Lean in Sweden: Tools < Thinking


I had an incredible visit to a hospital in Stockholm yesterday, to walk the “gemba” (the actual workplace)   to see their lean improvement efforts first hand. I'll share some details and highlights over time here on the blog.

One highlight was a portion of large educational poster that was hung in the laboratory hallway.

I love the mathematical representation that thinking is more powerful than tools. I saw a lot of evidence of Plan-Do-Check-Act (PDCA) improvement processes in the lab and different inpatient units around the hospital. I think the math is correct and I'll add that tools > 0. Tools have some value, but only in context of lean thinking and the lean management philosophy. Tools aren't value-less, but thinking is better. I know I risk raising the ire of those who run around saying tools have zero value – I'll be called a “toolhead” without those people reading my message that tools alone are useless. Tools with lean thinking can be quite helpful.

Implementing a method like 5S runs the risk of being tools driven. If we are “implementing 5S,” we run the risk of losing sight of our purpose. We should be focused not on the tool, but instead on improving patient care, reducing delays, and preventing errors. If 5S helps meet those goals, if 5S is an effective countermeasure and an improvement to the system, then great.

If we are blindly implementing a tool and, say, doing things like putting tape around pens in our desk drawer, then that sounds more like what the poster calls “Pretend LEAN.” That's another way of explaining my term of “Lean As Misguidedly Executed,” or “L.A.M.E.”

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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. Except for the fact that it’s in posters, the message is great. Because the U.S. in particular has had to unlearn many falsehoods in lean before it learns a truer path. Perhaps the later start of some industries and regions can benefit by learning from the mistakes of many of us, and start their journey from a healthier foundation.
    .-= Jamie Flinchbaugh ´s last blog ..Leading Change an Inch Wide and a Mile Deep =-.

  2. I don’t see it as a poster, but as a statement. It’s a sign of understanding.

    One question: Why is it in English and not Swedish?

  3. Simon – the hospitals’ employees have a very high English proficiency. There were signs in both languages – not bi-lingual, but some signs were English and some were Swedish (or a mix).

  4. Not only do the tools have significant value they, by and large, encourage thinking. It is possible to limit the value of tools based on the management system. But more often I think tools help change the culture and encourage thinking.

    It is hard to maintain a focus of blaming individuals when looking at control charts. Granted hard is not equal to impossible. Some manage to avoid understanding the tools being used and can maintain outdated views that don’t make sense when using the tools. Confirmation bias http://curiouscat.com/management/confirmationbias.cfm is a powerful thing.

    It is very helpful if you have people that are thinking to be able to point out the weakness of certain thinking and point to tools in use for evidence of why new ways of seeing things are more effective.
    .-= John Hunter ´s last blog ..The Trouble with Incentives: They Work =-.

  5. Hi Mark,
    Congratulations on a great blog.
    I agree with your sentiment on 5s. Many senior managers love the idea of 5s as it will make their business look much better and also gives them an excuse to see things out of place.
    I believe that the focus should be on delivering value and if 5s assists that goal, then go for it.
    Also, rather than catching employees out with audits, it is much better to positively comment on the areas where 5s has made a difference.
    .-= Steve Halpin ´s last blog ..Kanban – an example from your home =-.

  6. Hello,
    I live in Sweden, and I am a bit curious about which hospital it was that you visited? Are you maybe a speaker at the Lean Healthcare conference in Lund, Sweden at March 16-17?

  7. Marcus-

    I saw St. Goran in Stockholm and will blog more about that soon. Also saw a hospital in Skovde. I won’t be attending the conference in March, but John Toussaint will be a keynote speaker.



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