Right Method, Wrong Culture


I heard a great line from an Emergency Department doc and physician leader yesterday. Talking about his hospital's Lean efforts, he said, simply:

“Data should create light, not heat.”

Brilliant. Simply brilliant.

What he meant was that data should be used to enlighten us about our processes and systems. Far too often, data is used to “blame and shame” — it puts heat on people. Blame and shame is the old hospital culture that so many Lean practitioners are trying to move away from.

In the Lean approach, we preach about focusing on the process, but also on results. Not to set quotas or arbitrary targets, but to measure performance. But, as the doctor pointed out, data could be used for good or it can be used to harm people in the wrong culture. This can happen, unfortunately, with other Lean methods used out of context.

Some examples of where a new method is a bad fit with the old culture:

If you try to copy an “andon cord” approach from Toyota (by buying the physical equipment), but your culture is one where supervisors yell at people for stopping the line (as written about here), it's a bad fit.

If you have managers and leaders go to the “gemba” more, but they spend that time blaming individuals for poor performance, instead of being a coaching servant leader, you have a bad fit between new method and old culture.

If you encourage employees to speak up and call out problems (ala “no problems is a problem“), as Paul Levy and BIDMC in Boston did, but you don't have the organizational capacity to help employees fix things — this leads to frustration, and it's a bad fit (I can't find the link to where Paul apologized to his organization for the frustration caused by asking them to call things out, without being able to fix it). I'll update the post if I find it.

What other examples can you think of? What can we do, other than educate leaders, to avoid the bad fit between a random Lean method being dropped into a traditional culture?

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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. From a facebook friend:

    Awesome insight – the goal of a Lean mgmt system is to surface problems quickly. Blame generates friction, which creates resistance to change, making continuous improvement difficult at best. Forget the old adage, “If you can’t measure it, you can’t manage it” and replace it with “If you can see the problem, you can improve it.”

  2. Have a look at this article


    Ask yourself why hospitals and drugs/supplies companies can’t make the products so it is physically impossible to use the wrong one, for example, in my country you can’t insert a diesel bowser into a non-diesel inlet on a vehicle because the shape and size is wrong.

    Why couldn’t medical injectibles be incompatable with each other if they are the wrong type, for example, products intended for internal administration have a particular shape of outlet that matches catheters etc?


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