A Reinforcing Loop of Kaizen and Respect


We are going through the editing and typesetting process for our upcoming book Healthcare Kaizen this week.

After not really looking at the manuscript for a few months, a particular line stood out and made me think, as it's the description of a “chicken and egg” dynamic – what comes first in Lean, TPS, and Kaizen: respect for people or continuous improvement? You can't have one without the other.

We wrote:

“We strive for continuous improvement out of our respect for people, but it is our basic respect for people that helps make continuous improvement possible.”

I hope people find that to be an interesting point or something that's helpful in their Kaizen work. It's what the “systems dynamics” field of Jay Forrester and Peter Senge would call a “positive reinforcing loop.” But how do you get it started?

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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. RP enables CI. We have enormous empirical evidence that CI does not enable RP (e.g. the ubiquity of Fake Lean / LAME). It is more common to see CI disabling RP in management’s drive for immediate cost reduction.

    Get it started by telling and demonstrating to people – especially employees and suppliers – that Lean management will not cause them harm.

  2. You can certainly start on the road to CI without people respect. But, just like lowering inventory exposes sloppy inventory management so does focusing on continuous improvement expose all the real deficits in leadership. At that juncture the leader either gets it and changes (humility and learning) or sets up a delegation model. The problem with delegation is that as the delegates move ahead the leader gets further behind. This increasingly generates contempt and resentment as it becomes obvious to all except the corner office what (who) the constraint to CI is. This problem is not unique to healthcare as many “lean” manufacturing organizations relegate lean to the shop floor with superficial benefit.

  3. The optimal relationship – the sweet spot of super performance, comes from the emergence of the people blended with continuous improvement. Of course this means kaizen must have its hansei (reflection), management must have its leadership, work must have its spirit to optimize performance. To miss this is to miss it all IMHO.


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