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theda A Book, a Webinar, a Workshop & a Summit from the ThedaCare Center for Healthcare Value lean

I am an unabashed fan of the ThedaCare Center for Healthcare Value, as you’re probably aware. For full disclosure, I was previously an employee of the Lean Enterprise Institute, a key partner of the Center.

They have a lot of great information and events, so I’d like to use today’s post to share that with you and encourage you to take advantage of what they’re offering and to help share.

Book: Beyond Heroes

The Center is now taking orders for a new book: Beyond Heroes: A Lean Management System for Healthcare, written by Kim Barnas, a former Senior VP at the ThedaCare health system and a key leader in their Lean journey.

I was fortunate to read a preview copy and this is my endorsement blurb:

Many people talk about lean management, but Kim Barnas is one of the few who have actually built a robust lean management system in healthcare. Beyond Heroes will be immeasurably useful to organizations that are looking to move beyond tools and projects to a culture that creates the best patient care and a far better workplace for healthcare professionals. This book is full of impactful stories and meaningful, practical advice that is grounded in the realities of healthcare, while making real the potential that every organization should be achieving. I’d strongly recommend this book to every healthcare leader – read it, talk about it, and put in the hard work required to make these meaningful changes happen.

I have a lot of respect for Kim from my visits to ThedaCare and I can’t recommend this highly enough.

I’m told that a Kindle version will be available… but not at the moment:

Kim Barnas Podcast coming soon

I recently recorded a podcast with Kim and will be releasing that really soon.

Free Webinar

The Center also announced an upcoming webinar: Real World Evidence of Performance Improvement – Decreasing Readmission Rates at ThedaCare using Clinical Business Intelligence and Lean Process Improvement Techniques.

That’s a mouthful, but I’m sure it will be good. Check it out on April 30 and register today.

Let me also plug two webinars that I’m involved in that have nothing to do with the Center:

Lean for Physicians Workshop

I played a (paid) role last year to work with The Center and some ThedaCare physicians to help create a one-day “Lean for Physicians” workshop that’s now titled:

Lean for the Practicing Physician

“Lean for the Practicing Physician” is the new name for “The Science of Problem Solving for Physicians,” our 1-day program designed and facilitated by physicians, for physicians. We have also incorporated fresh content based on feedback from practicing physicians who use lean every day, such as a new module on how to accelerate problem solving through the application of improvement kata.

Join your colleagues!

>>Learn more

>>Attend at the Summit

Lean Healthcare Transformation Summit

If the words “at the Summit” confused you just there, you need to learn about the best Lean healthcare conference of the year: the 5th annual Lean Healthcare Transformation Summit.

This event is not only outstanding because of the speakers and presenters (all healthcare leaders, physicians, and practitioners), but also for the other attendees. If you’re looking for THE place to network and meet others who are doing what you’re doing in Lean healthcare, this is it.

Disclosure: I am attending for free, in exchange for moderating main stage Q&A sessions and moderating, for the 5th year, the CEO Panel. This year the panel features Kathryn Correia, Maura Davies, and Laura Easton.

I hope to see you there… and take advantage of these resources — both free (hooray) and paid (worth the price!)


blog photo A Book, a Webinar, a Workshop & a Summit from the ThedaCare Center for Healthcare Value leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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I’ve been amused by the Hotels.com “Captain Obvious” character and TV commercials. Hotels.com is, um, a site where you book hotels. Obvious.

It’s often said that Lean is “common sense.” If that’s true, I guess it goes along with the phrase that common sense is uncommon.

Aspects of a Lean culture often seem like common sense, but only in hindsight. We should involve all employees in identifying and solving problems. Obvious. Simple. Then why doesn’t that happen in most organizations?

As David Mann says, the challenge isn’t that Lean is complicated… the challenge is that it’s very different than the way most organizations operate.

To celebrate the “obviousness” of Lean, I’ve created some images (that I shared on Twitter with the hashtag #ObviouslyLean) and I’d invite you to create and share your own.

Slide1 540x272 Lean is Common Sense? #ObviouslyLean lean

Slide2 540x272 Lean is Common Sense? #ObviouslyLean lean

Slide3 540x272 Lean is Common Sense? #ObviouslyLean lean

Slide4 540x270 Lean is Common Sense? #ObviouslyLean lean

Slide5 540x272 Lean is Common Sense? #ObviouslyLean lean

Slide6 540x274 Lean is Common Sense? #ObviouslyLean lean

Slide7 540x271 Lean is Common Sense? #ObviouslyLean lean

A Contest:

And here is a blank template you can use to create your own (click on it for a larger file and download it). You can add text using PowerPoint or a graphics editor and then save as a .png or .jpg.  Here is a PowerPoint template you can use.

