Hospital Coach


Lean Leap to Health Care #4 (click for Part #3)
by Scott McDuffee

“Hey Coach Mike, what have you been up to?”

I had been sitting at my “second office,” which will remain nameless, though their symbol is an American Bison with little white wings (What is it with me and buffalo?) My standard fare includes traditional wings because as one waiter abrasively stated, “If you want chicken nuggets, go to McDonalds.”

So besides my favorite sauces of Caribbean Jerk and Teriyaki, the free internet signal creates a perfect second office – although it gets noisy during big games. It was a nice place to hang out for few hours before picking up my daughter at the airport.

On my laptop, I was researching Health Care organizations and trying to determine the decision-makers. It´s not easy to find out which hospitals are interested in or engaged in lean. If there is a list of hospitals with a lean involvement ranking, please share it.

Though not an exact science, I looked for titles within hospital staffs including words like operations, strategy, quality, and improvement. I added them to my marketing plan so I could attempt to find a connection via Linked-in or other means like those mentioned in Networking with Bison and Doctors.

I looked up from my laptop and there was Coach Mike looking right back at me from the next booth over. Mike and I coached Girl´s recreational basketball back when our daughters were 12 years old. Two years had passed so my question about what he was up to was more than just trite formality.

One of the healthy practices when planning a lean leap to Health Care is to brainstorm a potential contact list ranging from your family doc to anyone else you might now in the biz. Coach Mike was already on my list because he had a background in the hospital supply chain but the phone and e-mail address columns were blank.

After the folks he was dining with had left, Coach Mike stopped by my booth to visit. When I told him what I was working on, his face lit up. He explained that he had lost his job from October to January and had gone through a similar search and now was working for another prominent hospital system in the area as a support services manager.

I followed the standard networking format (don´t ask for a job or bring a resume; do ask for information, direction, and contacts). We planned to have lunch the following week. Upon Coach Mike's suggestion, we chose a great Tex-Mex place which he indicated was in the heart of Health Care districtâ. The thought struck me — I need to eat, drink, talk, and walk Health Care if I am going to leap into it. This would be a good start.

I chose to wear a sports coat as well as a tie, which I apparently spilled salsa on while waiting for him to arrive. When I met Coach Mike, we were dressed almost identically but I had the addition of a jacket. The job hunting conventional wisdom says to always dress a half notch above those you are meeting. I was on target for dress code but a little embarrassed when Coach Mike pointed out the salsa. It was not the conversation starter I had hoped for.

Mistakenly, I assumed our conversation would start with small talk and warm fuzzies. Despite setting this up as general networking, Mike grilled me like the fajita beef on the menu. He took charge of the conversation right from the beginning regardless of my prepared notes and standardized networking questions.

ºIf I am going to push for you to be in front of people and get you into Health Care, there are a few things I have to know. Let´s start with your specific expertise. Are you a productivity expert, a quality expert, or a customer care expert?

What a question! Thinking lean improves all these aspects and more, though it still seemed self-engrandizing to state, “All of the above.”

I awkwardly stumbled through his question illustrating aspects of all three by talking about productivity gains made in various settings, the first-pass-yield and poka yoke improvements in processes, and the lean enterprise work in customer service areas as well as problem resolutions and improvements at customer sites.

I explained to Coach Mike, although I had experience in all three categories, the application of lean principles is really a different way of seeing processes, thinking systemically, and embracing problems not as a means to blame but as a means to constantly improve and sustain via involvement then reinforcing behaviors.

Coach Mike got really excited when I shared insights about lean management systems. Of particular interest was the foundation points of David Mann´s book Creating a Lean Culture, which includes Visual Controls as real time process health measures, Leader Standard Work as reinforcing and sustaining mechanisms, Daily Accountability as a driver of improvement pace and direction, and Discipline which holds the whole thing together through leadership.

