Democrats at the "Gemba"


Clinton gets close-up glimpse of nurse's life –

It's probably all just political posturing, but Hillary Clinton recently spent two hours shadowing and observing a nurse at a hospital in Nevada.

The New York senator spent more than two hours shadowing Estrada in the fourth-floor medical/surgical ward before heading to Estrada's home for dinner with her and her three children. “I'm following Michelle around today to see what a nurse does,” Clinton explained to the patient in Room 471.

Politics aside (and it's tough for me to do that), this is admirable, on the surface. Granted, the RN works a 12-hour day and Hillary and the photographers may have gotten in the way or caused a distraction (always a risk when you go to the Gemba) during their two-hour visit. This was obviously a political gesture, where comments are going to be made that support her political agenda (as any candidate would do). Was she really at the Gemba to truly observe, or was she going in looking for things that support her views? Any of us have to be careful when going to the Gemba that we really use our eyes, not our bias. If you go to the Gemba in your factory with a mindset of “our workers are lazy,” you'll find examples of that, trust me.

Other Democrats are doing similar Gemba visits, sponsored by a service workers union (so yes, it's overtly political). On the other side of the aisle, Republican Presidential candidate Rudy Guiliani was criticized for somewhat overstating his “Gemba” time at the World Trade Center site after 9/11. I saw a quote that said something like “shaking hands and saying ‘good job' isn't the same as what we were doing.” Empathizing with people at the Gemba is good, but going too far in saying “I understand what you're going through” might not seem credible and can cause resentment. Sen. Clinton runs the same risk if she talks like she knows everything about being a nurse after two hours.

I'm sure Sen. Clinton saw a lot of waste and problems and frustration. I wonder if it registers with her that process improvement can help, or if it just cements views that the government and unions must solve everything?

So, we can nitpick her Gemba time, but I'll ask this, for thought:

  • How many hospital CEO's or executives (VP or above) have spent two hours shadowing an employee and looking for waste or soliciting improvement ideas?
  • How many manufacturing CEO's or executives have done the same thing recently?

If they spent that time out there, what was accomplished as a result?

I'm always honored and humbled when I get time at the Gemba. I place limitations on myself on what I write about my daily work, my Gemba time in hospitals. Yes, as we've discussed here, hospitals are complex. But at some level, it's just people doing work and others managing those people. I don't say “just work” to demean or belittle — it's work in the sense that all work should be honored and respected.

In that sense, the Lean mindset says we have an obligation to make sure work is designed and not just haphazard (especially in a hospital). It truly is a “type of waste” to see people frustrated and trying to do their best in the midst of a bad system. Work must be designed and managers must be leaders, to make sure people aren't robbed of their right to find “joy in their work,” as Deming taught us (again, especially in a hospital). We have an obligation to all of the nurses working long, tiring, frustrated days to help improve the systems and environments in which they work.

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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. Hillary seems to do this frequently. My sister-in-law works at a printer in Upstate NY, and Hillary made a similar stop for a couple hours. It seems to win her votes, as the employees were impressed by her and many became Hillary supporters.


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