ObviouslyLeanTemplate 540x275 Lean is Common Sense? #ObviouslyLean lean

If you have one to submit, post it to Twitter with the hashtag #ObviouslyLean or submit it for consideration via the form below. You might be selected to receive a copy of a book from my “Inventory of Duplicate Lean Books” or a copy of The Executive Guide to Healthcare Kaizen. It’s just that obvious.

* indicates required field

Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 1mb.

By submitting an image, you grant Mark Graban to post your image on LeanBlog.org (not all submissions will be published).


blog photo Lean is Common Sense? #ObviouslyLean leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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earthquake damage  avon river 150x150 How to Create a Dysfunctional Culture Where Employees & Customers Are Unhappy leanOn this blog, I write a lot about how to create a “Lean” culture where employees and customers are happy. Engaged employees lead to happy customers — and sustainable business success.

It’s often instructive, however, to see or hear about a broken and dysfunctional culture. Sometimes the clearest examples of WHAT to do come from looking at what NOT to do. That’s one reason why the first year of my stint at GM was so helpful to me, even if it was really frustrating (as I’ve written about here, here, here, and here). When you see the results of a BAD culture, it drives you to help create GOOD cultures. That’s what motivates me.

But let’s think about an typical bad company culture. Like a Dilbert cartoon, it could be about any company or combination of companies. None of it is made up or theoretical. Things like this happen in organizations. It makes you shudder. Shows like Kitchen Nightmares and Bar Rescue are also very instructive in these “best bad practices.”

What follows is a tongue in cheek guide for creating a dysfunctional culture and business failure.  Most of these tips would apply to a local “store manager” or “branch manager” of a business. I don’t recommend you follow this path. I’m incredibly fortunate to NOT be working in an environment like this now, although I have in the past. I’ve spoken with many people who DO work in this type of environment.

How to Create that Broken Culture

Insist on being “the boss,” who’s infallible and cannot be question. The boss is always right and must be listened to, or else.

Make alliances with some employees and make it clear you will protect them if they are loyal to you. Openly play favorites and let your favorites get away with things that you’d punish other employees for.

Hire young, inexperienced employees who you can manipulate, people who are happy to have a job and will see you as some sort of parent figure who they must be loyal to.

Encourage those “loyal” employees to spy on the other employees and give you reports on things you can use against them.

Tell the most loyoal employees that you are “out to get” some of the other employees and that you are working to get them fired.

Fire the first employee who dares to even slightly question what you’re telling them to do. You want employees who do what they’re told.

Fire the first employee who has too many ideas about how things should be better. Label them as difficult or insubordinate.

Have an employee train somebody new for how to do their job, then fire the person who did the training.

After you’re fired some of those employees, be sure to bad mouth them to customers. Accuse the fired employee of something like stealing.

Tell them you want their input… then brutally ignore it when they give input (this is also a great way to get “troublemakers” to identify themselves).

Make sure your employees know they can’t do anything other than basic tasks without checking with the boss for permission.

Ensure the employees don’t have all of the tools and supplies they need to do their jobs. If they complain about this, label them as insubordinate.

When things go wrong, blame the employees. Always.

Never ask customers if they are satisfied or if they have any feedback or ideas. If you must ask for feedback, send a confusing and badly designed survey. Don’t share any of those results or plans for improvement with customers (because there are no plans for improvement).

If customers complain about service or the product:

  • Ignore their feedback
  • Argue with the customers about what they are saying
  • Lie to the customers about what you had told them before
  • Tell them they are complaining too much and some people will just never be happy
  • Tell the customers they won’t get better service anyplace else, anyway

Then, badmouth those customers to employees (not the ones you have aligned yourself with). Remind everybody that the customer is the problem.

Take any feedback personally. VERY personally. If somebody criticizes the process or the product, internalize it and react as if they’ve just compared you to Hitler.

Make changes to policies and services without talking to your customers. The more insignificant and more arbitrary the changes the better, as this keeps your customers off guard.

Tell your employees to lie to the customers about problems, defects, or delays.

