More Trust, Less Fear


As I'm going through revisions of my book, Lean Hospitals, a theme jumps out at me in Chapter 2…. it's all about trust.

The first excerpt says:

Gary Convis, a retired Toyota senior vice president who had been one of the top-ranking Americans in the company, wrote that the “managerial culture for TPS is rooted in several factors, including developing and sustaining a sense of trust, a commitment to involving those affected by first, teamwork, equal and fair treatment for all, and finally, fact-based decision making and long-term thinking.

The Convis quote reference:  Convis, Gary, “Role of Management in a Lean Manufacturing Environment,” Society of Automotive Engineers,

The second reference says:

Lean “is a system that demands employees do their best, but does not overwork them. The sense of trust created between management and the workers can promote efficiency and at the same time a relaxed feeling.”   (Japanese Management Association, Kanban Just-in Time at Toyota: Management Begins at the Workplace (New York: Productivity Press, 1986), xv.)

How can we  utilize  any of the Lean practices in a culture where there isn't trust? Don't we need trust for people to speak up to identify waste or to make suggestions about improvements?

Dr. W. Edwards Deming always said the job of management was to drive out fear from the workplace.

More trust, less fear. Is the formula for what we'd call “Lean Culture” any more complicated than that?

Does the broader discussion in the Lean community need to be more about trust and fear?  I hear a lot of talk about 5S and A3, but not trust and fear. We often hear about cost savings from Lean, but maybe we need to talk more about the soft stuff, like morale and culture.

When the discussion online centers around things like “tell me how you used Lean methods in your patient admission process so I can copy what you did,” I think we're selling everybody short. Can we talk more about what we've done to reduce fear and increase trust in the workplace?

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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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. Comment from @zerotolandfill on twitter:

    “if your #lean efforts are struggling ask how much fear is in the org. fear of trying fear of failing fear of blame or punishment?”

  2. Trust is something I talk about with healthcare audiences all the time. Does the doctor trust the nurse if a problem is identified, and will he/she listen? Does the nurse trust the secretary is a problem is pointed out, and will he/she listen? In many cases, the answer is no, which prevents problem solving and improvements from happening. It’s an issue in any industry, and a big one in healthcare.

  3. You quote Convis as saying, “Lean “is a system that demands employees do their best, but does not overwork them.”

    My organize does demand the former without regard to all the obstacles we have put in front of employees, specifically for managers. Every time a local or corp initiative comes out that struggles for traction the senior leadership’s response is, “time to up the accountability index”.

    This is a cultural aspect that needed to be addressed before we even started to talk about lean. This is likley a major reason our lean implementation is struggling.

    • The cultural aspect cannot be ignored. It’s interesting when I brought the dysfunctional cynical and distrusting culture in the organization I am currently working with, the senior leadership’s response was that a positive culture would “come later”.

      While I cannot argue that I can take years to change the culture of an organization for the better, I am not aware of it being successful if you start with your head in the sand wishing the issue away.

      Management sometime needs to do a big mea culpa and start to build trust by having the integrity to admit that they have been screwing up.

  4. I think the conversation of trust and fear is deeply stemmed in the human psyche. Indeed, existential psychologists and philosophers have discussed fear and its impact on the human condition for centuries, not to mention its place (or lack thereof) in management/government.

    Several scholars agree that Machiavelli’s The Prince and its ruthless, tyrannical exploitations of the population were meant to be satirical, especially juxtaposed with his Discourses on Livy. 1984 is a discourse on fear, how it can be slanted negatively against a population, and the dangers therein.

    I always say that fear must be embraced (realized as fear) and replaced with knowledge, whether in a personal realm or a business environment. Fear comes from the unknown, from lack of understanding.

    Fear of failure is counter to Agile. In Agile, failure is embraced. The goal is rather simple: fail often and fail early. Of course, if these failures are hidden, nothing is gained from the failure.

    Napoleon Hill said that failure is opportunity in disguise. I think that’s the appropriate way to look at it.

    Err, I hope that makes sense :)

  5. I like the phrasing of focusing on developing and sustaining trust. So often we communicate in the negative. If I say “don’t think of the collor yellow” you are more likely to think of it! Maybe saying “eliminate fear” isn’t helping as much as saying “develop trust”! Good post.

