Why Lean? Start from Need!


I'd bet one that one of the greatest indicators of success for a Lean effort is tied back to the original question of “why are we doing Lean?”

Taiichi Ohno, one of the inventors of the Toyota Production System, always said “start from need.” Great advice to this day. “… doing Lean” is something I almost hate to say, since “doing Lean” isn't the point. For the Toyota, the point is to make money in the long-term and to serve their societal purpose. The same should be true for hospitals (“no money, no mission” as many would say).

If your hospital or department can't articulate why they are “doing Lean” (again, I cringe at the phrase), it's probably a sign of trouble.

Bad reasons for Lean might include:

  • The hospital down the road is using Lean
  • I heard about Lean at a conference from a famous hospital
  • My boss says I need to use a process improvement strategy

Even if you have slightly better reasons, how do you measure success? If your reasons for Lean are along the lines of “we need to get better” is that need for change “nice to have” or “must have?”

I'd propose the following are some compelling reasons for you and your team to fight to make your Lean efforts successful, because they are tied to organizational success:

We are having to cancel surgical procedures because pre-admission tests aren't getting done on time. We're losing a ton of money in the process and angering the surgeons, who threaten to take their patients elsewhere.

We don't want to spend millions to build a new laboratory, so we'd rather make more effective use of the space we DO have. Oh, and we also can't attract enough skilled medical technologists to our small town, so we really need to improve productivity and reduce stress so the techs I *do* have don't get frustrated and quit.

We desperately need to reduce central line infections in the ICU because it's the right thing for our patients and our hospital suffers a financial loss when an infection occurs.

Our primary care clinic is losing money and we need to improve service (reduce waiting times) to attract more patients or get more productive so we can cut hours and not spend as much on labor.

Outpatients wait for 15 weeks to get in for an MRI; we are losing business to competing hospitals where the patient's care won't be as good… our hospital loses the opportunity to provide care that comes after the MRI and the diagnosis.

When situations like those above are “must have” to the organization… then you have a fighting chance, a “burning platform,” if you will, for driving change.

If the goal is focused on implementing Lean tools, such as “our goal is to do 5S this year throughout our ancillary departments” or “our goal is to run XX kaizen events” then you're probably less likely to make an impact. You can probably “do without” 5S, so the incentive and drive to make that work than if the problem statement is “A patient could have been harmed because we couldn't readily find suction tubes when they were needed… so by implementing 5S, kanban, and standardized work, we'll make sure that NEVER happens again.”

If you're “struggling with Lean”, you might ask yourself if you're struggling with identifying and defining the right problems… the right needs, as Ohno would say.

What are your experiences with this?


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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. Mark,

    I appreciate your insight on this subject. I have been involved with several lean efforts and the differences are amazing form one to the next. Those that start their Lean efforts out of necessity have been much more successful than the others. “Going Lean” for Lean sake does not seem to capture hearts and minds of the people actually doing the work and without that, any improvement effort will surely fail. I wonder if a company, which is already very successful, can truly create a scenario that captures the passion of their employees, propelling the company to new heights.

    Again, great work on your blog. I attended a breakout meeting you did at Utah State last year at the Operational Excellence Seminar and was impressed with your thoughts on Lean Healthcare. I’ll be getting your book soon. Keep up the good work.

  2. Great post, Mark. As my health system embarks on improvement projects, we work with the various groups to provide guidance on where to apply our resources. This post is a nice guide for those who are getting started, or those who are being asked to “do something Lean”. Thanks.

  3. Awww man, you beat me to the punch for a post I am planning to do soon! I will still post my thoughs because I think this is a great topic that needs to be raised.

    My organization is tightening our internal consulting practices to require a statement of the problem and why it is a problem. A lot of the times CURRENT STATE doesn’t explicitly call out the problem and only show a baseline for improvement without ever verifying if it is the symptom or root cause.

    I see teams wanting to implement more advanced Lean concepts without understanding to problem they are solving. Getting “Lean Cred” is waste if the root cause is still festering without being addressed.

  4. What do you do if your costs are way out of line with what your customer expects? If you don’t find ways to optimize you get to close down a plant of 200 people? I don’t know your examples seem kinda Polyenaish. Sometimes there are more then just some nice reasons to start lean.

  5. Great post. This can apply to technology too. Just recently I was consulting with a company. One of the supervisors of the plant wanted to implement a new job shop scheduling system. I urged the Plant Manager not to implement a system just for the sake of having new technology. I instead pointed out that what the team needs to do is focus on the root cause. Simplicity is usually the better route. The moral as you have so pointedly stated is do not focus on the method as so much as the means to get to an end.

  6. Erik – “Pollyannaish” how?

    What about my reasons for doing Lean are naive and overly optimistic? They’re all very business driven.

    If your costs are out of line, then fix your costs. What about my post implied otherwise??

  7. I agree that it’s difficult to galvanize the troops when the problem is ill-defined.

    But what if you want to improve something even though there’s not a perceived problem? For example, it takes 4 hours to unload, check in, sort, and putaway freight in the warehouse (“dock-to-stock”). The process works fine and everyone’s happy but as a manager, you’ve studied similar environments and you know that the time can be reduced to 2 hours.

    Benefits include quicker availability of stock for your customers and lower operating cost.

    The world is fine with status quo but the IE in you sees opportunity to do it better AND it will benefit the customer.

  8. Right, JM. That is a horrible situation to be put in as an adviser/coach/consultant… “go fix this” where there isn’t agreement that there is a problem.

    If there’s no burning platform/crisis and the culture is one of “meh, it’s good enough as it is” then Lean won’t do much good, or at least it’s going to be very difficult and maybe not very rewarding.

  9. This is where an important and frequently overlooked tool – hoshin kanri, or policy management – comes in. We begin planning by defining the problem, at the enterprise level, not by pursuing random initiatives (e.g., everybody do “lean”). What are the most critical business needs? Even if there is not a “burning platform” there is always room for improvement, always identifiable needs, if we are not satisfied with the current condition.

    Art Smalley has a lot of good stuff to say about this in various writings over the years, recognizing the difference in intent of “going lean” vs. solving business problems, which is the actual objective and what makes the Toyota Way generalizable to any organization or purpose.


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