If an employee talks with a customer without you being there, be sure to confront the employee when they come to work the next day and ask them what they talked to the customer about.

Don’t tell employees about how to reach more senior leaders beyond their local manager. Don’t give them an employee handbook that includes information about the anonymous tip line they are supposed to be able to complain about ethical concerns.

Never do any anonymous employee surveys that would allow them to give honest feedback or raise concerns.

Spend most of your time telling your senior leaders who aren’t on site that everything is fine and that there are no problems and there’s especially not anything you need help with.

Don’t ask for management or leadership training, as that would indicate you are weak. Remember, you already know everything.

When employees speak up with concerns, ignore them or threaten them with termination (this is especially helpful when you’ve made it clear through the rumor mill that you’re “out to get” them).

Have a senior leader come visit to ask employees how things are going and if they like working for their boss. If you’ve properly intimidated your employees into not speaking up, they’ll tell the visiting senior leader that everything is fine. That reinforces your communication that things are fine.

Never have overall site team meetings. Hold meetings rarely with individual departments. Discourage employees from different areas or roles from talking with each other. Discourage employees from speaking freely to each other at all.

Special tips for senior leaders:

Rarely, if ever, visit the locations.

Do your best to isolate yourself from customers and front-line employees.

Base your decisions on how location sites or branches are operating on emailed reports, spreadsheets, and what the local managers tell you.

If a customer or an employee DOES somehow get to you, continually remind them that you value their honest input, even though you don’t.

Remind front-line employees that they can speak up freely (but then use anything they say against them). Even if you don’t get any details, assume the employees who try to speak up are, by default, troublemakers who need to be removed.

I think that’s a pretty good list. What else would you add for “how to create a dysfunctional culture?”


blog photo How to Create a Dysfunctional Culture Where Employees & Customers Are Unhappy leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


photo by: martinluff

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I’m not a racing fan, but wow this video is impressive. I can appreciate a great process and all of the planning that’s involved.

I can also see the difference between having four pit crew members and 18 crew members (or so… it’s hard to count).

What can you do to improve your processes? It takes more than “throwing people at it” if that’s even an option. What planning, training, tools and coordination are required?


blog photo Video: Formula 1 Pit Stops 1950 & Today... a Huge Difference leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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officer at periscope in control room of submarine 150x150 Things That Make Me Worry About My Colonoscopy: Patient Safety leanSorry to get all Katie Couric on you, but I’m going to have a colonoscopy on Friday. I turned 40 last October and I have some family history that leads my doctor to get one done now rather than at 50.

Unlike Katie, I won’t be broadcasting mine live, but I’ll share some articles and reflections on the process and, being process focused, what could go wrong. It’s a very necessary procedure, but there are, sadly, some very unnecessary and preventable risks.

According to  Dr. Wikipedia (backed by journals):

This procedure has a low (0.35%) risk of serious complications

That’s about 1 in 300 patients, put another way.

For those of you who speak Six Sigma, that’s a 99.65% first time yield and a 4.2 sigma level.

That’s not going to scare me away.

Maybe I should have asked what my physician’s complication rates are. What are the complication rates at the surgical center where this will be done? Is this safer than being at a full-blown hospital or doesn’t it matter? Should I be more of an “engaged patient?”

Should I have asked more questions of my primary care provider? Why did she refer me to this GI specialist? Is he a “Best” doctor? Does that matter?

If I treat them as a supplier (respectfully), should I be able to walk the process and see what they do to prevent, say, instrument or scope disinfection errors?

Should I have asked:

  • Show me how you disinfect the equipment
  • Show me your training records for the people doing this work
  • Show me your equipment maintenance records
  • How do you verify that the work is being done properly?
  • Have you had any complaints or incidents in the past?

I had my pre-procedure phone call on Monday. Maybe I should follow up and ask a few of these questions, even if I can’t go “walk the gemba” to check things out myself. What would you do?

Of course, I didn’t have data or information available to me to know:

  • Which specialist is best at this?
  • Who has the highest or lowest complication rates?
  • What are the prices for different doctors or locations?

I don’t know how a busy person makes an informed decision.

These problems seem to happen way too often:

Dirty Instruments Lead to Investigation of Seattle Hospital

A Seattle hospital is under investigation after hospital officials revealed that more than 100 patients were put at risk of infection because medical instruments were cleaned improperly.

