work, hire me – that seems to be his mantra).

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By: John Matthews

John Matthews — Mon, 09 Aug 2010 19:51:15 +0000

One thing I have learnt by living in a dysfunctional system is not to take things too personally – it is a blind alley. To me there is nothing more important than improving life and moving civilization on. Some of the most important ideas have come from those who others find objectionable. I’m reminded of someone who once criticised a leader of Greenpeace for smoking, which prompted the reply: “by all means come to me if you want to change the world, but don’t expect me to be a xxxxx saint at the same time!” As it happens, I don’t agree with you about John, however I hope we can keep on communicating. Much of what he says reflects his frustration with what he sees as other’s blind spot, but he can speak for himself. Perhaps you should be communicating with him? It worries me that you did not comment on any of the issues contained in my last submission. That would be really useful and is what I am really interested in. I really would like that.

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