From Workshop Discussion at LEI – What Lean Is and What Lean Is Not


The last two days, I've been facilitating my LEI workshop called “Key Concepts of Lean in Healthcare.”

We had a great group and had a number of people who had a good amount of Lean healthcare experience. To help baseline the room, after introductions I had the group do table discussions and then report out on the high level question of “What is Lean?” and “What is Lean NOT?” The groups did a really nice job with the exercise…

Here is the easel pad summary of what the attendees came up with. It's not necessarily all-inclusive, but it's very correct:

The group didn't say them in order, but they got both elements of the Toyota Production System (Just-in-Time/Flow and Jidoka/Quality) and both aspects of the Toyota Way (continuous improvement and “respect for people.”) The attendees had been studying up!

One thing that's hard to read (my bad handwriting) is “process not the people” meaning be hard on the process, not on the people (similar to a “no blame” culture).

What would you have added to the discussion?

Below is the picture for the “Not Lean” side (or what I'd call “L.A.M.E.“):

The group great points that Lean is not meant to be restrictive, nor is “standardized work” overly rigidly specific, nor is it driven top down. It's certainly not a “shut off your brain” approach to anything.

Lean's not just projects, not just tools… this list set up a really good two-day discussion about Lean management methods, Lean culture, and Lean tools that support those mindsets.

What would you add to the “NOT” list (or either list)? Do you agree with what the group came up with?

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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. A suggestion would be to expand on one of the items in the “What is Lean?” category to give it a deeper meaning: change ‘respect people’ to ‘respect, challenge and grow people’. The term respect and challenge are often thought of being in opposition of one another but in fact to challenge someone in a respectful manner allows them to grow, both personally and professionally.

    • Yes, that was certainly the expansion of the “Respect for People” discussion during the two days (this was just the shorthand capturing of initial thoughts).

      We talked a lot about how Toyota considers the goal of TPS to be the development of people and how that’s good for the company as well as the employees. A manager challenges people to get better… “respect” doesn’t mean being easy on people. I agree with you that challenge and respect go together. Thanks for the comment.

  2. Nice job by the group.

    A couple of things that come to mind for the “not” list (I’m sure there are more…):

    Lean is not easy
    Lean is not just a tool set

    • Sorry that’s hard to see. In that initial discussion, the first thought from an attendee was “it’s not just a bunch of projects” and someone else said “it’s more than just tools,” so I sort of combined it. That was certainly a theme of the workshop… the diagram I have in my book from Toyota that shows Lean is a triangle with the sides of technical/tools, management practices, and philosophy (with “human development” in the middle of it all.

  3. I think it’s extremely important to also include that Lean is intended to be a non-zero-sum (win-win) management system for all key stakeholders (employees, suppliers, customers, investors, and communities). Tremendous emphasis is needed on this particular point by all Lean advocates to help get managers out of their long-established patterns of zero-sum conventional management thinking and practice (rooted in chaotic batch-and-queue processing). Otherwise, we will just see a lot more examples of Fake Lean / L.A.M.E.


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