A breakdown in training resulted in instruments used during colonoscopies being improperly cleaned, hospital officials said.

Scopes used during colonoscopies were found to have been cleaned improperly last November, according to a hospital statement.

Technicians used improper cleaning techniques on the scopes between July 2011 and November 2013, hospital officials said. As a result the hospital has started notifying 106 patients who were at risk of infection as a result of undergoing a colonoscopy during that time.

We’re going to look for what went wrong and what can be done and what has been done to stop it from happening again,” agency spokesperson Donn Moyer told ABCNews.com.

Why was there a breakdown in training? What are other hospitals doing to prevent this same problem? It’s good to react using good problem solving and improvement mindsets (looking at the process, figuring out how to prevent reoccurrence), but you can prevent these incidents to begin with?

Dirty Endoscopes Raising Alarms for Colonoscopies

A new study disturbingly discovered that an average of 15 percent of flexible endoscopes used to examine GI tracts and colons at five hospitals were harboring “bio-dirt”–cells and other material from previously examined patients. This was even after the instruments had been cleaned.

And that yucky finding is likely to be matched at other hospitals across the country, according to study author Marco Bommarito, Ph.d, lead research specialist at 3M’s infection prevention division.

“During a day [a single] scope may be used on half a dozen to a dozen patients–maybe even more.”

The article also says:

A guideline issued by the American Society of Gastroenterology said documented cases of infectious complications from endoscopic procedures were as rare as 1 in 1.8 million procedures.

But Bommarito thinks the actual number might be higher. He noted that it will not necessarily be obvious that a person’s disease came from an unclean endoscope used on them.

So you have detection problems and self-reporting problems. Will some healthcare organizations cover up problems and not inform patients?

Atlanta surgery center admits error in cleaning colonoscopy equipment

“One of our physicians asked the staff, ‘how do you clean these instruments?’ It was through that process, they identified that we weren’t using the high-level disinfectant,” Hamby said.

I realize “bad process” and “bad process management” runs rampant in healthcare. Poor training. Poor supervision.

These are not worker problems — they are management problems.

Lawmakers Blast VA Over Bad Colonoscopies

“What stops contaminated fluids from backing up into this tube is this crucial green valve,” he said, illustrating with a colonoscopy tube. “Investigators found not only was this valve missing, but this tubing wasn’t being cleaned in between patients.”

In surprise inspections at 42 VA medical centers on May 13 and 14, investigators found that only 43 percent had standard operating procedures in place and could show they properly trained their staffs for using their equipment.

Unclean Colonoscopy Equipment Affects 64 Colorado Patients

According to Denver’s 9News , patients who had colonoscopies between July 17 and Aug. 13 were being contacted via telephone and mail and told to be tested for HIV and hepatitis after it was discovered that the hospital’s disinfecting machine was not working properly.

St. Charles: Colonoscope Not Fully Sanitized

According to the suit, filed last week by attorney Jennifer Coughlin, the hospital failed to fully disinfect a scope that had been used on four previous patients last September.

A letter to the woman from St. Charles CEO Jay Henry acknowledged a programming error led to the final disinfecting steps to be skipped.

Hospital removes chief exec after dirty tools risked 2,500 veterans

The Miami Veterans Administration (VA) hospital is holding its chief accountable for improperly washed colonoscopy equipment that may have exposed 2,500 veterans to diseases, reports the Miami Herald.

After the colonoscopy scandal, the VA’s Administrative Investigation Board began inspecting the Miami VA facility and found it to have “poor quality control, lax supervision and sloppy procedures,” notes the Miami Herald.

Tainted Colonoscopy Equipment a Wide Spread Concern

Secretary Shinseki confirmed this was not a one-time or limited place occurrence. Shinseki went on to say this concern is shared system wide across VA hospitals, clinics, and medical facilities. 

Shinseki’s analysis concluded this problem was not the fault of a person not doing their job. Instead, this situation presented itself because of lack of proper standards being in place in all VA medical facilities. Following the investigation into the problem, more proactive procedures were put into place to make sure this practice does not continue.

Endoscopy doc ran dirty, dangerous clinic: Report 

A cluttered procedure room with five combustible oxygen tanks, “questionable” air quality, possible patient exposure to toxic fumes, contaminated garbage under the procedure table and a lack of monitoring of patients’ vital signs during procedures.