He wasn´t so excited; however, when I used the word “gemba.” He suggested some language would not translate well from the factory to Health Care. I was a bit incensed; then failed to take the clue by continuing to use the word gemba until he was noticably annoyed. He said at the hospital system where he worked they called it Management by Walking Around (MBWA). When in Rome…

First, I energetically explained gemba walking as a more purposeful process than walking around. Gemba is a three prong process using the Socratic method of questions like – What do you see? What should be here? How do I know if the process is healthy? to 1) share expectations, 2) train the walkee to “see”, and 3) make incremental improvement assignments. Then, I bit my tongue and asked him to say more about this potential language barrier. I was, after all, claiming to be a change agent and language is CRUCIAL in leading culture change

Trusted advisors like David Mann and Mark Graban had indicated the lean movement was alive and well in Health Care and not to balk at marketing myself specifically as a lean change leader. But at Coach Mike's Hospitals, they didn´t use lean terminology.

I needed to be aware I was not to speak Japanese there (I don't really speak Japanese but rather I'm a student {gakusei} of the language of Toyota). Instead, they use a similar customer driven improvement model put together by the Studer Group. Coach Mike recommended I read Hardwiring Excellence and other Studer publications.

My gut check with Mark suggested this was an excellent system in alignment with lean principles. It just uses different language and tends to not mention Toyota. Quint Studer´s work similarly spoke of the pursuit of perfection and looked for fire starters (catalysts) to bring hospitals out of mediocrity with the patient/customer as the focus.

As we left the Tex Mex place, Coach Mike said he was absolutely sure I would make a huge impact on Health Care but suggested I emphasize my participative leadership, culture change processes, and management principles versus my lean knowledge and factory background. Mike said he would get started immediately being my advocate and connecting me to decision-makers.

It is great to have a hospital coach!

Still I was left wondering – How can I find organizations in Health Care that DO speak the lean lexicon?

Click here for Part 5

Scott McDuffee is an experienced Lean professional who is currently searching for a new career opportunity. He is based in Mansfield, TX.”

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Scott McDuffee
Scott is a Lean Change Leader who has worked in multiple manufacturing sectors. He blogged primarily about his steps taken to investigate switching into healthcare in 2009.


  1. Here’s one idea for prospecting new clients: check out hospitals that have adopted RFID-based technology solutions for things like tracking hospital assets (sometimes referred to as RTLS). I only say that because a) the hospitals have already taken steps to impove quality and lower cost (albeit adopting technology as the solution) and therefore should be open to Lean and b) the press releases and articles often contain names of the local decision makers.

    Here are some examples:

  2. Interesting…you typed:

    “Still I was left wondering – How can I find organizations in Health Care that DO speak the lean lexicon? “

    And I was left wondering…after all that you stated to the contrary…why you believe it important to speak the lean lexicon? I don’t mean to come across as abrasive, but nothing drives me more crazy than lean leaders that want to use terms rather than plain language.

    From a strictly lean perspective, I could and have argued that all this does is create waste because either your listener has to translate the concept and/or wastes your time because they are thinking “Why is this guy using fancy words to describe a simple concept?” This is not only true of using “big” or “Japanese” terms, but anyone that gets involved in acronym-soup or other jargon.

    Use the simplest language possible. Not only is it much easier to understand, but it gives a sense of humility to the audience. If you feel the need to demonstrate knowledge, which is very real in the job-hunting market, then use and explain the term ONCE to let those know you know…then get back to speaking clearly.

    Just my $0.02…good luck in your endeavors!

  3. Agree with you, Kevin. I facilitate lean in healthcare and I’ve found no greater turnoff to medical staff than manufacturing consultants coming in with Japanese terms. Pure gimmickery. How does it facilitate lean learning? Tell people in plain English what they need to understand – more substance, less flash. There are hospitals that are exceptions to this – Virginia Mason being one. Lean has its roots in a number of places, including the U.S. No need to pay homage to Toyota or the Japanese…

    Scott, Mike was definitey a friend to you in pointing this out with the particular hospital he was discussing. If you were to insist upon using the Japanese terms while meeting with the employer, this would have shown an “in your face” attitude – not something any employer necessarily desires, and even if they did, it would be a place not many people want to work.

    Thanks for the good article, Scott.

  4. Hi Scott,

    Good luck with the quest, I found your blog post of particular interest as it has relevance to implementers irrespective of environment, as indicated by the responses above. An awareness that keeping it simple is critical in conveying the message of change. I think one of the successes of David Mann’s work is that he keeps it grounded in a language and tone that most folk can relate.

    Look forward to hearing how your search has gone.

