"I know what this is about!!"


    I ran into my first real “nasty” person in the healthcare world back a few months back. I still have my scars from working on lean and improvement activities in the factory world, the nasty looks and the negative attitudes that people give you when they think you are there personally to take away their job or to tell them what to do.

    I never had my tires slashed in the factory world, but I had some people who were downright hostile to me when they heard I was probably one of those stopwatch-and-clipboard-toting Industrial Engineers they had learned to hate. I was the type of guy the UAW rep would call a “diaper wearing college brat”, until they got to know me and the lean approach. I could usually win people over, at least personally. They knew I was there to help them, that was something I was able to demonstrate and prove out. Getting nagging maintenance or safety items fixed for them, after they had complained for months with no response. That kind of thing wins people over.

    I know the idea of “lean” sounds scary (“lean and mean”) and it sometimes, regrettably, leads to layoffs. I understand the history of how mass production management works in the factory world and how people tend to be scared of consultants. It's fully understandable.

    Now doing lean in healthcare has been different. Sure, hospital management practices many of the same ineffective methods as the mass production factory world does (reliance on reports and metrics rather than going to the “gemba”, rewarding fire fighting or blaming instead of root cause problem solving, etc.).

    But, in most cases, I've been incredibly positively surprised by my reception by the “front line” people in the hospital world, such as nurses and medical technologists. For one, they are all incredibly oriented around fixing things for the patients (and lean healthcare really helps patients in terms of improving quality and reducing waiting time). Secondly, job security is typically pretty good for the front line people because A) healthcare is growing and B) there's a shortage of qualified nurses and techs. Hospital management I've worked with has always been great about communicating that lean is not about cutting heads and they're committed to not using lean for that. And people seem to believe them. Usually.

    So, I was at a major urban public hospital. Management understood that lean is not about cutting heads and they tried to communicate all of the right messages via memos and team meetings before I arrived for the lean assessment. But, there are scars. I was warned that, ten years earlier, a more traditional (and unfortunate) efficiency consultant was brought it and it was just a head-cutting exercise (think the movie “Office Space”).

    On my third day on site, I ran across a woman who probably lived through that earlier non-lean downsizing debacle. She practically growled at me, “I know what this is about.” I said, “You probably have the wrong impression of what lean is.” She said, “It's about time studies.” I said, “lean isn't about pushing people to work faster or to do more than they can, it's about eliminating waste and making life easier for people.” Her face showed her skepticism and loathing of me as a consultant. “Well I don't like people in my face, so go stand over there. I'm going to dinner.”

    I know not to take it personally. The scars she had (from the previous consultants) are understandable. I know the people like that are a challenge for a lean project. I enjoy winning over people like that, once you can build some trust. It doesn't mean that meeting them is pleasant at all.

    How do you handle and react to situations and people like that in your lean efforts? Is it different being an “outside” consultant versus someone working on lean as an employee?

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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. I always looked at it as “consulting power”. Your best weapon is listening. People like that woman are amazed that someone will actualy listen to them and the most powerful sentence you can say is “Tell me more”. They complain because they are disastified, a great thing to be in a lean environment.

      If after some time you find out that they really are just negative…evil and beyond hope. Then they shouldn’t ruin it for everyone else on the lean journey and should be removed.

    2. Yes, you are right. In my current project, one woman who did complain and yell at first was surprised when I listened, respected what she had to say and calmly worked with her. Her attitude changed to the positive pretty quickly and I think she can now be a positive factor and advocate for our lean efforts. I’d rather have someone be direct with their concerns (and to be thinking) instead of being passive aggressive or just going along with things without thinking.


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