  6. The main issue is that Lean and Kanban emphasize process and tools. But people tend to forget that without the right culture it will never work.

    Fear as a motivator, or a source of power leads to mediocrity. Mistakes are hidden, creativity is stifled, and good performer leave for a place where respect is the norm. In Agile XP says it best: trust is numbe one in any team. Fear destroys trust. Honesty, hard work and dare we say it: love and caring for your team leads to Excellence.

    And yes we can measure fear and trust, just create a KPI. And get top management to believe in this, or you will never be able to put trust first and fear last.

    Joseph Hurtado
    IT Project Manager
    Toronto, Canada

    • Joseph, I’m happy to have more software people reading and participating, since Lean is Lean – we all have a lot to learn from each other.

      As engineers and technical people, we don’t typically like talking about “love” in the workplace (platonic love!) – but check out this wonderful idea of “loving care” in a healthcare setting:

      It’s not often comfortable in healthcare, either! But it’s a great phrase.

      As a “KPI” for fear and trust, I really like “# of employee ideas implemented” as a single metric of that engagement level. Not # suggested, but the # implemented.

  7. Here at KCOE, we talk early and often about the idea of “Mutual Trust and Respect”. If you allow this to be a core value – something that drives mindsets and behaviors daily – and, if you are truly seeking to get those lean components working for sustained change, there is no way to get around this. We talk about needing to address cultural issues: this is the key cultural issue. Every transaction between two people in your organization offers the opportunity to exercise this core value. The real trick comes in finding the method for the change. Wishing for this value might be as profitable as wishing to win the lottery…it may happen, but really?

    Mark: you consistently are asking the right questions!

    • I don’t know all the answers, but I love asking questions! :-)

      I love (now that word is coming out everywhere) the phrase “mutual trust and respect.” That’s a critically important core value. Dr. Stephen Covey talks about the same powerful principles.

  8. As another, maybe funny thought:

    The top-down command-and-control manager reads this post and puts out a memo warning everybody that they need to trust their leaders more!

    • That is funny.

      I totally agree that the broader discussion in the Lean community might need to be more about trust and fear. Both the social/cultural and technical/tool-based sides of Lean are part of the system. However, I’ve often seen organizations see their lean coaches as almost strictly technical/tool-based resources, with no credibility or mandate on the social/cultural side.

      What’s the countermeasure to that common view?

      • A few countermeasures I have seen:

        1) the technical “lean” group partners up VERY closely with a strong organizational development or HR department

        2) the lean group has people who DO have that credibility and/or a social sciences / counseling / psychology background

    • Yes, and when satisfaction scores go down the command and control leader warns managers that patients better get happier, and when the gallup employee engagement scores don’t rise the same says your score better start going up, and when joint commission is coming the same warns that you better not have any findings and all the while the “accountable” leader provides not improve a single improvement to make all this happen. Let’s label this lean leader test #2.

  9. Those sound like good countermeasures. In the short-term, #1 is really appropriate. And #2 is doable in the long-term, if us lean coaches build up our credibility/background in the areas you mentioned. I know I’ve been mulling over ways to do just that through graduate studies. In healthcare, fancy book learning means a lot. Not sure if it’s enough, though.

    • One of my personal countermeasures is to stop reading Lean books. I’m reading more books like “Authentic Conversations” that your colleague gave me. Books by people like Deming, Scholtes, Senge, etc. are probably most helpful for those who already know “Lean” tools… and as you’ve implied a lot of people don’t get “beyond tools.”

      Knowing tools is just the admission exam to the lifelong lean learning academy!

  10. One of the best books on team building is “The 5 Dysfunctions of Team” and in it you learn that no team can move forward or develop without trust. Many organizations have process improvement programs but only a handful excel, and all of the top performers make working on the “trust” issue a priority. Most executives have a lot of trouble building a Trusting-Culture because to do that you must make yourself vulnerable.

  11. Excellent discussion. One fundamental underpinning of trust is value. In particular, as a prerequisite for trust, management must truly value their employees as an asset. Lacking this, it is more likely that management members will make decisions and take actions that do not engender mutual trust.


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