Lean is “Loving Care”? Lean IS Loving Care… Or Should Be


Lean in SwedenAs you read this, I'll have just arrived in Stockholm, Sweden, where I have the honor of being the guest of UniLabs, a European medical diagnostics company, for the week. I'm not the most accomplished world traveler, but I've had the privilege of seeing hospitals in England and The Netherlands in addition to those in the U.S. and Canada. In Sweden, I'll get to see some hospitals and speak about lean at a laboratory medicine conference on Thursday.

While the big picture “health systems” (including the payer system) are very different, one thing that always strikes me is that, at the level where patient care is actually provided (the “gemba”), things are very much the same regardless of the country you're in. Nurses and other staff members struggle with the same types of waste and problems that are seen everywhere: silos, poor communication, lack of employee involvement, and batch thinking. But when I was in The Netherlands, there was one amazing positive difference… and I'm finally getting around to write about it.

Pictured below is Dr. Jacob Caron, an orthopedic surgeon at St. Elisabeth Hospital in Tilburg, The Netherlands. Jacob was giving a talk at a lean healthcare symposium organized by an amazing team at St. Elisabeth, including Marc Rouppe van der Voort author of two lean healthcare blogs, including an English blog (“Lean Thinking in Healthcare”) and one in Dutch. Dr. Caron, Marc, and Peter Kabel, a microbiologist, are three of the leading advocates for lean at St. Elisabeth.

I want you to take in that picture for a good minute. Really, just look at the picture for a while and think, if you will. I was so blown away by the way this wonderful thought was articulated at St. Elisabeth. They said that “loving care” was the best translation from Dutch or their sense of purpose about lean, although it wasn't a perfect translation.

Here is Dr. Caron, a leading orthopod and the chairman of the medical staff, talking about lean and caring. Your reaction might be, “What? I thought lean was all about cold ruthless efficiency and standardizing work to turn people into robots.”

It's so critically important to recognize that hospitals and the people there provide more than clinical care. The “value” that a nurse or a tech provides to a patient is more than just administering medications or taking vitals. Value is often taking a moment to talk and make a patient feel comfortable upon admission.

When you step back and look at why a nurse might be short with a patient, it might be that they are stressed out or they're being run ragged because of bad systems, systemic overburden, and all of the waste in their system. The nurse might not have time to provide what the Dutch described as “loving care.” This is the furthest thing from cold, heartless clinical care.

Far from turning people into unthinking robots, lean should help and support the caregivers so they can truly “give care,” to provide clinical care in a caring way. There's a similar principle behind programs like the UK's “Releasing Time to Care” and the U.S. “Transforming Care at the Bedside” programs. With lean, instead of just jamming in new methods without thinking much, we have to start with a sense of purpose. If that sense of purpose says “providing loving care to the patients,” then we need to use lean to reach that purpose.

Anyway, from my time at St. Elisabeth and the couple of times I've met Jacob, Marc, and Peter, I've been very impressed. We need more people spreading a message like this even if the phrase “loving care” is a bit much for some people. Here's is Marc's summary of the Dutch symposium I participated in and he touches on “loving care” a bit there.

To Dr. Caron's question: “Lean and loving”… is it a “mission impossible”?? What do you think? What are you seeing in practice?

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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. What is the ultimate example of “respect for people”? Love. We need to get over this resistance to being “touchy feely”. It may be uncomfortable for some people to “care” about the people they work with, but I think it is as essential to long term sustainability as any kaizen event or A3. A robot can’t love anything; a person can. As one of your recent blogs stated, we need to respect people’s humanity. Is love not part of what it is to be human?

    Thank you for this topic, Mark. I agree that it is profound and impressive.

  2. Excellent stuff, Mark. The “ruthless efficiency” subject comes up frequently. I always emphasize with people that compassion is a critical part of the healthcare business, and no amount of process improvement should interfere with the time we spend with our patients. When we measure value-added time, one of the value-added components is comforting patients, even if it delays something else. I like the idea of “Lean and Loving”, and I think it fits well with how Lean and healthcare fit together.

  3. Hi Mark, thanks for putting our theme on your blog, great how you stress what lean is about. Since the symposium Jacob Caron and others have lead the development of a (concept) framework for our lean journey. We call it …. The St. Elisabeth Healthcare Improvement System (St. Elisabeth ZorgVerbeterSysteem) with four elements in a triangle. The three sides are:
    – Agility
    – Quality
    – Safety
    In the center of the triangle: loving care

    Loving care refers to patients, but also to each other as care providers. The Dutch term is ‘Menslievendheid’ which literally would be translated into ‘loving people’ or perhaps ‘human compassion’.

    We’re now starting learning communities on loving care. The first community is ‘oncology’ and is formed by doctors and nurses. Lean and loving care are starting to mingle and are leading to great discussions. Yes we need to become more efficient and process oriented. And we also want to become more sensitive to the individual needs of every patient. The two really strengthen each other.

    St. Elisabeth Hospital
    .-= Marc Rouppe van der Voort ´s last blog ..Continuous improvement with the ‘improvement chart’ =-.

  4. Marc – thanks for the update and elaboration on that. Sounds like a great message for inspiring improvement with the right purpose.

    To all — just to clarify, when I made my comment about “ruthless efficiency”, I wasn’t knocking efficiency. I was knocking the “ruthless” part that would ignore purpose and mission. I don’t think I’d be accused of not liking efficiency… but just wanted to clarify after reflecting on what I wrote.

    I think Marc is right when efficiency and care should support each other.

  5. Great! I love the lovely picture!

    I actually have been trying to substitute in my teaching “love for people” instead of “respect for people” as one of the two fundamental principles of “lean.” I think it’s a more powerful principle that encompasses the “respect” version. Unfortunately, it doesn’t seem to go over well (yet) because of the sensitivity to the “love” word.

    My inspiration for this was twofold–once hearing Fred Kofman define “love” as “radical respect for the right of another to be an other” and a quote from Humberto Maturana: “We can expand our cognitive domain through a novel experience brought forth through the expression of a biological interpersonal congruence that lets us see the other person and open up for him room for existence beside us. This act is called ‘love,’ or the acceptance of the other person beside us in our daily living. Without acceptance of others living beside us, there is no social process and, therefore, no humanness. Biologically, without acceptance of others, there is no social phenomenon.”

    Love is healthy; health is love. Sounds like John Lennon (“Love is real; real is love”).

    Thanks for the post!

  6. Marc – Great post! Lean and loving is not mission impossible but mission possible almost by definition. Lean IS loving, especially in this case. It frees up time for the nursing staff to do what they love best – provide high-quality care. Enjoy you time in Sweden!

  7. […] Lean leaders help connect people to the mission and the purpose of their work. A Lean culture doesn’t just ask “why?” when problem solving or investigating a root cause, it also “starts with why” and explains why work should be done a certain way. We don’t want people to just be busy (including searching for supplies, which is busy but not value adding or rewarding), but we want them to be able to care for patients and focus on the work that’s most meaningful (see the “Loving Care” approach from Holland). […]


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