Guest Post: Learning to See… and Feel


Mark's note: Today's guest blog post comes from a good friend of this blog and long-time reader and commenter Brian Buck. Brian blogs at his site named Improve With Me, where he recently blogged about seeing healthcare and waste from a patient perspective (his wife just had a baby) instead of from his usual perspective as an internal lean consultant at a children's hospital.

I've met Brian at his hospital before and also recently saw some of his colleagues at our Lean Healthcare Transformation Summit. I'm happy to bring you his perspective… check out his blog and his twitter feed: @brianbuck. Now, his post:

Learning To See … And Feel

The heart is just as important as the head for your Lean journey.    Some people think the technical side of lean is logical enough to drive improvements but it is much more effective when you feel the need to change.

I think most people in hospitals can intellectually recognize what is considered waste for the patient and families.    I have seen doctors and nurses effectively “learn to see” improvement opportunities in their areas. Unfortunately, some are not driven to action because they do not empathize with the patient's pain caused by the waste.

What are some reasons why providers may not take action on what they see?

  • “The Shrug Factor” –  The Lean Manager (Balle/Balle) describes this effect as being when people say “that is just the way it is”. Providers may feel the experience is normal for patients and shrug off the need to change.
  • “It's  Better Than  Before” – Somewhat similar to the Shrug Factor, but this is where hospital staff consider there are no further opportunities because a process has been improved previously. Just because you reduced patient wait time from 60 minutes to 40 does not mean you are done improving!
  • Low Expectation Patients – Some patients will not complain about long wait times because they just expect it.    Lean teaches us to aim for the ideal of just-in-time care with the highest quality. If patients aren't outright asking for it, they will appreciate it when they experience it.

Empathizing with the patient's experience will help drive your improvements. Feeling their pain will prevent you from intellectualizing a reason for not changing. If your heart feels disturbed enough on behalf of your patients, you will look for a solution/counter-measure instead of stopping at the first obstacle.

What else have you seen cause people to not take action? What can we do to help people feel the need to improve?

About Brian Buck: Brian is an internal consultant at a children's hospital.   He blogs at and can be found on  Twitter as


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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

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