However, the most troubling of the observations are related to the possibility of dirty devices used during the scope procedures.

Some, like biopsy forceps, weren’t being sterilized using the right equipment, the report says.

During one procedure, inspectors watched the doctor dip forceps in a formaldehyde solution to get rid of a specimen and reinserted the forceps into the patient’s esophagus.

Healthcare is in no position to get on a high horse and lecture Toyota or GM about quality, eh?


blog photo Things That Make Me Worry About My Colonoscopy: Patient Safety leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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do more with less 215x300 #Lean *IS* about Doing More with Less, But Be Careful Saying That lean

It’s often said that Lean is about “doing more with less.”

Historically, and practically speaking, it’s true. But, it’s a phrase that we should be careful about, for a number of reasons.

Looking back at the origins of the term “Lean” as “Lean Production” 25 years ago (read more here). Generally speaking, the term “lean” was used because Toyota (and to some extent other Japanese automakers) did more with less. That was a fact and it was backed by data.

The idea of “do more with less” is helpful as a comparison between organizations in the sense of, ew, benchmarking. It’s less helpful (or even dangerous) as a prescription for an organization.


blog photo #Lean *IS* about Doing More with Less, But Be Careful Saying That leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


photo by: Chris Piascik

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royal instant pudding 150x150 My Comments on #Lean Healthcare in These Challenging Times leanThanks to Dodge Communications for interviewing me for their blog: “Improving healthcare–there’s no instant pudding.”

I was, of course, citing the late great Dr. W. Edwards Deming and his “There is no instant pudding” admonition. Hospitals and health systems are facing a lot of pressure right now, especially with lower reimbursements. Lean is powerful, but healthcare leaders who expect a quick fix will be disappointed.

Part of the interview:

Dodge: It sounds like the ACA, much like Toyota’s WWII dilemma, is a catalyst for hospitals really examining their processes. But more holistic approaches, like Lean, are competing for a hospital’s attention. For example, there are groups out there pushing the latest technology for efficiency or new marketing programs. Do you see hospitals turning to Lean instead of these other approaches?

Graban: Yes and no. Lean is a powerful strategy but it’s not a quick fix. So much of what Lean is built upon is W. Edwards Deming’s philosophy. He had a saying that “there is no instant pudding.” Those quick fixes, silver bullets, generally don’t exist, or have a short-term effect and a bad outcome long-term. There’s never going to be a shortage of sellers and buyers for quick-fix, cost-cutting solutions.

Financial results are of course important, but we have to look at the long term, not this quarter’s financials. That’s really tough for a lot of people to do because there’s serious pressure. You tend to see cost reduction with Lean, but as an end result of these other things that come with it–like improving quality, reducing wait times and making a more positive work place. Lean’s definitely a more sustainable approach to cutting costs.

For example, I’ve worked with a number of hospital labs. Some have realized a 25-30% productivity improvement through Lean. Once they achieved that improvement, they didn’t lay off 25-30% of their people. What they did was take on additional lab testing volume so they could do that much more work with the same amount of people. Because of Lean, these people aren’t running around stressed–they’ve improved quality and eliminated waste and reduced turn-around time. They can do more work with the same amount of people. That’s the kind of reduction that goes along with greater quality and service.

In general I think there are far too many hospitals in this environment that are going strictly after cost cutting and ignoring process improvement.

I’m curious to hear what you think about my comments. Do you agree? Am I full of it? You can comment on their post or you can comment here.


blog photo My Comments on #Lean Healthcare in These Challenging Times leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


photo by: afiler

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Screen Shot 2014 04 11 at 8.57.11 PM 150x150 My Skepticism about GMs Speak Up for Safety Program leanI have a new article posted on LinkedIn: “My New Program: Speak Up About “Speak Up for Safety” at GM.”

GM seems to continue their “blame the employees” game, as they’ve suspended two engineers (in my mind, blaming individuals for systemic cultural problems). CEO Mary Barra says that some executives may be punished, but starting from “the bottom up” with the punishments doesn’t sound like a new GM.

I’m skeptical that a “speak up” program will do anything. The problem wasn’t a lack of employees speaking up, but rather a lack of leaders actually listening. A funny commenter, Rod Barnett,  suggested that the new GM program should be called “Listen Up for Safety” and should be directed at executives, not engineers.

