A Year in Healthcare


    I've been working with “lean healthcare” in my day job for about a year now. I'm giving a presentation on Friday about lean healthcare for a manufacturing audience and it provided an opportunity to reflect on what I've seen and learned.

    A few reflections:

    • Lean is truly a powerful methodology. If you didn't believe that lean truly is a “business system,” then you would after seeing the positive impact in healthcare. Sure, there is a risk that lean is viewed as a magic bullet, a trendy cure-all, but lean really does work outside of manufacturing. If it was just a bunch of tools that applied only to making cars, it wouldn't be helping in healthcare. If blindly tried to copy a Toyota-style moving line with fixed stop locations, we'd be missing the point. After seeing it work in healthcare, I'm less likely to be patient with anyone who gives “it doesn't work here” excuses in the industrial world.
    • People are people. The dynamics between “front line” employees and management are astonishing similar. When I hear skilled Medical Technicians complain that management isn't listening to them, it harkens back to my days at GM. People want to be listened to, I think that's human nature and it ties into the “8th type of waste” — not getting the most out of human potential. In this same category, people will be fearful for their jobs if they are worried that lean will lead to layoffs. It's just human nature. We need to put food on the table, so why would anyone participate in lean if they are afraid? As Deming always said, we need to remove fear from the workplace. This is one thing that healthcare seems to be doing better than manufacturing — making no layoff pledges and not using lean to drive labor cost reductions (all this is amazing considering that labor is a higher % of costs in healthcare, compared to manufacturing).
    • Healthcare people have incredible intrinsic motivation. You don't have to worry about motivating healthcare people. Most of them entered the field to help others and, in most cases, that hasn't been sucked out of them by poor management. Because of this, it is easier for them to get behind lean efforts that help the patient. In the manufacturing world, what is your motivation to drive improvements if it just leads to people at HQ getting a bigger bonus? It's much more satisfying to improve patients lives than it is to shave a few pennies off the cost of a widget.
    • Humility and asking questions is better than being a know-it-all. Entering a new environment, such as healthcare, was a bit scary at first. There's new terminology, new rules, new organizations to figure out. But, that was good for me. Not that I used to operate as a “know it all” in manufacturing settings, but being in a totally unfamiliar environment really stretches you to 1) ask questions and 2) teach concepts to those who really do understand the environment, so they can “figure it out” themselves. I think that leads to better results than if I came in and said “I know how to run a lab better than you, here's what you need to do….”
    • Lean learning can come full circle. Toyota learned from Ford. Now Ford is trying to learn from Toyota. It can all come full circle. Healthcare has been learning from the manufacturing world. But I also think there are opportunities for the manufacturing world to learn from healthcare. As I said above, I think hospitals are doing a GREAT job of seeing lean as a business strategy. It's not just about cutting costs, you can use lean as a growth strategy, using freed up space and personnel to grow the business and to serve more patients. Lean is also a job security strategy for the employees, look at Toyota as an example, they've avoided layoffs for 50 years (for permanent employees). These are all things that the manufacturing world can learn. Lean isn't just about “eliminating waste,” per Toyota's first principle. Lean is also about “respect for humanity” (also in Toyota's terms). If you're reading this as a manufacturer, think about this: have you only focused on eliminating waste? Or are you also focusing on your people?

    I'm thrilled with my move into healthcare. It's incredibly rewarding — not without frustration, but I'm enjoying this more than anything I can remember, and I've done some fun things in the manufacturing world. I feel fortunate to be doing what I am doing.

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


    1. Excellent comments on rolling out Lean at a Hospital. A lot of your points resound the learnings & experience I have had over the last Seven Months, in a hospital at least. In the latest role the challenge has become increasingly difficult in regards to the people and profession portion. In my limited experience working with Design Engineers was difficult, especially in regards to Lean, then it was specialty Medical Doctors, but to date the most difficult profession I have encountered appears to be the pharmicists. Not only do they disregard you because you are not one of them, but very few if any really see what flow can do. Thats my 2-cents…..


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