    Kind regards,


  5. It is exciting to have many Hospital Coaches! These comments are well conceived and well received. Language is important. Thank you for pointing out improvements in mine.

    I don’t necessarily want to speak the lean lexicon but it may be wise to seek organizational decision-makers that do. I really want an organization that embraces continuous improvement and respect for people all the way to the top.

    Attempting lean transformations without executive leadership on board can be accomplished. But, this is also one of the main reasons for failure as attributed by many lean practitioners. My approach also has been simple, organic, and hands-on although improvement really accelerates and has legs when the organization’s leaders are vocal cheerleaders, barrier removers, and gain sustainers.

    There is a difference in strategy for getting in the door versus what to do once on the floor. Once in, I couldn’t agree more, keeping it simple and humble is the right recipe. Match the culture before leading it somewhere new. In parallel with your suggestions about speaking clearly to the audience, David Mann has reminded me over the past decade – “Sometimes as consultants we have a fire hose and those we are mentoring have tea cups.”

    Certainly, I am not discounting the organization where Coach Mike works as a potential employer. However, I think the leap may be farther based on how positions are defined. Without some lean language or awareness, those hospital decision-makers may not see my skills as transferrable. Many seem to be looking for some letters behind my name that are just not there.

    At the other end of the spectrum, I have seen hospital positions with lean in their titles as well as requirements preferring a manufacturing background. It seems more likely the decision-makers in this case may view my background and accomplishments as relevant.

    Maybe I should have stated, “Still I was left wondering – How can I find organizations in Health Care that are excited and engaged in improving the delivery of the total patient experience as well as eliminating activities which do not use the hospital’s talent and resources in the best ways possible?”

    Let me know if you feel I’m still not getting it.

  6. I definitely think you’re getting it, Scott. I think Mann’s comment was dead on target – we need to match the audience we are trying to reach. I’m wondering, though, if you might be more suited to an organization that is more advanced. I wonder if you might be frustrated by an organization that’s taking baby steps while you’re ready to do the sub-4-minute mile. Something to think about…

    One other thing… I’d have to say in my experience that any continuous improvement initiative, whether it be rooted in Lean or any other philosophy, is doomed without top management support. I’ve been involved in 3 attempts at using continuous improvement and all 3 have floundered with weak or no top management support. It’s a small sample size, I know, but 0 for 3 isn’t exactly promising…

    Best of success to you. In reading your posts you seem like a very engaged person with a lot to offer. You deserve a chance with a company that deserves YOU.

  7. Scott, thanks for your posts. Each one is more thought provoking than the one before.

    As you know from our previous exchanges, I am also outside of healthcare seeking a position on the inside. Just a few days ago I had a similar wake up call from my friend Amy that you received from Coach Mike and some of the posters above.

    I am now convinced that I need to dramatically increase my health care vocabulary and translate my world of experience into health care language. (I’m still figuring out the best ways to do that.) I see a few very practical reasons to do this. First, and we’ve all experienced this: “We’re different, your way of doing things couldn’t apply to us.” Of course, this never ends up being true, but waving a red flag of jargon in front of people doesn’t help them overcome their (mis)perception. Second, while there are some health care organizations that are more receptive to non-health care folks, as indicated above, in the main, hospitals prefer practitioners with healthcare background. Name any industry and the same will be true–preference for one’s own. Implication: in my job search I’m not looking to transform human nature, I just want a job. I’m trying to camouflage–I mean position!–myself into as much of a health care guy as I can. Finally, think about the gatekeepers. Now, I have successfully networked into some department leaders and directors who lead performance improvement and lean teams–and they readily make the connection between my non-health care background and the contribution I could make in their organization. But they’re not the only one I need to convince. Just for starters, think about that junior staffer in HR. I haven’t been able to personally network into every one of my target organizations yet, and even when I do, I still need to submit my resume through the normal HR channels. And who is the first to screen it? And what does all of that 50 cent, masters degree, non-health care industry terminology mean to the junior staffer? He or she doesn’t know what it means and my resume ends up in the big pile instead of the little one. Or better yet, the screening software accomplishes the same thing without human intervention.

    So, I think I’ve been looking in the wrong end of the telescope…and perhaps you are too.




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