It’s All The Same – Leadership Challenges and Organizational Dynamics


I was able to have a chat with Eric Ries yesterday as we were recording some video of him answering some follow up questions from the LEI webinar he did for us last week on Lean Startups (that will be on the LEI website relatively soon).

As Eric talks about some of the management and leadership challenges found in startups, it's hard to not recognize these problems as just basic human nature that we're fighting against, or the common dynamics in organizations, even big healthcare systems.

After he answered one question, I asked him “Are you sure you've never worked in healthcare??” It seems like it's all the same… from manufacturing to healthcare to startups.

There are a few common dynamics at play, it seems.

For manager and leaders, are you able and willing to admit that you've ever made a mistake, based on data and evidence? Do you even look for data? Data means you might be proven wrong, so that's scary to some. Being able to admit a mistake, reacting to feedback from customers is what Eric calls a “pivot” in lean startups terminology. It's a necessary part of any PDCA cycle, looking at data and gauging if you should continue forward or adjust your course – in that case, changing your product or your business model.

Some leaders, operating in a mindset or culture where they have to be somehow infallible – they won't admit to making mistakes. For example, if we've taken some action, in a hospital, to improve patient satisfaction, yet the data shows otherwise, are we willing to accept that data? Are we really being scientists and following the Plan-Do-Check-Act cycle?

One hospital I worked with had the CEO make a pretty imperial top-down decision to carpet the inpatient unit hallways, the theory being that would cut down on nighttime noise and patient complaints would fall. The carpet was first installed in one unit and the data actually showed that the carpet didn't help – in fact, it created more problems for the staff with zero impact on patient satisfaction. But senior leadership declared victory and decided to install carpet in other units. Staff members and the quality department saw data that suggested they actually shouldn't do that, but the word didn't (couldn't?) get to senior leadership.

I guess you could call that a Plan-Do-Don'tCheck Cycle (PDdC).

When we feel that we can't be wrong, leaders will often to go any extreme to rationalize or justify their past decisions, to prove themselves correct. This is dysfunctional and harmful to the organization. Why do leaders fear being wrong? What creates that climate? Is it external factors (fear of losing their job) or pride that gets in the way of admitting that the “Check” in the PDCA cycle says we need to change course? Why are staff members sometimes fearful to present data that might contradict their leaders?

There's what you might call a Plan-Do-Check-Justify Cycle (PDCJ).

All of the discussion about Lean – “lean startups” or “lean healthcare” often isn't about technical tools at all. It's about changing mindsets and deeply ingrained human and organizational behaviors. That's why Lean is so difficult even though the concepts are relatively simple to understand.

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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,

    Excellent Post! This is one of the great challenges in implementing anything that works across the organization rather than in just one of the silos (Lean, Innovation, etc.). The problem is we (society) are taught to think in a very compartmentalized way to become an expert in a subject area (finance, marketing, biology, etc.) and not trained to look at the system and the cause and effect impacts of our actions across the entire system. This is perpetuated in our traditional organization structures / silos developed in a time when it made sense to divide labor for efficiency.

    Our tools and techniques for organizational improvement have evolved and improved, but our organizational structure and management have not.


    p.s. The Lean Startup webinar by Eric was great!

  2. Great article, Mark. I think its not just leadership that has a fear of failure, but its also the staff that has a fear of LEADERSHIP failing. I… See more’ve seen examples, several times, where leadership DOES makes a mistake, backtracks it, even admits it, but then the few people in the group they manage, will hold it against them, even develop a competitive attitude about it. Then, they undermine their leaders. Very toxic.

    In my opinion, the leadership hierarchy, and the nature by which upper management makes decisions that do not filter down to solicit opinions of people on the “ground floor,” instantly contributes to a culture of bad messaging and mistrust. With a reward system based on significant salary increases, where the one with the “best” idea or the “best” executed project gets the most doe, just generates poor motivation and hyper competitiveness where no one agrees on anything because they believe they have the best idea.

  3. The Toyota Production System, based upon PDCA, encourages managers and leaders to be actively involved in the improvement process through such activities as a Gemba Walk. John Black’s book “The Toyota Way to Healthcare Excellence” is full examples of examples of senior leaders involvement in continuous quality improvement activities at Park Nicollet Health Services and Virginia Mason Medical Center. Without the structures and involvement illustrated in the book significant and long lasting improvements will not succeed and money will be wasted. The money wasted in Mark’s illustration could be spent in much better activities, such as staff training in lean approaches to healthcare.

  4. There’s a great book on the subject of owning up to mistakes and how people justify their actions: Mistakes Were Made (but not by me), by Carol Tavris and Eliot Aronson. Their thesis: We are all cognitively wired to have data fit our preconceptions, and when confronted with a contradiction, out of ego self preservation, we alter data to fit our views, especially our positive views of ourselves.


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