By December 15, 2010 3 Comments Read More →

Reader Question: When the Stated Values Don’t Match Daily Reality

I received a question from a reader, a retiree from a manufacturing company who is now a volunteer for a healthcare organization. We have exchanged messages before about opportunities to apply Lean thinking in a faith-based mission-driven organization like this, to provide better care and to have a better experience for the volunteers (not to mention the full time staff members).

The core question, including the question I’m publishing below (with permission) is about why the stated values of organization might be so out of sync with the daily reality in “the gemba” or the real workplace.

Here is the question and info from the reader begins:

I had two meetings at our organization yesterday. At the 5:00 volunteer meeting, I was asked what difficulties I was having (as opposed to what could be improved), I related how I wanted to supply an empty patient room but had a hard time visually finding the list and then the location of supplies in various locations. The supply of washbasins in stock had been depleted to zero, so no matter how I looked, I wasn’t going to find them.

She just didn’t get it. Her first response was to defend management why they did it this way (the doors of the four similar-looking stock / utility rooms aren’t labeled because the administrator “doesn’t want it to look institutional”). Then she told me how they had one of the nuns label the shelves in the store room, and if we still can’t find stuff, it must either be our fault or the nun’s for not labeling it properly (she doesn’t assist in patient care, so I doubt she even knows what most of the stuff is, let alone what it is for).

This is a really common problem in healthcare, wasting people’s time with what many call “hunting and gathering.” Supply systems aren’t set up to properly support those doing the work (or the volunteering).

What I’m also reading here is a blaming response from the leader. She’s blaming him for not being able to find things. How easy it can be for a manager to blame you for problems you are bringing up. It would be understandable if my reader, the volunteer, started hoarding washbasins someplace to make sure he always had a supply. Don’t you wish there had been a different reaction from the manager?

The reader continues:

So to her, the problem boiled down to how I couldn’t find washbasins. She suggested that maybe we have a person put a bunch of “kits” together so that whenever a room needs stocked, everything is together in the kit.

Kitting is a fairly common solution in healthcare, creating “bundles” of supplies, such as a kit for doing central line insertion. You can often buy these items as a kit from a distributor. But buying a solution doesn’t change the core thinking of the organization and it doesn’t change the management style. Does the organization have a value statement that says “we won’t waste the time of our volunteers or employees?” Maybe they should. If they start buying kits, will volunteers then have trouble finding the kits, if they haven’t addressed the root cause of why they can’t find things (looking to systems and processes instead of blaming people?).

The rest of the story:

Then in the following meeting, the same woman talked about and showed a 30 minute video on the core values of the parent organization.

Two of the core values are

  • “respect for human dignity” (includes “> Foster an environment that supports retention of qualified and committed employees”) and
  • transformation”, described as:”The process that encourages an open mind and heart, leading to continuous improvement of the person and ministry.”

It continues:

The value of transformation requires us to:

  • > Seek to continuously improve our services.
  • > Use best practices to help the ministry achieve its goals.
  • > Maintain competencies and skills that support excellent service.
  • > Place the common good above personal convenience.
  • > Respectfully challenge colleagues/co-workers to consistently uphold our ministry’s mission and values.
  • > Work in a spirit of teamwork and collaboration to achieve organizational goals.

Unfortunately, I think there’s a bit of a disconnect! But since the values are there and they are committed to them (maybe they just don’t quite know how to execute), there is hope.

There’s no evidence from my exchanges with the reader that this organization practices Lean or knows anything about it.

But, surprisingly, their two core values there sound a lot like those of Toyota:

  1. Continuous improvement
  2. “Respect for People”

Does the manager have “an open mind and heart” that leads to continuous improvement? It seems that the leader might not be living up to the standards stated on their website.

I see many Lean-type buzzwords in the “value of transformation” statement, including:

  • continuously improve
  • excellent service
  • common good
  • respectfully challenge
  • spirit of teamwork and collaboration

So my reader says maybe there is hope. I don’t know. It’s very easy for an organization and its leaders to NOT live up to the stated values. It’s pretty common, even.

When I started my career at the now-defunct GM Livonia Engine Plant, part of the appeal to me as college student who had read Dr. W. Edwards Deming’s Out of the Crisis for “fun” during college was that the idea that they followed the “Deming Philosophy” under the name of the “Livonia Philosophy.” It all sounded good. But when I showed up to work, it became clear that the Livonia Philosophy was just a bunch of paper hanging on the wall.

Oh, the irony. Dr. Deming would have hated that, I’m sure. His ideas had been turned into mere posters and slogans.

That plant didn’t live up to the stated values until we got a new plant manager who had NUMMI experience with Toyota and Lean. He brought a different attitude and a new management approach. Things quickly got better in that plant and their performance improved greatly, with the same people and the same machines.

It’s sad when hospitals – organizations that are supposed to be very caring and mission-driven – don’t live up to their high-minded ideals and values. It seems particularly sad when a church-based or faith-based organization falls short of those goals.

I guess the managers don’t start the day by reading the stated values on the organization website. And it seems they might be missing leaders who continually look out for people who aren’t living those values.

Forget tools and methods (like 5S or kanban for making sure supplies are well-organized and re-stocked). It all comes down to leadership, doesn’t it? There are clearly many, many good things that happen in healthcare organizations every day, but little frustrations can certainly add up to poor morale and people who get really cynical and burned out after decades of not being listened to.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

3 Comments on "Reader Question: When the Stated Values Don’t Match Daily Reality"

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  1. Mark Welch says:

    I have a colleague who, when experiencing this gap between stated and practiced values, likes to use the phrase “managing expectations.” In other words, lowering them. It helps her cope on a regular basis. Perhaps such an approach could be helpful for the reader who is having the above experience because I agree that it is very common for organizations to have such a gap. If the leadership isn’t going to live or reinforce them, the situation is not going to change.

    I agree that it’s particularly sad when the institution is faith-based, because they are stating that they are holding themselves to a higher, ecclesiastical standard, which makes the hypocrisy, the gap between values and practice, appear that much greater to staff and patients. Of course, those of us who practice a faith always fall short. Myself included. It’s just that the perception on the part of staff and patients results in a greater gap. And maybe it’s more than just perception.

  2. Roger Chen says:

    The theme of “no performance improvement without performance management” seems to be resonating with me a lot lately. There seems to be an inherent difficulty or dichotomy with the personality of many health “care – givers” to deliver performance feedback that feels or seems like conflict or “hurts” a person’s feelings. Throw in faith based or not for profit mission driven values, and the dichotomy increases. Granted, this is not corporate America (debatable given the dollars), however, the need to improve requires coaching and development, which is performance management. I would love to get a debate going on this one.

  3. Adam Zak says:

    Healthcare. Manufacturing. Financial Services. Volunteer. Paid. Profit-minded. Non-Profit. It does NOT matter.

    Readers here know the Lean principles. We know the Lean tools. It all boils down to two critical things: Leadership and Execution. These are the key elements I look for in every executive candidate I interview. Everything else is just frosting on the cake.

    Adam Zak

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