I recently shared a “speak up” story about quality and, in the new LinkedIn piece, I share a new personal story about speaking up about employee safety. It includes me having hands placed around my neck in a threatening way. Good times.


blog photo My Skepticism about GMs Speak Up for Safety Program leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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disco ball 150x150 What Lean is Lacking: Disco Medallions? lean

When we lament why Lean hasn’t been more widely embraced as a new management model in healthcare (or other industries, for that matter), it’s good to ask “why?” We can identify gaps and propose countermeasures that might help solve this problem.

As much as I believe that benchmarking isn’t as useful as many think it is, I did see a recent innovation in the Six Sigma world that we might want to consider… or maybe not.

As I’ve written about before, I’m not a certified Six Sigma anything. I took Green Belt classes when I worked at Dell, but was never certified. I have learned statistical methods through my engineering and business education and I use statistical process control and other basic statistical methods in the course of my Lean work (as Toyota does, although they don’t do formal Six Sigma).

I’m all for using statistics and data, as appropriate. But, I’m not a huge proponent of formal Six Sigma programs. This is probably “Six Sigma As Misguidedly Executed” (like Lean As Misguidedly Executed), but the last manufacturing company I worked for had trained and certified nearly everybody as a Green Belt. But, hardly anybody was actually using Six Sigma methods (other than full-time Black Belts).

So, even knowing that I’m not a “Six Sigma guy” and I have my concerns about formal Lean certifications, a friend asked me about a well-known consultant’s new “Executive Master Black Belt” offering. I said, “I dunno, but I’ll take a look.” A lot of it was vague and somewhat unclear – OK, a Master Black Belt who understands better how to work with senior executives. I guess that’s helpful.

Since I like to nitpick and small details often fascinate me, here is one of the things that jumped at me in the brochure (obscuring the author/consultant’s name, because it seems like the polite thing to do):

Screen Shot 2014 04 09 at 9.42.45 AM 540x214 What Lean is Lacking: Disco Medallions? lean

So you not only get certified and get a black belt, you get a medallion? You can wear your disco medallion, I mean “victory medal,” to conferences and business events?

Who would actually do that?

Disco Stu from “The Simpsons” says, “Disco Stu finally has a reason to get Six Sigma certified!”

disco stu What Lean is Lacking: Disco Medallions? lean

Good grief. What silliness.


blog photo What Lean is Lacking: Disco Medallions? leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


photo by: andrewmalone

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roots 150x150 Kaizen Tip: Just Do Its and Root Causes leanIn the Kaizen process, we ask everybody to identify problems (or opportunities) and then to write down an idea that could potentially solve the problem (or at least solve it to some extent). 

What’s written down on the card (or submitted into KaiNexus software) is the starting point for discussion within a team and/or with a supervisor.

When coaching an organization on Kaizen recently, I got a really good question from a physician who had taken the excellent week-long Lean healthcare training at the University of Michigan. She said that, in the Lean training, they said you should never “jump to a solution” in the course of problem solving. She raises a good point.

Many of the problems identified and brought forward through this Kaizen process don’t require any root cause analysis. That might sound shocking. Isn’t Lean all about “the 5 whys” and root cause analysis? Sure, where it’s needed. Root cause analysis happens a lot in Lean.

Some relatively problems, “Our IV trays are disorganized” have a somewhat obvious solution, “Organize the trays and remove unneeded items.”

We can just fix the trays and then recognize those who did so, share the idea with others, and then check back to see if the idea really worked and if it was sustained.

Some problems are more complex, such as “Patients are waiting too long in the waiting room.” We couldn’t really jump to a simple solution there. We’d want to do root cause analysis and maybe manage this through an “A3 problem solving process” or something more rigorous like a “Rapid Improvement Event” or a longer-project.

Or, we can break a bigger problem down into smaller pieces, taking care to not sub-optimize anything.

As Kaizen leaders, we learn how to triage things that are submitted through the Kaizen process. It this idea an easy “just fix it”? If so, we can have a bias for action and test ideas experimentally, in the PDSA approach. If it’s a more complicated problem or something with a non-obvious solution, we can start an A3 or get a Rapid Improvement Event sponsored.

This can all work together. We can’t oversimplify everything, nor should we overcomplicate everything.

A similar contrarian thought is that not every improvement needs to be a formal “Rapid Improvement Event.”


blog photo Kaizen Tip: Just Do Its and Root Causes leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


photo by: Vinay Kumar C

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